Does REM Sleep-Dependent Obstructive Sleep Apnea Have Clinical Significance?
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Haba-Rubio, J.; Janssens, J.P.; Rochat, T.; Sforza, E. Rapid eye movement-related disordered breathing: Clinical and polysomnographic features. Chest 2005, 128, 3350–3357. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Koo, B.B.; Dostal, J.; Ioachimescu, O.; Budur, K. The effects of gender and age on REM-related sleep-disordered breathing. Sleep Breath. Schlaf Atm. 2008, 12, 259–264. [Google Scholar] [CrossRef]
- Koo, B.B.; Patel, S.R.; Strohl, K.; Hoffstein, V. Rapid eye movement-related sleep-disordered breathing: Influence of age and gender. Chest 2008, 134, 1156–1161. [Google Scholar] [CrossRef]
- Resta, O.; Carpanano, G.E.; Lacedonia, D.; Di Gioia, G.; Giliberti, T.; Stefano, A.; Bonfitto, P. Gender difference in sleep profile of severely obese patients with obstructive sleep apnea (OSA). Respir. Med. 2005, 99, 91–96. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Conwell, W.; Patel, B.; Doeing, D.; Pamidi, S.; Knutson, K.L.; Ghods, F.; Mokhlesi, B. Prevalence, clinical features, and CPAP adherence in REM-related sleep-disordered breathing: A cross-sectional analysis of a large clinical population. Sleep Breath. Schlaf Atm. 2012, 16, 519–526. [Google Scholar] [CrossRef]
- Lee, S.A.; Paek, J.H.; Han, S.H. REM-related sleep-disordered breathing is associated with depressive symptoms in men but not in women. Sleep Breath. Schlaf Atm. 2016, 20, 995–1002. [Google Scholar] [CrossRef] [PubMed]
- Mokhlesi, B.; Punjabi, N.M. "REM-related" obstructive sleep apnea: An epiphenomenon or a clinically important entity? Sleep 2012, 35, 5–7. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Chami, H.A.; Baldwin, C.M.; Silverman, A.; Zhang, Y.; Rapoport, D.; Punjabi, N.M.; Gottlieb, D.J. Sleepiness, quality of life, and sleep maintenance in REM versus non-REM sleep-disordered breathing. Am. J. Respir. Crit. Care Med. 2010, 181, 997–1002. [Google Scholar] [CrossRef] [Green Version]
- Pamidi, S.; Knutson, K.L.; Ghods, F.; Mokhlesi, B. Depressive symptoms and obesity as predictors of sleepiness and quality of life in patients with REM-related obstructive sleep apnea: Cross-sectional analysis of a large clinical population. Sleep Med. 2011, 12, 827–831. [Google Scholar] [CrossRef] [PubMed]
- Cho, Y.W.; Lee, J.H.; Son, H.K.; Lee, S.H.; Shin, C.; Johns, M.W. The reliability and validity of the Korean version of the Epworth sleepiness scale. Sleep Breath. Schlaf Atm. 2011, 15, 377–384. [Google Scholar] [CrossRef] [PubMed]
