Rapid Eye Movement-Related Sleep-Disordered Breathing

Koo, Brian B.; Patel, Sanjay R.; Strohl, Kingman P.; Hoffstein, V.

doi:10.1378/chest.08-1311

Cited by 119 publications

(143 citation statements)

References 14 publications

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“…1,2,16 However, in the current study, we adopted the aforementioned formula to avoid division by zero, which is in case AHI-NREM is zero. REM-predominant OSA defined by AHI-REM/AHI-NREM > 2 would be equal to %AHI in NREM ≤ 33.3% in our formula.…”

Section: The Definition Of Nrem-or Rem-predominant Osamentioning

confidence: 99%

“…1,2 In general, upper airway obstruction and hypopnea is in REM sleep when upper airway muscle tonus is decreased as compared to nonrapid eye movement (NREM) sleep. However, OSA occurring predominantly in NREM sleep or equally in a numeric manner in both REM and NREM sleep is also encountered in clinical practice; neither prevalence nor mechanisms driving the relative distribution of REM and NREM events have been considered in any detail.…”

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confidence: 99%

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Nonrapid Eye Movement-Predominant Obstructive Sleep Apnea: Detection and Mechanism

Yamauchi

Fujita

Kumamoto

et al. 2015

Journal of Clinical Sleep Medicine

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Study Objectives: Obstructive sleep apnea (OSA) can be severe and present in higher numbers during rapid eye movement (REM) than nonrapid eye movement (NREM) sleep; however, OSA occurs in NREM sleep and can be predominant. In general, ventilation decreases an average 10% to 15% during transition from wakefulness to sleep, and there is variability in just how much ventilation decreases. As dynamic changes in ventilation contribute to irregular breathing and breathing during NREM sleep is mainly under chemical control, our hypothesis is that patients with a more pronounced reduction in ventilation during the transition from wakefulness to NREM sleep will have NREM-predominant rather than REM-predominant OSA. Methods: A retrospective analysis of 451 consecutive patients (apnea-hypopnea index [AHI] > 5) undergoing diagnostic polysomnography was performed, and breath-tobreath analysis of the respiratory cycle duration, tidal volume, and estimated minute ventilation before and after sleep onset were examined. Values were calculated using respiratory inductance plethysmography. The correlation between the percent change in estimated minute ventilation during wakesleep transitions and the percentage of apnea-hypopneas in NREM sleep (%AHI in NREM; defi ned as (AHI-NREM) / [(AHI-NREM) + (AHI-REM)] × 100) was the primary outcome. Results: The decrease in estimated minute ventilation during wake-sleep transitions was 15.0 ± 16.6% (mean ± standard deviation), due to a decrease in relative tidal volume. This decrease in estimated minute ventilation was signifi cantly correlated with %AHI in NREM (r = −0.222, p < 0.01). 1,2 In general, upper airway obstruction and hypopnea is in REM sleep when upper airway muscle tonus is decreased as compared to nonrapid eye movement (NREM) sleep. However, OSA occurring predominantly in NREM sleep or equally in a numeric manner in both REM and NREM sleep is also encountered in clinical practice; neither prevalence nor mechanisms driving the relative distribution of REM and NREM events have been considered in any detail. In NREM sleep, detailed physiologic studies detect dynamic changes in ventilatory control during state transitions, which are considered to induce irregular breathing, and lead to obstructive apnea and/or hypopnea. [3][4][5][6][7] Detailed studies in REM sleep are absent, leaving an opportunity for the clinical polysomnogram to inform not only REM-predominant OSA but the possibility of NREM predominant OSA as well. ConclusionsVentilation decreases an average of 10% to 15% during the transition from wakefulness to sleep due mainly to a decrease in tidal volume; however, the literature reports substantial

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Section: The Definition Of Nrem-or Rem-predominant Osamentioning

confidence: 99%

mentioning

confidence: 99%

Nonrapid Eye Movement-Predominant Obstructive Sleep Apnea: Detection and Mechanism

Yamauchi

Fujita

Kumamoto

et al. 2015

Journal of Clinical Sleep Medicine

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“…Üst hava yolu tonusu non-REM uykuda azalır ve REM uykuda da azalmaya devam eder, böylece üst hava yolu rezistansında ve kollapsında artış meydana gelir. Ayrıca, uykunun REM evresinde hipoksi ve hiperkapniye meduller duyarlılık azalır ve tüm bunların sonucunda REM'de daha fazla solunumsal olayların yanında daha fazla oksijen desatürasyonu olur (2)(3)(4)(5).…”

Section: Introductionunclassified

The frequency and properties of REM related obstructive sleep apnea among the patients with mild related obstructive sleep apnea

