A paradox has arisen because the American Academy of Sleep Medicine (AASM) made it optional to score RERAs on diagnostic studies, yet it mandates treatment of RERAs on titration studies. This is confusing to other sleep facilities, so we wrote a commentary that was accepted for publication in the Journal of Clinical Sleep Medicine on the rationale for scoring RERAs on all sleep studies.6 Clinically, we see our best results when we aggressively treat RERAs in insomnia patients by using advanced PAP therapy devices; whereas, if we don’t treat the RERAs, we find most of these patients can neither use PAP therapy consistently nor achieve the greatest improvements in their insomnia.
I have never understood the rationale for optional scoring of RERAs. An analogous situation occurs with cardiac arrhythmias; no one thinks the only arrhythmia is asystole (no heart beat). It’s widely acknowledged various arrhythmias must be treated. In sleep, there are various airflow patterns that cause problems. UARS events have been described in the scientific literature for more than two decades and linked to daytime sleepiness, trips to the bathroom at night, high blood pressure, and possibly depression. In my opinion, failing to treat UARS borders on medical malpractice.
There are some who say that “UARS doesn’t exist.” It so much doesn’t exist, that sleepapnea.org mentions it in the obituary honoring Christian Guilleminault MD who is described as “Sleep apnea’s greatest pioneer”