- Sohn, S.I.; Kim, D.H.; Lee, M.Y.; Cho, Y.W. The reliability and validity of the Korean version of the Pittsburgh Sleep Quality Index. Sleep Breath. Schlaf Atm. 2012, 16, 803–812. [Google Scholar] [CrossRef] [PubMed]
- Cho, Y.W.; Song, M.L.; Morin, C.M. Validation of a Korean version of the insomnia severity index. J. Clin. Neurol. 2014, 10, 210–215. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sung, H.K.J.; Park, Y.; Bai, D.; Lee, S.; Ahn, H. study on the reliability and the validity of Korean version of the Beck Depression Inventory-II (BDI-II). J. Korean Soc. Biol. Psychiatry 2008, 14, 201–212. [Google Scholar]
- Berry, R.B.; Brooks, R. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specification, Version 2.0; American Academy of Sleep Medicine: Darien, IL, USA, 2012. [Google Scholar]
- O’Connor, C.; Thornley, K.S.; Hanly, P.J. Gender differences in the polysomnographic features of obstructive sleep apnea. Am. J. Respir. Crit. Care Med. 2000, 161, 1465–1472. [Google Scholar] [CrossRef]
- Oksenberg, A.; Arons, E.; Nasser, K.; Vander, T.; Radwan, H. REM-related obstructive sleep apnea: The effect of body position. J. Clin. Sleep Med. JCSM Off. Publ. Am. Acad. Sleep Med. 2010, 6, 343–348. [Google Scholar] [CrossRef] [Green Version]
- Trinder, J.; Kay, A.; Kleiman, J.; Dunai, J. Gender differences in airway resistance during sleep. J. Appl. Physiol. 1997, 83, 1986–1997. [Google Scholar] [CrossRef] [PubMed]
- Popovic, R.M.; White, D.P. Upper airway muscle activity in normal women: Influence of hormonal status. J. Appl. Physiol. 1998, 84, 1055–1062. [Google Scholar] [CrossRef]
- Shahar, E.; Redline, S.; Young, T.; Boland, L.L.; Baldwin, C.M.; Nieto, F.J.; O'Connor, G.T.; Rapoport, D.M.; Robbins, J.A. Hormone replacement therapy and sleep-disordered breathing. Am. J. Respir. Crit. Care Med. 2003, 167, 1186–1192. [Google Scholar] [CrossRef] [PubMed]
- Yamazaki, H.; Haji, A.; Ohi, Y.; Takeda, R. Effects of progesterone on apneic events during behaviorally defined sleep in male rats. Life Sci. 2005, 78, 383–388. [Google Scholar] [CrossRef] [PubMed]
- Zwillich, C.W.; Natalino, M.R.; Sutton, F.D.; Weil, J.V. Effects of progesterone on chemosensitivity in normal men. J. Lab. Clin. Med. 1978, 92, 262–269. [Google Scholar]
- Brooks, L.J.; Strohl, K.P. Size and mechanical properties of the pharynx in healthy men and women. Am. Rev. Respir. Dis. 1992, 146, 1394–1397. [Google Scholar] [CrossRef] [PubMed]
