Purpose Oral appliances (OA) are used to treat patients with obstructive sleep apnea (OSA). The purpose of this study is to evaluate the efficacy of OA treatment in patients with rapid eye movement (REM)-related OSA. Methods Forty-six patients with REM-related OSA and 107 with non-stage-specific OSA were prescribed OA treatment after diagnosis by polysomnography (PSG) and a follow-up sleep test by PSG was conducted. Efficacy and treatment outcome predictors were evaluated according to the following criteria for treatment success: #1, reduction of the apnea-hypopnea index (AHI) to less than 5 and > 50% compared with baseline; #2, AHI reduction to less than 10 and > 50% compared with baseline; and #3, > 50% AHI reduction compared with baseline. Results Success rates according to criteria #1, #2, and #3 were 45.7%, 50.0%, and 50.0% in REM-related OSA and 36.4%, 52.3%, and 63.6% in non-stage-specific OSA, respectively. No significant differences in success rate were found between the two groups. In multivariate logistic regression analysis with each criterion as the response variable, only BMI was extracted as a significant predictor. The BMI cutoff values defined based on the maximum Youden index according to the three criteria were 26.2 kg/m 2 , 25.6 kg/m 2 , and 26.2 kg/m 2 , respectively. Conclusions No significant differences in success rate of OA treatment were found between REM-related OSA and non-stagespecific OSA. BMI has greater impact on treatment outcome of OA in patients with REM-related OSA.

Purpose Rapid eye movement (REM) obstructive sleep apnea (OSA) is a prevalent clinical phenotype. However, the literature focusing on the pathophysiology of REM OSA is limited. This study compared the proportion of individuals with a low respiratory arousal threshold between patients with REM and non-REM OSA. Methods REM OSA was defined as having an apnea–hypopnea index (AHI) ≥ 5 and AHI during REM (AHI-REM)/AHI during NREM (AHI-NREM) ≥ 2. REM OSA was sub-divided into REM-predominant OSA and REM-isolated OSA. REM-predominant OSA was defined as satisfying the definition of REM OSA and having an AHI-NREM ≥ 5. REM-isolated OSA was defined as satisfying the definition of REM OSA and having an AHI-NREM < 5. Patients with an AHI-REM/AHI-NREM < 2 were defined as having non-REM OSA. A low respiratory arousal threshold was defined as having 2 or more of the following conditions: AHI < 30 events/h, proportion of hypopnea > 58.3%, and nadir SpO2 > 82.5%. Results The proportions of individuals with low respiratory arousal thresholds among individuals with REM-predominant OSA and REM-isolated OSA were significantly higher (77.2% and 93.7%, respectively) than that of patients with non-REM OSA (48.6%). This was also true when the analysis was performed according to sex. Conclusion These results indicate that a low respiratory arousal threshold might be an important endotype that contributes to the pathogenesis of REM OSA, especially in REM-isolated OSA.

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