REM obstructive sleep apnea: risk for adverse health outcomes and novel treatments

Abstract

Rapid eye movement (REM) sleep was discovered nearly 60 years ago. This stage of sleep accounts for approximately a quarter of total sleep time in healthy adults, and it is mostly concentrated in the second half of the sleep period. The majority of research on REM sleep has focused on neurocognition. More recently, however, there has been a growing interest in understanding whether obstructive sleep apnea (OSA) during the two main stages of sleep (REM and non-REM sleep) leads to different cardiometabolic and neurocognitive risk. In this review, we discuss the growing evidence indicating that OSA during REM sleep is a prevalent disorder that is independently associated with adverse cardiovascular, metabolic, and neurocognitive outcomes. From a therapeutic standpoint, we discuss limitations of continuous positive airway pressure (CPAP) therapy given that 3 or 4 h of CPAP use from the beginning of the sleep period would leave 75% or 60% of obstructive events during REM sleep untreated. We also review potential pharmacologic approaches to treating OSA during REM sleep. Undoubtedly, further research is needed to establish best treatment strategies in order to effectively treat REM OSA. Moreover, it is critical to understand whether treatment of REM OSA will translate into better patient outcomes.

<p>The Associations of Gender, Menopause, Age, and Asthma with REM-Predominant Obstructive Sleep Apnea: A Prospective Observational Study</p>

“…In the current study, the ESS was lower in REM-predominant OSA than in NSS-OSA and was independently associated with REM-predominant OSA after adjusting for demographics, BMI, and PSG parameters. Although sleepiness usually correlates with OSA severity, 27 studies that assessed patients with REM-related OSA reported less association with daytime sleepiness. 27 – 29 However, there is no consistency on data related to sleepiness in REM-related OSA; a clinic-based study of 1821 subjects who underwent both PSG and multiple sleep latency reported that after adjusting for age, sex, BMI, and the duration of NREM and REM sleep, the REM-related OSA severity was not associated with daytime sleepiness.…”

“…Although sleepiness usually correlates with OSA severity, 27 studies that assessed patients with REM-related OSA reported less association with daytime sleepiness. 27 – 29 However, there is no consistency on data related to sleepiness in REM-related OSA; a clinic-based study of 1821 subjects who underwent both PSG and multiple sleep latency reported that after adjusting for age, sex, BMI, and the duration of NREM and REM sleep, the REM-related OSA severity was not associated with daytime sleepiness. 29 Similarly, in the Sleep Heart Health Study, REM-related OSA was not associated with daytime sleepiness measured by the ESS after adjusting for demographics, BMI, and NREM-AHI.…”

The Burden of Associated Comorbidities in Patients with Obstructive Sleep Apnea—Regional Differences in Two Central–Eastern European Sleep Centers

“…As part of the study, we distinguished between obstructive respiratory events occurring in REM and non-REM sleep. Recent attention has focused on the clinical significance of obstructive respiratory events occurring during REM sleep [21]. REM-related OSA was found to be an independent risk factor for cardiovascular disease [22] and diabetes [23], although no such association was found for dyslipidemia [24].…”

“…REM-related OSA was found to be an independent risk factor for cardiovascular disease [22] and diabetes [23], although no such association was found for dyslipidemia [24]. REM sleep is characterized by increased sympathetic activity and decreased muscle tone compared to non-REM sleep, and in addition, there is an altered production of some hormones such as the growth hormone or thyrotropin between the two phases of sleep [21]. However, in our study, we did not find a statistically significant difference between AHIREM and AHINREM sleep phases in the prevalence of comorbidities.…”

The Importance of Sleep Fragmentation on the Hemodynamic Dipping in Obstructive Sleep Apnea Patients

“…In fact, ABPM recordings give little detailed information over the night-time period, since both micro-and macrostructure of the sleep are not recorded. This is of clinical relevance since respiratory events during REM sleep are associated with higher BP surges (Sasaki et al, 2018) and are thought to be especially relevant for the cardiovascular risk of OSA patients (Mokhlesi et al, 2015;Mokhlesi and Varga, 2018;Varga and Mokhlesi, 2019). Missing BP recordings during REM periods due to large intervals might therefore generate nocturnal BP values that might not reflect reality.…”