Effects of Continuous Positive Airway Pressure on Phasic Events of REM Sleep in Patients with Obstructive Sleep Apnea

Abstract

In patients with obstructive sleep apnea and associated rapid-eye-movement (REM) sleep deprivation and disruption, the first night of nasal continuous positive airway pressure (CPAP) is often associated with increases in REM sleep time and REM density (REM rebound). The amount of REM rebound, however, varies considerably. We sought to characterize the magnitude of REM rebound and to determine what factors determine individual differences in REM rebound with initial CPAP treatment. Twenty-six patients with sleep apnea had a baseline nocturnal polysomnogram and a second night with a trial of CPAP. REM sleep time increased by 69% with CPAP, REM density increased by 73%, and REM activity by 169%. REM density was highest in the second REM period. Improvement in respiratory disturbance index with CPAP correlated significantly with increased minutes of REM sleep with CPAP. Of polysomnographic measures on the baseline night, change in minutes of REM sleep with CPAP correlated best with minimum oxygen saturation and to a lesser degree with respiratory disturbance index, and minutes of Stage 1 sleep. One possible explanation for the effect of hypoxemia on subsequent REM rebound is that some physiological functions of REM sleep may fail when oxygen saturation falls below a certain level.

Proportional positive airway pressure: a new concept to treat obstructive sleep apnoea

“…Patients with OSAS have a typically disrupted sleep structure with an increased number of arousals and increased proportion of NREM sleep stages 1 and 2 and depressed slow wave sleep (SWS) as well as REM sleep. CPAP was shown to eliminate obstructive eventrelated arousals, to increase SWS and REM sleep and to decrease NREM sleep stages 1 and 2, even during the ®rst night [22,23]. The present results proved that the titration with PPAP affected the sleep structure in the same manner, as did CPAP.…”

Rapid Eye Movement (REM) rebound on initial exposure to CPAP therapy: a systematic review and meta-analysis

“…Four hundred sixty-seven articles were screened, 58 were evaluated in full-text form, and 14 studies met the established criteria (Brillante et al 2012;Koo et al 2012;Kushida et al 2011;Yaegashi et al 2009;Osuna et al 2008;Drake et al 2003;Verma et al 2001;Randerath et al 2001;Parrino et al 2000;Yamashiro and Kryger 1995;Lamphere et al 1989;Aldrich et al 1989;Issa and Sullivan 1986;Collard et al 1996). Eleven of the 14 studies noted a statistically significant increase in amount of REM sleep during the titration night, compared to the baseline sleep study.…”

“…Consequently, sleep becomes more consolidated with an increase in the duration of REM sleep compared to the diagnostic study. REM rebound (Brillante et al 2012;Koo et al 2012;Kushida et al 2011;Yaegashi et al 2009;Osuna et al 2008;Drake et al 2003;Verma et al 2001;Randerath et al 2001;Parrino et al 2000;Yamashiro and Kryger 1995;Lamphere et al 1989;Aldrich et al 1989;Issa and Sullivan 1986;Collard et al 1996) is the polysomnographic phenomenon of substantial increase in duration of REM sleep in a patient with untreated OSA when first undergoing CPAP titration. Similarly, some patients may exhibit an increase in the duration of slow wave sleep called slow wave sleep rebound (Brillante et al 2012;Osuna et al 2008;Verma et al 2001).…”

Association of Naso-Oro-Pharyngeal Structures with the Sleep Architecture in Suspected Obstructive Sleep Apnea

“…Wake time and N2 decreased with the improvement of REM duration and REM cycling. Earlier studies report decrement of N1/N2 stages with consequent rebound of N3 and REM sleep period during the first CPAP night [32,33]. Kondo et al [34] found that beneficial effects of CPAP treatment on sleep architecture lasts till the device is used for controlling apneas.…”