Clin Exp Otorhinolaryngol.  2019 May;12(2):190-195. 10.21053/ceo.2018.00934.

Does Rapid Eye Movement Sleep Aggravate Obstructive Sleep Apnea?

• Kim SH
• Yang CJ
• Baek JT
• Hyun SM
• Kim CS
• Lee SA
• Chung YS

• KMID: 2447428
• DOI: http://doi.org/10.21053/ceo.2018.00934

Abstract

OBJECTIVES
.: To investigate the apnea-hypopnea index (AHI) according to the sleep stage in more detail after control of posture.
METHODS
.: Patients who underwent nocturnal polysomnography between December 2007 and July 2018 were retrospectively evaluated. Inclusion criteria were as follows: age >18 years, sleep efficacy >80%, and patients who underwent polysomnography only in the supine position (100% of the time). Patients were classified into different groups according to the methods: the first, rapid eye movement (REM)-dominant group (AHIREM/AHINREM >2), non-rapid eye movement (NREM)-dominant group (AHINREM/AHIREM >2), and non-dominant group; and the second, light sleep group (AHIN1N2>AHISWS) and slow wave sleep (SWS) group (AHISWS>AHIN1N2).
RESULTS
.: A total of 234 patients (mean age, 47.4±13.9 years) were included in the study. There were 108 patients (46.2%) in the REM-dominant group, 88 (37.6%) in the non-dominant group, and 38 (16.2%) in the NREM-dominant group. The AHI was significantly higher in the NREM-dominant group than in the REM-dominant group (32.9±22.9 events/hr vs. 18.3±9.5 events/hr, respectively). There were improvements in the AHI from stage 1 to SWS in NREM sleep with the highest level in REM sleep. A higher AHISWS than AHIN1N2 was found in 16 of 234 patients (6.8%); however, there were no significant predictors of these unexpected results except AHI.
CONCLUSION
.: Our results demonstrated the highest AHI during REM sleep stage in total participants after control of posture. However, there were 16.2% of patients showed NREM-dominant pattern (AHINREM/AHIREM >2) and 6.8% of patients showed higher AHISWS than AHIN1N2. Therefore, each group might have a different pathophysiology of obstructive sleep apnea (OSA), and we need to consider this point when we treat the patients with OSA.

Keyword

Obstructive Sleep Apnea; Sleep Stages; REM Sleep; Slow-Wave Sleep

MeSH Terms

Eye Movements
Humans
Polysomnography
Posture
Retrospective Studies
Sleep Apnea, Obstructive*
Sleep Stages
Sleep, REM*
Supine Position

Figure

• 

  Fig. 1. Apnea-hypopnea index (AHI) according to sleep stage. REM, rapid eye movement; SWS, slow-wave sleep. a)Repeated measures analysis of variance: overall P<0.001 (assessed using multiple comparison by Bonferroni’s correction).

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