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

REM sleep obstructive sleep apnoea

Obstructive sleep apnoea (OSA) can occur in both rapid eye movement (REM) and non-REM sleep or be limited to REM sleep, when the upper airway is most prone to collapse due to REM sleep atonia. Respiratory events are usually longer and more desaturating in REM than in NREM sleep. The prevalence of REM OSA is higher in women than in men and REM OSA usually occurs in the context of mild-moderate OSA based on the apnoea-hypopnoea index calculated for the entire sleep study. Studies have highlighted some detrimental consequences of REM OSA; for example, its frequent association with systemic hypertension and a degree of excessive daytime sleepiness similar to that found in nonsleep-stage-dependent OSA. Moreover, REM OSA could increase cardiometabolic risk. Continuous positive airway pressure (CPAP) treatment aimed at preventing REM OSA should be longer than the 4 h usually considered as good compliance, since REM sleep occurs mostly during the second half of the night. Unfortunately, patients with REM OSA show poor adherence to CPAP. Alternative non-CPAP treatments might be a good choice for REM OSA, but data are lacking. This review summarises the available data on REM OSA and critically examines the weaknesses and strengths of existing literature.

Co-existence of OSA and respiratory diseases and the influence of gender

INTRODUCTION

Sleep-disordered breathing (SDB), especially obstructive sleep apnea (OSA), is commonly associated with respiratory diseases, such as COPD, asthma and interstitial lung disease.

AREAS COVERED

This narrative review aims to comprehensively synthesize the existing information on SDB in respiratory diseases, investigate the role of gender in this association, and highlight the importance of OSA management in improving sleep, quality of life, and disease prognosis in these specific patient populations.

EXPERT OPINION

Research indicates a synergistic link between OSA and chronic respiratory diseases, which leads to greater morbidity and mortality compared to each disorder alone. Given the lack of an optimal OSA screening tool for these patients, a comprehensive patient approach and overnight diagnostic sleep study are imperative. Despite the limited evidence available, it seems that gender has an impact on the prevalence, severity, and susceptibility of this coexistence. Recognizing the role of gender in the coexistence of OSA and other respiratory diseases can enhance everyday medical practice and enable clinicians to adopt a more personalized approach toward optimal screening and diagnosis of these patients.

The prevalence of rapid eye movement-related obstructive sleep apnea in a sample of Saudi population

BACKGROUND

This study aimed to estimate the prevalence of rapid eye movement-related obstructive sleep apnea (REMrOSA) using common definitions.

METHODS

This was a retrospective cohort study that used three sets of criteria to identify patients with REMrOSA. These criteria were defined as strict, intermediate, and lenient depending on the apnea-hypopnea index (AHI), AHI during REM sleep/(AHI during non-REM sleep [NREM-AHI]), NREM-AHI and REM duration.

RESULTS

The study included 609 patients with OSA and full sleep study. The prevalence of REMrOSA was 26%, 33%, and 52% using the strict, intermediate, and lenient criteria, respectively. There were no differences in the patients' general and demographic characteristics between the different groups of the three definitions. REMrOSA patients were more likely to be younger females than non-REMrOSA (NREMrOSA) patients. Comorbidities were more frequent in the REMrOSA group compared to NREMrOSA when using strict and intermediate definitions. In contrast, AHI, mean O2 saturation, and time spent <90% O2 saturation were significantly worse during NREMrOSA compared to REMrOSA, regardless of the criteria used. Our study reported higher AHI, lower mean oxygen saturation, lower minimum oxygen saturation, and longer time of desaturation during REMrOSA when lenient definition was used compared to when strict and intermediate definitions were used.

CONCLUSIONS

REMrOSA is a common condition with a prevalence ranging between 26% and 52% depending on what definition is applied. Although OSA tends to be more severe with lenient definition, however, the clinical and polysomnographic features were similar among REMrOSA groups regardless of the definition used.

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

PURPOSE

This article focuses on recent evidence linking rapid eye movement (REM) obstructive sleep apnea (OSA) (REM-OSA) to neurocognitive dysfunction and mood changes; the proposed mechanisms for increased risk of neurocognitive dysfunction in REM-OSA, and future research prospects.

METHODS

PubMed and Google Scholar records were examined for articles utilizing pre-defined keywords. In this work, we mainly included studies published after 2017; nevertheless, critical studies published prior to 2017 were considered.

RESULTS

REM-OSA is an under-recognized stage-related sleep-disordered breathing in which obstructive respiratory events happen chiefly in stage REM. The disorder is commonly seen amongst younger patients and females and has recently been linked to cardiometabolic complications. Although less symptomatic than non-REM-OSA and non-stage-specific OSA, current findings indicate that REM-OSA may have neurocognitive repercussions and mood changes and could be linked to insomnia, increased dreams, and nightmares.

CONCLUSION

Currently available evidence indicates that REM-OSA may present with insomnia and nightmares and could affect cognitive function and mood.