Özçelik

Akkoyunlu²,

Bostanlı³

et al. 2013

Tuberk Toraks

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ÖZET Hafif obstrüktif uyku apneli hastalarda REM ile ilişkili obstrüktif uyku apne sıklığı ve özellikleri GİRİŞObstrüktif uyku apne (OUA); üst hava yolunda tekrarlayan tıkanmalarla karakterize, erişkin popülasyonun %2-4'ünü etkileyen uykuyla ilişkili solunum hastalıkları-nın yaygın bir formudur. Uyku sırasında üst hava yolunda gelişen tıkanıklıkların hipoksemi, hiperkapni, otonomik sinir sistemi değişiklikleri ve uykuda bölünmeye yol açması OUA patofizyolojisinde belirleyicidir (1). REM ile ilişkili OUA ise apne ve hipopnelerin REM uykusu esnasında daha yoğun olduğu bir durumdur. REM ile ilişkili OUA prevalansının sınırlı sayıda yapılan klinik çalışma-larda tüm OUA'lı popülasyon içinde %10-36 arasında olduğu ve daha çok kadınlarda görüldüğü gösterilmiştir. Üst hava yolu tonusu non-REM uykuda azalır ve REM uykuda da azalmaya devam eder, böylece üst hava yolu rezistansında ve kollapsında artış meydana gelir. Ayrıca, uykunun REM evresinde hipoksi ve hiperkapniye meduller duyarlılık azalır ve tüm bunların sonucunda REM'de daha fazla solunumsal olayların yanında daha fazla oksijen desatürasyonu olur (2-5).REM ile ilişkili OUA, "Hafif ve orta OUA olgularında daha fazla görülmesi nedeniyle uykuda solunum bozuklukları spektrumunun erken bir işareti midir?" yoksa "Tamamen ayrı bir antite midir?"sorusu araştırmacıla-rın son zamanlarda oldukça dikkatini çekmektedir. Bu çalışmada, hafif OUA tanılı hastalar arasında REM ile ilişkili OUA hastalarının sıklığını ve diğer hafif OUA tanılı hastalardan farkını görmek; ayrıca REM ile ilişkili OUA hastalarında gündüz aşırı uykululuk ile AHİ ilişki-sini değerlendirmek amaçlanmıştır. MATERYAL ve METOD

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“…In studies that used diagnostic criteria similar to ours, AHI have ranged between 10% and 13% (16,17 Because of differences in the definition criteria, in cases with REM-related OSAS, clinical characteristics also demonstrate differences. In many studies, a higher incidence of REM-related OSAS has been reported in women (3,6,12,13,19,20). Higher AHI REM relative to AHI NREM in women suggest the protection of women from respiratory events in NREM sleep.…”

Section: Discussionmentioning

confidence: 95%

“…The prevalence of REM-related OSAS varies within a wide spectrum (10-36%) (6,(11)(12)(13). These highly variable outcomes stem from differences in criteria used for the definition of REM-related OSAS.…”

Section: Discussionmentioning

confidence: 99%

A Different Clinical Type of OSAS: REM-Related OSAS

Köseoğlu¹,

Kanbay²,

Demir³

2015

Eurasian J Pulmonol

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INTRODUCTIONObstructive sleep apnea syndrome (OSAS) is characterized by repetitive episodes of complete or partial upper airway obstruction during sleep. Repetitive episodes of airway obstruction lead to increasing respiratory efforts, intermittent arterial oxygen desaturation, systemic and pulmonary arterial blood pressure surges, and sleep disorders (1). We sleep occupies for nearly one-third of our life, and it is an essential and vital part of our life. Although it is perceived as a resting period for the body, during some stages of sleep, the brain and many bodily systems are extremely active. Sleep is evaluated in two stages as rapid eye movement (REM) and non-REM. The REM stage is named after REM during this phase. This stage is classified as tonic and phasic REM. During this stage, brain activity with mixed frequency, erection, thermoregulation loss, muscle twitching, cardiorespiratory disorder, respiratory control impairment, and irregular ventilation occur (2, 3). During REM, pharyngeal muscle activity decreases, and upper airway collapsibility increases as a result of the absence of excitatory, noradrenergic, and serotonergic stimuli in upper airway motor neurons (4). Therefore, in patients with OSAS during REM sleep, the number and duration of obstructive respiratory events increase with resultant serious oxygen desaturation. REM as a specific respiratory disorder was first described in 1996. From that day on, different expressions and diagnostic criteria have been used for the presence and definition of REM-related OSAS. Some authors have accepted this disorder as not a separate entity, but rather a component of an OSAS spectrum, and they indicated REM-related OSAS as an essentially early (baseline presentation) phase of classical OSAS, while others defined it as a different clinical type of OSAS (3,5,6). In the present study, we aimed to compare the clinical and polysomnographic findings of REM-related and non-REM-related OSAS patients to test whether REM-related OSAS is a different clinical type OSAS or the manifestation of early stage or the onset of OSAS. Methods:The study had a retrospective design. Patients with an initial diagnosis of sleep-related breathing disorders were later diagnosed to have OSAS based on an apnea-hypopnea index (AHI) of ≥5 and were divided into the following two groups: patients with AHINREM of <5 and AHIREM/AHINREM of >2 whose REM recordings were obtained for at least 30 min were defined as having "REM-related OSAS," and those who did not meet this description were defined as having "non-REM-related OSAS."Results: A total of 329 patients with a mean age of 51±10 years were included in the study. Thirty-five (10.6%) patients with OSAS were REM-related and 294 (89.4%) were non-REM-related. Age, body mass index, smoking status, and concomitant diseases were comparable between groups (p>0.05). In REM-related patients, AHI was lower, REM duration was longer, and mean oxygen saturations were comparatively higher (p<0.05). Conclusion:Similarities between groups in age, body ...

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Rapid Eye Movement-Related Sleep-Disordered Breathing

Cited by 119 publications

References 14 publications

Nonrapid Eye Movement-Predominant Obstructive Sleep Apnea: Detection and Mechanism

Nonrapid Eye Movement-Predominant Obstructive Sleep Apnea: Detection and Mechanism

The frequency and properties of REM related obstructive sleep apnea among the patients with mild related obstructive sleep apnea

A Different Clinical Type of OSAS: REM-Related OSAS

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