- Lee, S.E.; Han, K.; Kang, Y.M.; Kim, S.-O.; Cho, Y.K.; Ko, K.S.; Park, J.-Y.; Lee, K.-U.; Koh, E.H.; Diabetes Fact Sheet of the Korean Diabetes Association. Trends in the prevalence of metabolic syndrome and its components in South Korea: Findings from the Korean National Health Insurance Service Database (2009–2013). PLoS ONE 2018, 13, e0194490. [Google Scholar] [CrossRef] [PubMed]
- Fryar, C.D.; Kruszan-Moran, D.; Gu, Q.; Ogden, C.L. Mean body weight, weight, waist circumference, and body mass index among adults: United States, 1999–2000 through 2015–2016. Natl. Health Stat. Report 2018, 122, 1–16. [Google Scholar]
- Byun, J.-I.; Kim, D.-H.; Kim, J.-S.; Shin, W.C. Usefulness of using alternative Body-Mass Index and neck circumference criteria for STOP-Bang questionnaire in screening South Korean obstructive sleep apnea patients. Sleep Med. Res. 2020, 11, 38–43. [Google Scholar] [CrossRef]
- Carskadon MA, D.W. Normal human sleep: An overview. In Principles and Practice of Sleep Medicine, 5th ed.; Kryger, M.H., Roth, T., Dement, W.C., Eds.; Elsevier Saunders: St. Louis, MA, USA, 2011; pp. 12–16. [Google Scholar]
- Moon, H.L.S.; Kim, D.H.; Kim, D.E.; Hwang, S.H.; Cho, Y.W. Clinical characteristics of REM-dependent obstructive sleep apnea in Korean adults. J. Korean Neurol. Assoc. 2016, 34, 124–129. [Google Scholar] [CrossRef]
- Punjabi, N.M.; Bandeen-Roche, K.; Marx, J.J.; Neubauer, D.N.; Smith, P.L.; Schwartz, A.R. The association between daytime sleepiness and sleep-disordered breathing in NREM and REM sleep. Sleep 2002, 25, 307–314. [Google Scholar]
- Nykamp, K.; Rosenthal, L.; Folkerts, M.; Roehrs, T.; Guido, P.; Roth, T. The effects of REM sleep deprivation on the level of sleepiness/alertness. Sleep 1998, 21, 609–614. [Google Scholar] [CrossRef] [Green Version]
- Oksenberg, A.; Silverberg, D.S. The effect of body posture on sleep-related breathing disorders: Facts and therapeutic implications. Sleep Med. Rev. 1998, 2, 139–162. [Google Scholar] [CrossRef]
- Richard, W.; Kox, D.; den Herder, C.; Laman, M.; van Tinteren, H.; de Vries, N. The role of sleep position in obstructive sleep apnea syndrome. Eur. Arch. Oto-Rhino-Laryngol. Off. J. Eur. Fed. Oto-Rhino-Laryngol. Soc. Affil. Ger. Soc. Oto-Rhino-Laryngol.-Head Neck Surg. 2006, 263, 946–950. [Google Scholar] [CrossRef]
Total (n = 692) | REM-OSA (n = 140) | nREM-OSA (n = 552) | p Value | |
---|---|---|---|---|
Patients, % | 100 | 20.2 | 79.8 | |
Female (%) | 195 (28.2) | 75 (53.6) | 120 (21.7) | <0.001 |
Age, year | 50.3 ± 13.4 | 48.7 ± 12.9 | 50.7 ± 13.4 | NS |
BMI, kg/m2 | 25.6 ± 3.8 | 25.4 ± 4.1 | 25.6 ± 3.8 | NS |
Heart disease (%) | 98 (14.2) | 15 (10.7) | 83 (15.0) | NS |
Hypertension (%) | 227 (32.8) | 29 (20.7) | 198 (35.9) | 0.001 |
Diabetes (%) | 92 (13.3) | 11 (7.1) | 82 (14.9) | 0.016 |
