Features of REM-related Sleep Disordered Breathing in the Japanese Population

Obstructive sleep apnea (OSA) is a common disorder that includes an intermittent mechanical obstruction of the upper airway during sleep, which can occur either during rapid eye movement (REM) phase or non-REM (NREM) phase. In this study, we aim to evaluate the differences in demographic and polysomnographic features between REM- and NREM-related OSA in a Jordanian sample, using both the broad and the restricted definitions of REM-related OSA. All patients who were referred due to clinical suspicion of OSA and underwent sleep study were screened. We included patients with a diagnosis of OSA who had Apnea-Hypopnea Index (AHI) greater than or equal to five. We classified patients into REM-related OSA according to either the broad definition (AHIREM/AHINREM ≥ 2) or the strict definition (AHIREM > 5 and AHINREM < 5 with a total REM sleep duration of at least 30 minutes), and patients with AHIREM/AHINREM less than two were classified as NREM-related OSA. A total of 478 patients were included in this study with a mean age of 55.3 years (±12.6). According to the broad definition of REM-related OSA, 86 (18%) of OSA patients were classified as having REM-related OSA compared to only 13 (2.7%) patients according to the strict definition. Significant differences were found between both NREM-related OSA and REM-related OSA according to the broad and to the strict definitions for arousal index (p < 0.001 and p < 0.032), respectively, duration of saturation below 90% (p < 0.001 for both), and saturation nadir (p < 0.036 and p < 0.013), respectively. No significant differences were found between this group and other OSA patients regarding age, BMI, ESS, and snoring. Our study showed that the stricter the definition for REM-related OSA, the milder the associated clinical changes.

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“…In contrast to our study, they found a lower mean BMI among REM-related OSA patients compared to those with NREM-related OSA [ 18 ].…”

Section: Discussioncontrasting

confidence: 99%

Comparing REM- and NREM-Related Obstructive Sleep Apnea in Jordan: A Cross-Sectional Study

Oweidat

AlRyalat

Al-Essa

et al. 2018

Canadian Respiratory Journal

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“…32 Congested respiratory tract mucosa due to the hormonal influences of pregnancy might enhance upper airway narrowing. 33 Furthermore, REM-related OSA is more prevalent among women, younger people and patients with mild or moderate OSA, 34,35 and such background factors are consistent with most pregnant women. Thus, pregnancy might cause an increased tendency to develop REM-related OSA.…”

Section: Discussionmentioning

confidence: 94%

Nocturnal oxygen desaturation in the late third trimester of uncomplicated pregnancy for prediction of late‐onset gestational hypertension

Watanabe

Shinohara

Kodama

2020

J of Obstet and Gynaecol

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Aim This study aimed to determine whether 1‐night screening of oxygen desaturation in women with uncomplicated pregnancy about 1 month before the due date is useful to predict late‐onset gestational hypertension (GH) after 37 weeks of gestation. Methods We recruited 102 women with uncomplicated pregnancy between 34 and 36 weeks of gestation. These women then completed the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Berlin Questionnaire for obstructive sleep apnea, and recorded their oxygen saturation (SpO2) and physical acceleration profiles during nocturnal sleep for 1 night at home using a portable pulse oximeter and actigraph, respectively. Thereafter, their blood pressure was monitored weekly until delivery. Results Pulse oximetry data between 34 and 36 weeks of gestation revealed that three women had an oxygen desaturation index (ODI) ≥5.0 and seven had a minimum SpO2 < 90%. During follow‐up until delivery, two women with an ODI ≥5.0 and a minimum SaO2 <90% developed GH at 37 weeks of gestation. Among clinical measures at recruitment, body mass index (BMI) and pulse oximetry measures appeared available for the prediction of GH. The positive predictive values (95% confidence intervals) of the criteria using these measures were 0.67 (0.26–0.67) for ODI ≥5.0, 0.29 (0.10–0.35) for minimum SpO2 <90%, and 0.07 (0.02–0.07) for BMI ≥25.0. Conclusion For the prediction of late‐onset GH after 37 weeks of gestation, pulse oximetry measures about 1 month before the due date are particularly useful because of their high positive predictive values.

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“…The dependent variable was the presence or absence of REM-related OSA, and the independent variable was the PSQI. Each model was adjusted for covariates which were selected based on their established clinical difference between individuals with REM-related OSA and NREM-related OSA [2,3,20]. In Model 1, age, gender, and BMI were selected as covariates; in Model 2-a, AHI REM was also included as a covariate, alongside the covariates that were selected in Model 1; in Model 2-b, AHI NREM was also included as a covariate, alongside the covariates that were selected in Model 1.…”

Section: Discussionmentioning

confidence: 99%

Insomnia as a Symptom of Rapid Eye Movement-Related Obstructive Sleep Apnea

Hoshino

Sasanabe

Murotani

et al. 2020

JCM

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Rapid eye movement (REM)-related obstructive sleep apnea (OSA), a polysomnographic phenotype that affects 12–36% of OSA patients, is defined by apnea and hypopnea events that predominantly or exclusively occur during REM sleep. Recent studies indicated that REM-related OSA was associated with the development of nocturnal non-dipping of systolic and diastolic blood pressure, metabolic syndrome, diabetes, and depressive symptoms. However, to date, the association between REM-related OSA and insomnia still remains unclear. We investigated whether there was a difference between REM- and non-REM-related OSA in terms of insomnia-related sleep disturbance as measured by the Pittsburgh Sleep Quality Index (PSQI) in 1736 patients with OSA. REM-related OSA showed a significant association with increased PSQI in all adjusted models. In the subgroup analysis, the coefficients of all models were higher in female than in male patients with REM-related OSA. Insomnia should be considered an important complaint in patients with REM-related OSA, and its indicators, such as the PSQI, should be included in routine diagnostic testing.

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Features of REM-related Sleep Disordered Breathing in the Japanese Population

Cited by 17 publications

References 20 publications

Comparing REM- and NREM-Related Obstructive Sleep Apnea in Jordan: A Cross-Sectional Study

Comparing REM- and NREM-Related Obstructive Sleep Apnea in Jordan: A Cross-Sectional Study

Nocturnal oxygen desaturation in the late third trimester of uncomplicated pregnancy for prediction of late‐onset gestational hypertension

Insomnia as a Symptom of Rapid Eye Movement-Related Obstructive Sleep Apnea

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