Rapid Eye Movement (REM) rebound on initial exposure to CPAP therapy: a systematic review and meta-analysis

Abstract

Objective: Rapid Eye Movement (REM) rebound is a polysomnographic phenomenon where a substantial increase in REM sleep is noted in patients with untreated obstructive sleep apnea (OSA) when first undergoing continuous positive airway pressure (CPAP) titration. The objectives of this study are to determine: 1) the percentage of patients experiencing REM rebound during CPAP titrations, 2) to quantify the relative increase in REM sleep duration and 3) to identify if there are patient variables associated with REM rebound. Methods: Four databases (including PubMed/Medline) were systematically searched through March 12, 2017.Results: Four hundred sixty-seven articles were screened, 58 were reviewed in full-text form and 14 studies met the criteria for inclusion in this review. Eleven of the fourteen studies noted a statistically significant increase in amount of REM sleep during the titration night, compared to baseline sleep study. Pre-and post-CPAP REM sleep duration percentage means ± standard deviations (M ± SD) in 1119 patients increased from 13.8 ± 8.2% to 20.0 ± 10.1%; random effects modeling demonstrated a mean difference of 7.86 (%) [95% CI 5.01, 10.70], p-value <0.00001, corresponding to a 57% relative increase in REM sleep duration. The standardized mean difference (SMD) is 0.90 [95% CI 0.59, 1.22], representing a large magnitude of effect. Conclusions: In studies reporting REM rebound, the REM sleep duration increased by 57% during the first CPAP titration night compared to the baseline sleep study. The prevalence of REM rebound varied between 23 and 46%. A low amount of REM sleep on the diagnostic PSG predicted REM rebound.

Rapid eye movement sleep and slow wave sleep rebounded and related factors during positive airway pressure therapy

“…SWS rebound was defined as a ≥ 10% increase in SWS during the treatment portion; however, the study did not define the REM and SWS rebound threshold. The parameters age, %REM in diagnostic PSG, and the ODI, which is linearly related to AHI, were predictors of changes in REM and SWS in the current study, and BMI and AHI were considered predictors of changes in REM sleep in other studies 9 . Differences in the definitions of REM and SWS rebound, differences in the characteristics of patients with OSA (age: 47.0–58.6 years, BMI: 25.7–39.2 kg/m 2 , AHI 23.6–72.9 times/h) and %REM in diagnostic PSG (6.7–18.4%) 9 lead to different prevalence rates of REM rebound and SWS rebound on the first night of exposure to PAP therapy.…”

An Update on Assessment, Therapeutic Management, and Patents on Insomnia

“…In a subgroup of OSA patients, breathing disturbance results in intermittent sleep and insomnia. The therapy of OSA with positive airway pressure (PAP) can enhance quality of sleep for these patients [ 157 ]. But, for some other individuals, PAP therapy may intensify sleeplessness (especially in patients with co-morbid PTSD) [ 158 ].…”

Sleep Study Interpretation in Obstructive Sleep Apnea

“…When CPAP is initiated in patients with OSA especially with severe grades, the loss in REM due to disease is compensated in form of increase in frequency (6 to 20%) and depth of REM phases called as REM rebound. 6 REM phase behavioural disorder (RBD) is a form of parasomnia which is characterized by loss of normal skeletal muscle atonia which is usually associated with REM sleep leading to prominent motor activity allowing the person to "act out" his or her dreams. 7 Patients with narcolepsy, like patients with RBD, present a higher percentage of REM sleep without atonia.…”