Hyperlipidemia (%) | 104 (15.0) | 17 (12.1) | 87 (15.8) | NS |
OSA severity | <0.001 | |||
5 ≤ AHI < 15 | 201 (29.0) | 97 (69.3) | 104 (18.8) | |
15 ≤ AHI < 30 | 196 (28.3) | 42 (30.0) | 154 (27.9) | |
AHI ≥ 30 | 295 (42.6) | 1 (0.7) | 294 (53.2) | |
K-ESS | 8.8 ± 4.7 | 8.7 ± 4.8 | 8.9 ± 4.7 | NS |
K-PSQI | 8.1 ± 4.0 | 8.4 ± 3.9 | 8.0 ± 4.0 | NS |
K-ISI | 12.1 ± 6.6 | 12.3 ± 6.9 | 12.0 ± 6.5 | NS |
K-BDI2 | 13.2 ± 9.4 | 14.7 ± 9.5 | 12.9 ± 9.3 | NS |
Total (n = 692) | REM-OSA (n = 140) | nREM-OSA (n = 552) | p Value | |
---|---|---|---|---|
TST, min | 35.1.3 ± 55.6 | 363.8 ± 49.0 | 348.1 ± 56.8 | NS |
Sleep latency, min | 11.9 ± 21.0 | 14.7 ± 21.7 | 11.3 ± 20.7 | NS |
REM latency, min | 108.6 ± 60.8 | 100.1 ± 62.0 | 110.8 ± 60.3 | 0.031 |
Sleep efficiency, % | 82.6 ± 11.7 | 85.1 ± 10.5 | 82.0 ± 12.0 | NS |
WASO | 62.5 ± 45.5 | 50.9 ± 39.7 | 65.5 ± 46.4 | <0.001 |
N1, % | 25.9 ± 13.3 | 16.4 ± 7.8 | 28.3 ± 13.2 | <0.001 |
N2, % | 52.5 ± 12.5 | 60.3 ± 9.3 | 50.5 ± 12.5 | NS |
N3, % | 3.0 ± 6.8 | 3.7 ± 7.2 | 2.9 ± 6.7 | NS |
REM, % | 18.6 ± 5.9 | 19.6 ± 5.9 | 18.2 ± 5.8 | NS |
Supine position, % | 62.2 ± 27.7 | 68.0 ± 25.4 | 60.7 ± 28.1 | NS |
Total arousal index | 38.4 ± 19.3 | 25.0 ± 10.8 | 41.8 ± 19.5 | <0.001 |
AHI | 31.6 ± 22.5 | 12.4 ± 5.5 | 36.5 ± 22.6 | <0.001 |
HI | 22.9 ± 15.4 | 11.0 ± 5.0 | 26.0 ± 15.7 | <0.001 |
AI | 8.7 ± 15.0 | 1.4 ± 2.2 | 10.6 ± 16.2 | <0.001 |
REM AHI | 34.2 ± 23.9 | 31.5 ± 15.9 | 35.9 ± 25.5 | NS |
NREM AHI | 30.9 ± 24.2 | 7.6 ± 3.8 | 36.8 ± 23.7 | <0.001 |
Supine AHI | 43.2 ± 28.8 | 16.6 ±10.7 | 49.9 ±28.1 | <0.001 |
Off-supine AHI | 15.4 ± 21.3 | 5.3 ± 9.0 | 18.0 ± 22.6 | <0.001 |
Mean SaO2, % | 94.8 ± 2.6 | 95.5 ± 2.9 | 94.6 ± 2.5 | NS |
PLM index | 4.9 ± 12.6 | 5.6 ± 14.2 | 4.7 ± 12.2 | NS |
Mild (n = 201) | Moderate (n = 196) | |||||
---|---|---|---|---|---|---|
Variables | REM-OSA (n = 97) | nREM-OSA (n = 104) | p Value | REM-OSA (n = 42) | nREM-OSA (n = 154) | p Value |
Female (%) | 57 (58.8) | 33 (31.7) | <0.001 | 17 (40.5) | 41 (26.6) | NS |
Age, year | 48.7 ± 12.7 | 48.7 ± 14.7 | NS | 48.5 ± 13.5 | 50.7 ± 12.8 | NS |
BMI, kg/m2 | 25.2 ± 4.0 | 24.2 ± 2.8 | NS | 26.1 ± 4.6 | 24.9 ± 3.4 | NS |
Heart disease (%) | 11 (11.3) | 13 (12.5) | NS | 4 (9.5) | 21 (13.6) | NS |
Hypertension (%) | 18 (18.6) | 24 (23.1) | NS | 10 (23.8) | 54 (35.1) | NS |
Diabetes (%) | 7 (7.2) | 11 (10.6) | NS | 2 (4.8) | 23 (15.0) | NS |
Hyperlipidemia (%) | 11 (11.3) | 13 (12.5) | NS | 6 (14.3) | 22 (14.3) | NS |
K-ESS | 8.4 ± 5.1 | 8.2 ± 4.7 | NS | 9.2 ± 3.7 | 8.6 ± 4.8 | NS |
K-PSQI | 8.4 ± 3.9 | 8.2 ± 4.0 | NS | 8.4 ± 3.7 | 8.1 ± 4.0 | NS |