Characteristics of rapid eye movement-related obstructive sleep apnea in Thai patients

Obstructive sleep apnea (OSA) is a common sleep disorder that has been associated with cardiovascular consequences. Rapid eye movement (REM)-related obstructive sleep apnea (OSA) is a subtype of OSA which is characterized by apneas or hypopneas predominately during REM sleep. The factors associated with REM-related OSA are still unclear. We aimed to determine the prevalence and associated characteristics of REM-related OSA in Thai patients. A total of 408 patients’ charts were retrospectively reviewed. Demographic and anthropometric characteristics, comorbidities and polysomnographic data were obtained. The patients were divided into two groups: REM-related OSA and non-stage specific OSA. REM-related OSA was defined as an apnea–hypopnea index (AHI) ≥ 5 per hour, with a ratio of REM-AHI to NREM-AHI > 2, and NREM-AHI < 15 per hour. The prevalence of REM-related OSA was 21.6%. AHI and arousal index were both lower in REM-related OSA than in non-stage specific OSA. REM-related OSA was significantly associated with females (OR 2.35, 95% CI 1.25–4.42, p = 0.008), age < 60 years (OR 2.52, 95% CI 1.15–5.55, p = 0.021), and mild OSA (OR 17.46, 95% CI 9.28–32.84, p < 0.001). In conclusion, age < 60 years, female gender, and mild severity of OSA were associated with REM-related OSA.

A new design of mandibular advancement device (IMYS) in the treatment of obstructive sleep apnea

OBJECTIVE

The mandibular advancement device (MAD) is currently suggested in patients with mild to moderate obstructive sleep apnea (OSA). This study investigated the effects of a new fully customizable MAD-type device called, "It Makes You Sleep" (IMYS), in patients with mild to moderate OSA.

METHODS

Sixteen patients (14 men and 2 women; mean age 62; SD ± 11 years) were retrospectively enrolled. Each patient received home sleep apnea testing (HSAT) at baseline (T0) and after three months (T1) of IMYS treatment. The Apnea-Hypopnea Index (AHI), the Oxygen Desaturation Index (ODI), the Minimum Oxygen Saturation (minSO2) and the Medium Oxygen Saturation (medSO2) were analyzed.

RESULTS

From T0 to T1, the IMYS treatment showed a significant reduction of AHI and ODI and a significant increase of minSO2 and medSO2.

CONCLUSION

The IMYS appliance is an effective device for treating mild or moderate OSA.

[Progress in clinical research of REM-related obstructive sleep apnea]

REM-related obstructive sleep apnea （REM-OSA） refers to apneas and hypopneas in which most respiratory events occur during REM. The total AHI of REM-OSA is low compared to NREM-OSA, but the duration of apnea hypopnea events is longer and the oxygen saturation is lower. Only focusing on the total AHI value will miss the diagnosis of REM-OSA, and even some patients with severe hypoxemia cannot be effectively treated.REM-OSA may be an early manifestation of OSA, and active early recognition and intervention may benefit patients.The pathophysiology and mechanism of REM-OSA are still unclear. In this article, we reviewed the existing REM-OSA related research.

Rapid eye movement predominant obstructive sleep apnoea: prognostic relevance and clinical approach

PURPOSE OF REVIEW

Rapid eye movement (REM) obstructive sleep apnoea (OSA) is a stage-specific OSA, in which obstructive events occur primarily during REM sleep. This review discusses REM-OSA definitions, its cardiometabolic correlates, associated comorbidities and treatment, and addresses diagnostic ambiguities and therapeutic pitfalls.

RECENT FINDINGS

Current evidence indicates that REM-OSA is prevalent among younger age groups and women and is independently associated with cardiometabolic complications, particularly hypertension, metabolic complications such as insulin resistance and metabolic syndrome. However, currently, there is no consensus on the accepted diagnostic criteria for REM-OSA. Available data suggest that adherence to positive airway pressure (PAP) therapy in patients with REM-OSA is suboptimal. Moreover, the currently accepted criteria for good adherence to PAP therapy of 4 h/night, 70% of the days may not be suitable for REM-OSA, as it will not cover most of the REM sleep periods. In addition, further research is needed to assess the impact of REM-OSA treatment on cardiometabolic outcomes.

SUMMARY

Patients with REM-OSA are at an increased risk of cardiometabolic complications. A high index of suspicion is needed to diagnose this disorder, and close follow-up is required to enhance adherence to therapy.

Current Update on Clinically Relevant Sleep Issues in Parkinson's Disease: A Narrative Review

Sleep disturbances are among the common nonmotor symptoms in patients with Parkinson’s disease (PD). Sleep can be disrupted by nocturnal motor and nonmotor symptoms and other comorbid sleep disorders. Rapid eye movement sleep behavior disorder (RBD) causes sleep-related injury, has important clinical implications as a harbinger of PD and predicts a progressive clinical phenotype. Restless legs syndrome (RLS) and its related symptoms can impair sleep initiation. Excessive daytime sleepiness (EDS) is a refractory problem affecting patients’ daytime activities. In particular, during the COVID-19 era, special attention should be paid to monitoring sleep problems, as infection-prevention procedures for COVID-19 can affect patients’ motor symptoms, psychiatric symptoms and sleep. Therefore, screening for and managing sleep problems is important in clinical practice, and the maintenance of good sleep conditions may improve the quality of life of PD patients. This narrative review focused on the literature published in the past 10 years, providing a current update of various sleep disturbances in PD patients and their management, including RBD, RLS, EDS, sleep apnea and circadian abnormalities.