When scoring Respiratory Effort-Related Arousal (RERA), which signal is best for assessing change in respiratory effort?

The most effective signal for assessing changes in respiratory effort when scoring Respiratory Effort-Related Arousal (RERA) is esophageal pressure. This approach provides a direct measurement of the pressure changes within the thoracic cavity, reflecting the effort the diaphragm and accessory muscles generate during respiration.

Esophageal pressure monitoring enables the evaluation of how effectively a patient is breathing and can detect subtle variations in respiratory effort that may not be evident through other methods. This precision is crucial for scoring RERA, as the definition relies on changes in respiratory effort that lead to arousals from sleep.

While other options, such as nasal thermal sensors and thoracic impedance belts, can provide supportive data regarding airflow and general respiratory activity, they lack the specificity that esophageal pressure can offer for diagnosing and understanding RERA. Intercostal EMG, while indicative of muscle activity, does not directly measure the pressure changes that are critical for the assessment of respiratory effort involved in RERA. Therefore, esophageal pressure is the gold standard for directly evaluating respiratory effort changes related to arousals.