K-ISI | 12.5 ± 6.9 | 12.1 ± 6.4 | NS | 11.8 ± 7.0 | 12.0 ± 6.8 | NS |
K-BDI2 | 14.4 ± 9.0 | 14.0 ± 9.9 | NS | 15.2 ± 10.6 | 13.6 ± 9.2 | NS |
Polysomnography data | ||||||
TST, m | 365.4 ±52.5 | 355.6 ± 57.5 | NS | 360.5 ± 41.1 | 354.6 ± 59.1 | NS |
Sleep latency, min | 14.7 ± 21.0 | 12.2 ± 22.9 | NS | 14.5 ± 23.7 | 10.2 ± 12.2 | NS |
REM latency, min | 106.8 ± 64.5 | 104.8 ± 57.6 | NS | 85.4 ± 54.2 | 108.7 ± 56.6 | NS |
Sleep efficiency | 84.9 ± 10.9 | 81.8 ± 12.3 | NS | 85.9 ± 9.4 | 83.0 ± 11.5 | NS |
WASO | 51.3 ± 41.3 | 68.3 ± 50.2 | 0.049 | 48.7 ± 35.7 | 62.0 ± 47.2 | 0.046 |
N1, % | 16.0 ± 7.5 | 18.9 ± 8.1 | 0.042 | 17.4 ± 8.2 | 23.7 ± 10.7 | <0.001 |
N2, % | 60.6 ± 9.3 | 54.5 ± 11.9 | NS | 59.8 ± 9.2 | 54.0 ± 12.3 | NS |
N3, % | 4.3 ± 7.6 | 6.5 ± 9.0 | 0.032 | 2.5 ± 6.3 | 3.5 ± 8.0 | NS |
REM, % | 19.1 ± 5.8 | 20.1 ± 6.1 | NS | 20.2 ± 5.8 | 18.8 ± 5.8 | NS |
Supine position (%) | 66.0 ± 25.5 | 53.6 ± 26.7 | NS | 74.3 ± 22.7 | 57.7 ± 29.3 | NS |
Arousal index | 23.5 ± 10.7 | 24.4 ± 13.2 | NS | 28.1 ± 10.6 | 33.1 ± 12.5 | 0.009 |
AHI | 9.4 ± 2.9 | 9.9 ± 3.0 | NS | 18.9 ± 3.2 | 22.5 ± 4.3 | <0.001 |
HI | 8.6 ± 2.8 | 9.0 ± 2.9 | NS | 16.3 ± 3.7 | 19.8 ± 5.2 | <0.001 |
AI | 0.9 ± 1.2 | 0.9 ± 1.2 | NS | 2.6 ± 3.3 | 2.8 ± 4.0 | NS |
REM AHI | 24.7 ± 10.9 | 7.4 ± 5.5 | NS | 46.3 ± 14.4 | 27.0 ± 17.6 | NS |
NREM AHI | 5.9 ± 2.7 | 10.5 ± 3.4 | <0.001 | 11.4 ± 3.0 | 21.7 ± 5.0 | <0.001 |
Supine AHI | 13.5 ± 8.7 | 21.6 ± 21.9 | <0.001 | 24.2 ± 20.6 | 36.0 ± 16.5 | <0.001 |
Off-supine AHI | 3.7 ± 4.7 | 3.7 ± 2.9 | NS | 8.5 ± 13.6 | 8.8 ± 8..2 | NS |
Mean SaO2, % | 95.5 ± 3.3 | 95.8 ± 1.7 | NS | 95.4 ± 1.4 | 95.3 ± 1.5 | NS |
PLM index | 6.1 ± 15.6 | 6.6 ± 14.0 | NS | 4.5 ± 10.7 | 5.0 ± 13.0 | NS |
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Lee, S.C.; Kim, D.-E.; Hwangbo, Y.; Song, M.L.; Yang, K.I.; Cho, Y.W. Does REM Sleep-Dependent Obstructive Sleep Apnea Have Clinical Significance? Int. J. Environ. Res. Public Health 2022, 19, 14147. https://doi.org/10.3390/ijerph192114147
Lee SC, Kim D-E, Hwangbo Y, Song ML, Yang KI, Cho YW. Does REM Sleep-Dependent Obstructive Sleep Apnea Have Clinical Significance? International Journal of Environmental Research and Public Health. 2022; 19(21):14147. https://doi.org/10.3390/ijerph192114147
Chicago/Turabian StyleLee, Seung Cheol, Doh-Eui Kim, Young Hwangbo, Mei Ling Song, Kwang Ik Yang, and Yong Won Cho. 2022. "Does REM Sleep-Dependent Obstructive Sleep Apnea Have Clinical Significance?" International Journal of Environmental Research and Public Health 19, no. 21: 14147. https://doi.org/10.3390/ijerph192114147