Estimated respiratory arousal threshold in patients with rapid eye movement obstructive sleep apnea

Abstract

Purpose Rapid eye movement (REM) obstructive sleep apnea (OSA) is a prevalent clinical phenotype. However, the literature focusing on the pathophysiology of REM OSA is limited. This study compared the proportion of individuals with a low respiratory arousal threshold between patients with REM and non-REM OSA. Methods REM OSA was defined as having an apnea–hypopnea index (AHI) ≥ 5 and AHI during REM (AHI-REM)/AHI during NREM (AHI-NREM) ≥ 2. REM OSA was sub-divided into REM-predominant OSA and REM-isolated OSA. REM-predominant OSA was defined as satisfying the definition of REM OSA and having an AHI-NREM ≥ 5. REM-isolated OSA was defined as satisfying the definition of REM OSA and having an AHI-NREM < 5. Patients with an AHI-REM/AHI-NREM < 2 were defined as having non-REM OSA. A low respiratory arousal threshold was defined as having 2 or more of the following conditions: AHI < 30 events/h, proportion of hypopnea > 58.3%, and nadir SpO2 > 82.5%. Results The proportions of individuals with low respiratory arousal thresholds among individuals with REM-predominant OSA and REM-isolated OSA were significantly higher (77.2% and 93.7%, respectively) than that of patients with non-REM OSA (48.6%). This was also true when the analysis was performed according to sex. Conclusion These results indicate that a low respiratory arousal threshold might be an important endotype that contributes to the pathogenesis of REM OSA, especially in REM-isolated OSA.

Long-term outcomes regarding arterial stiffness and carotid artery atherosclerosis in female patients with rapid eye movement obstructive sleep apnea

“…Moreover, Hoshino et al reported a low respiratory arousal threshold in patients with REM OSA than in those with non-REM OSA. 30 In the current study, although the arousal index in the enrolled patients with REM OSA was lower than that in patients with non-REM OSA before treatment, sympathetic tone might have been elevated in patients with REM-OSA. This in turn might have affected the progression of arterial stiffness.…”

Rapid eye movement dependency is associated with increased inflammatory activity in obstructive sleep apnea syndrome

“…(2020) conducted a study on a large group of participants and found a significant association between REM‐related OSA and increased Pittsburgh Sleep Quality Index (PSQI) scores in all adjusted models. The same group also discovered that patients with REM‐related OSA have a lower arousal threshold, which prevents them from reaching the deeper sleep stage where stable breathing is observed (Hoshino et al., 2022). The two conditions that are reported frequently in this phenotype could amplify the aforementioned process through oxidative stress.…”

The Present and Future of the Clinical Use of Physiological Traits for the Treatment of Patients with OSA: A Narrative Review

“…Similarly, ventilatory overshoot during arousal’s opening of the UA lowers the PaCO 2 (and thus ventilatory stimuli for airway opening), promoting the recurrence of UA collapse [ 42 ]. A low ArTH is more common in individuals with REM-dependent OSA [ 44 ], and among those who are non-obese, older, and taking antidepressants [ 45 ]. Individuals with post-traumatic stress disorder may also have a lower ArTH, presumably due to their hyperadrenergic state [ 46 ].…”