Obstructive Sleep Apnea during REM Sleep and Hypertension. Results of the Wisconsin Sleep Cohort

Abstract

Rationale: Obstructive sleep apnea (OSA) is associated with hypertension.Objectives: We aimed to quantify the independent association of OSA during REM sleep with prevalent and incident hypertension.Methods: We included adults enrolled in the longitudinal community-based Wisconsin Sleep Cohort Study with at least 30 minutes of REM sleep obtained from overnight in-laboratory polysomnography. Studies were repeated at 4-year intervals to quantify OSA. Repeated measures logistic regression models were fitted to explore the association between REM sleep OSA and prevalent hypertension in the entire cohort (n = 4,385 sleep studies on 1,451 individuals) and additionally in a subset with ambulatory blood pressure data (n = 1,085 sleep studies on 742 individuals). Conditional logistic regression models were fitted to longitudinally explore the association between REM OSA and development of hypertension. All models controlled for OSA events during non-REM sleep, either by statistical adjustment or by stratification. Measurements and Main Results:Fully adjusted models demonstrated significant dose-relationships between REM apnea-hypopnea index (AHI) and prevalent hypertension. The higher relative odds of prevalent hypertension were most evident with REM AHI greater than or equal to 15. In individuals with non-REM AHI less than or equal to 5, a twofold increase in REM AHI was associated with 24% higher odds of hypertension (odds ratio, 1.24; 95% confidence interval, 1.08-1.41). Longitudinal analysis revealed a significant association between REM AHI categories and the development of hypertension (P trend = 0.017). Non-REM AHI was not a significant predictor of hypertension in any of the models.Conclusions: Our findings indicate that REM OSA is crosssectionally and longitudinally associated with hypertension. This is clinically relevant because treatment of OSA is often limited to the first half of the sleep period leaving most of REM sleep untreated.

Theories on possible temporal relationships between sleep bruxism and obstructive sleep apnea events. An expert opinion

“…Even if more rarely described and not yet fully understood, this kind of temporal relationship may find support in the otolaryngology and sleep medicine literature suggesting that REM-sleep phases may be accompanied by mucosal swelling of the upper airways, leading to nasal congestion [27]. Such nasal congestion recognizes its pathogenesis in a trigeminal activation and may be responsible for apnea in those subjects having REM-predominant OSA events [28]. Support to this scenario may also come from the studies on the physiology of sleep arousals, which are centrally mediated .…”

Effect of One Week of 8-Hour Nightly Continuous Positive Airway Pressure Treatment of Obstructive Sleep Apnea on Glycemic Control in Type 2 Diabetes: A Proof-of-Concept Study

“…We recently reported a significant association between OSA during REM sleep and glycemic control in T2DM (4). Because REM sleep predominates in the early morning hours before typical awakening, the cardiometabolic benefits of CPAP therapy may not be achieved with the typical CPAP use of 3-4 hours per night (4,8).…”

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

“…REM sleep has been shown to induce a rise in the sympathetic nerve activity and instability of the cardiovascular system, processes that are accelerated by obstructive apnea and hypopnea during the REM period in patients with OSAS, thus leading to increased cardiovascular risks (4,5). Indeed, a recent study demonstrated a cross-sectional and longitudinal correlation between REM OSAS and hypertension (6). Most studies have shown that REM-related SDB more often affects women, younger people and patients with mild or moderate, rather than severe, airway obstruction (3,(7)(8)(9).…”