Natural History of REM-OSA in Children and Its Associations with Adverse Blood Pressure Outcomes: A Longitudinal Follow-Up Study

Chan, Kate Ching Ching; Au, Chun Ting; Yu, Michelle; Wing, Yun Kwok; Li, Albert M.

doi:10.2147/nss.s331389

Cited by 8 publications

(13 citation statements)

References 44 publications

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“…The prevalence of REM-related OSA in our study was 50.3%, lower than previous study which reported at 65% ( 17 ). In the past, there was significant heterogeneity in defining REM-predominant OSA.…”

Section: Discussioncontrasting

confidence: 88%

“…They postulated children with obstructive events mainly in REM sleep may have less cardiovascular complications than those with stage-independent OSA ( 23 ). However, recent study revealed that REM-related OSA was associated with higher nocturnal BP and a lesser degree of nocturnal SBP dipping in children ( 17 ). In our study, we did not find significant differences in the proportions of children with systemic hypertension between OSA subgroups.…”

Section: Discussionmentioning

confidence: 99%

“…Hormonal changes during puberty or thereafter might lead to the reversal of REMS-NREMS OSA predominance. However, recent study revealed that the majority (72%) of children with REM-related OSA at baseline and persistent OSA at 10-year follow-up remained to have REM-related OSA ( 17 ). Further study of the longitudinal changes during the transition to adulthood may shed light on this issue, particularly considering the higher risk of OSA recurrence after adolescence in children who were previously diagnosed and treated for OSA during childhood ( 39 ).…”

Section: Discussionmentioning

confidence: 99%

“…In children, OSA occurs predominantly in REM sleep ( 12 , 13 ) possibly due to the reduced muscle tone, blunted arousal and ventilatory responses during this sleep stage ( 14 , 15 ). Previous studies reported the prevalence of REM-predominant OSA ranging from 69.6 to 74.7%, while NREM-predominant OSA accounts for 16.7–25.3% of childhood and adolescent OSA ( 12 , 13 , 16 , 17 ).…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and Risk Factors for Rapid Eye Movement-Related Obstructive Sleep Apnea in Children

et al. 2022

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ObjectivesDifferent pathophysiological mechanisms and the distribution of respiratory events among rapid eye movement (REM) and non-rapid eye movement (NREM) sleep modulate the effect of obstructive sleep apnea (OSA). We aimed to study the prevalence and risk factors for REM-related OSA in children.Study DesignRetrospective, cross-sectional study.MethodsWe recruited 366 children with OSA confirmed by polysomnography (PSG) over a 5-year period. REM-related OSA is defined by an obstructive apnea-hypopnea index (OAHI) in the REM sleep ≥2× than during NREM sleep.ResultsThe prevalence of REM-related OSA in children was 50.3%. Children with REM-related OSA were more likely to be female (P = 0.042), and had lower prevalence of adenotonsillar hypertrophy (P = 0.043) compared with children with other OSA subtypes. Children with REM-related OSA slept longer in the supine position (P = 0.003), had shorter duration of NREM1 sleep (P = 0.018), lower nadir SpO2 (P = 0.005), and a higher oxygen desaturation index 3% (ODI3%) (P = 0.014), and lower arousal index (P = 0.034) compared with other OSA subtypes. Female gender and supine sleep was the independent risk factors for REM-related OSA.ConclusionThe prevalence of REM-related OSA was 50.3%. OAHIREM should be considered as an important parameter in future clinical research studies done in children with OSA.

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Section: Discussioncontrasting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prevalence and Risk Factors for Rapid Eye Movement-Related Obstructive Sleep Apnea in Children

et al. 2022

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“…A REM AHI/ NREM AHI ≥ 2 defined REM-predominant OSA and a ratio of <2 defined REM-independent OSA. 31,32…”

Section: Variablesmentioning

confidence: 99%

Does REM AHI Predict Persistent OSA After Pediatric Adenotonsillectomy?

Fields,

Poupore,

Barengo

et al. 2024

Ann Otol Rhinol Laryngol

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Objective: The utility of REM AHI in managing pediatric obstructive sleep apnea (OSA) is not fully understood. This study aimed to evaluate the relationship of preoperative REM AHI to postoperative persistence of OSA in children who underwent adenotonsillectomy. Methods: This retrospective chart review identified children under the age of 18 years that received an adenotonsillectomy for OSA and a preoperative and postoperative polysomnogram. Children with craniofacial or neuromuscular disorders or a tracheostomy were excluded. The primary outcome was the postoperative persistence of OSA, defined as a postoperative obstructive apnea-hypopnea index (oAHI) ≥ 1.5 events/hour. REM-predominant OSA was defined as a ratio of REM/NREM AHI ≥ 2. REM AHI minus NREM AHI and REM AHI minus oAHI helped to identify patients with a larger distribution of REM AHI. Results: A total of 353 patients were included. Postoperative persistent OSA was seen in 232 (65.7%) children. The preoperative REM AHI, REM AHI minus NREM AHI, and REM AHI minus oAHI of children with persistent OSA did not differ significantly from children with resolution of OSA. Rates of persistence were not different between those with REM-predominant OSA and REM-independent OSA (63.8% vs 70.7%, P = .218). Conclusion: This study suggests that preoperative REM AHI may be a poor predictor of OSA persistence after adenotonsillectomy. Further study is needed to help characterize how pre-operative REM AHI should impact clinicians’ decision making, family counseling and recommendations.

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Neurocognitive, mood changes, and sleepiness in patients with REM-predominant obstructive sleep apnea

2022

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Natural History of REM-OSA in Children and Its Associations with Adverse Blood Pressure Outcomes: A Longitudinal Follow-Up Study

Cited by 8 publications

References 44 publications

Prevalence and Risk Factors for Rapid Eye Movement-Related Obstructive Sleep Apnea in Children

Prevalence and Risk Factors for Rapid Eye Movement-Related Obstructive Sleep Apnea in Children

Does REM AHI Predict Persistent OSA After Pediatric Adenotonsillectomy?

Neurocognitive, mood changes, and sleepiness in patients with REM-predominant obstructive sleep apnea

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