Among patients referred for OSA evaluation, routine polysomnographic data can identify physiological phenotypes that capture risk of adverse cardiovascular outcomes otherwise missed by conventional OSA severity classification.

REM SDB prevalence decreases with age in women as does REM AHI/NREM AHI, perhaps secondary to a disproportionate age-dependent rise in NREM vs REM AHI in women. Younger women may be protected from SDB during NREM sleep, even in the face of obesity. These patterns may reflect age-related decreases in female hormones.

Sleep disordered breathing occurring predominantly in rapid eye movement REM sleep (rapid-eye-movement-related sleep-disordered breathing, REM SDB) is present in 10 to 36% of patients undergoing polysomnography (PSG) for suspected obstructive sleep apnea (O'Connor et al. in Am J Respir Crit Care Med 161:1465-1472, 2000; Resta et al. in J Respir Medicine 99:91-96, 2005; Haba-Rubio et al. in Chest 128:3350-3357, 2005; Juvelekian and Golish, American Academy of Sleep Medicine, abstract, 2004). We hypothesize that REM SDB is an age-related condition in women and, additionally, more prevalent in women than in men. Subjects with REM SDB were identified retrospectively among 1,540 obstructive sleep apnea (OSA) patients with an apnea-hypopnea index (AHI) >or= 5. Inclusion criteria for REM SDB were age >18, AHI >or= 5, NREM AHI < 15, and REM AHI/NREM AHI > 2. PSG data included sleep latency, REM latency, total sleep time (TST), AHI, REM AHI, NREM AHI, and sleep stage percentages. Demographic data and medical and psychiatric histories were also obtained. Statistical comparisons were made between men and women and women older and younger than 55 years, a marker for menopausal status. Two hundred twenty-one subjects fulfilled the criteria for REM SDB, yielding a prevalence of 14.4%. Overall, female apneics had a significantly higher prevalence of REM SDB than did men (24.5 vs 7.9%; p < 0.001). Younger women had a significantly higher prevalence than did older women (27.2 vs 18.6%; p = 0.008); younger men had a significantly higher prevalence of REM SDB than did older men (9.9 vs 4.5%; p = 0.002). Women were significantly older and more obese than were men. Younger women were more likely to be depressed and were significantly more obese than were older women. REM SDB is more prevalent in women than in men and more prevalent in men and women younger than 55 than those older than 55. In this population, women are more obese and older than men, while younger women were more obese than older women. These descriptive distinctions suggest differences in mechanism which may depend on gender and age.

This study indicates that chronic poor sleep quality is associated with increased signs of intrinsic ageing, diminished skin barrier function and lower satisfaction with appearance.

Background Periodic limb movements during sleep (PLMS) cause repetitive sympathetic activation and may be associated with increased cardiovascular risk. We hypothesized that PLMS frequency (PLMI) and PLMS arousal frequency (PLMAI) are predictive of incident cardiovascular disease, including coronary heart disease (CHD), peripheral arterial disease (PAD) and cerebrovascular disease (CBD) in an elderly male cohort. Methods and Results 2,911 men in the observational MrOS sleep study cohort underwent in-home polysomnography with PLMS measurement and were followed four years for the outcomes CHD, CBD, PAD and all-cause cardiovascular disease (cCVD): CHD, CBD or PAD. Cox proportional hazards regression assessed association between PLMI, PLMAI and these outcomes. Models were minimally adjusted for age, clinic and body mass index, then fully adjusted for conventional cardiovascular risk factors. During follow-up, 500 men experienced cCVD: 345 CHD, 117 CBD and 98 PAD events. In fully adjusted models, men with PLMAI≥5 compared to the referent PLMA<1 group had 1.26-fold increased relative hazard (RH) for cCVD. Similar findings were observed for PLMI and cCVD. For PAD, men with PLMI≥30 compared to the referent PLMI<5 group had a 2-fold increased RH (1.14–3.49, p=0.025). Compared to the referent group, men with PLMI ≥30 had an increased risk of CHD (RH=1.31, 1.01–1.70; p=0.045) after minimal adjustment, but this association attenuated after further adjustments. After stratification, risk of incident cCVD among high PLMI and PLMAI groups was significantly elevated only for men without prevalent hypertension (p interactions <0.10). Conclusions These findings provide evidence that PLMS frequency is associated with incident cardiovascular disease in community dwelling elderly men.