Long-term adherence to continuous positive airway pressure in patients with rapid eye movement-only obstructive sleep apnea: a prospective cohort study

Almeneessier, Aljohara S.; Almousa, Yasser; Hammad, Omeima; Olaish, Awad H; AlAnbay, Eiman; BaHammam, Ahmed S.

doi:10.21037/jtd.2017.09.57

Cited by 23 publications

(29 citation statements)

References 28 publications

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“…4 REM-related OSA is used loosely by sleep clinicians when polysomnography (PSG) shows obstructive sleep-disordered breathing events that occur predominantly or exclusively in REM sleep. 5 A common criterion used for diagnosis is the ratio between the apnea-hypopnea index (AHI) during REM and NREM sleep (the AHI-REM/AHI-NREM ratio), where an AHI-REM/AHI-NREM ratio ≥ 2 indicates a preponderance of respiratory events during REM sleep, or REM-related OSA. 5 However, this definition is not accurate if REM sleep duration and NREM-AHI are not considered.…”

Section: Introductionmentioning

confidence: 99%

“…5 A common criterion used for diagnosis is the ratio between the apnea-hypopnea index (AHI) during REM and NREM sleep (the AHI-REM/AHI-NREM ratio), where an AHI-REM/AHI-NREM ratio ≥ 2 indicates a preponderance of respiratory events during REM sleep, or REM-related OSA. 5 However, this definition is not accurate if REM sleep duration and NREM-AHI are not considered. Therefore, we need to use criteria that account for REM sleep duration and NREM-AHI.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, we need to use criteria that account for REM sleep duration and NREM-AHI. 5 Blood pressure increases following obstructive events during REM and NREM sleep. 6 However, REM sleep has been shown to be accompanied by enhanced sympathetic activity and instability of the cardiovascular system; 6 therefore, theoretically, REM-related OSA may be related to more cardiovascular harmful events than NREM OSA.…”

Section: Introductionmentioning

confidence: 99%

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

Bahammam¹,

Alqahtani²,

Aleissi³

et al. 2020

NSS

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The study sought to assess demographics, clinical features, comorbidities, and polysomnographic features of a large cohort of clinic-based patients with rapid eye movementpredominant obstructive sleep apnea (REM-predominant-OSA) in both genders, while assessing the relationship between REM-predominant OSA in one hand and menopausal status and age on the other. Methods: This prospective observational study was conducted between January 2003 and December 2017. REM-predominant OSA diagnostic criteria included an AHI of ≥5/h, with REM-AHI/non-REM-AHI of >2, a non-REM-AHI of <15/h, and a minimum of 15 min of REM sleep. Patients who had an AHI>5 events/h and did not meet the criteria for REMpredominant OSA were included in the non-stage-specific OSA group (NSS). Results: The study consisted of 1346 men and 823 women (total=2169). REM-predominant OSA was diagnosed in 17% (n=369). The prevalence of REM-predominant OSA in women was 25% compared with 12% in men. Several independent associations of REMpredominant OSA were identified in the whole group, including age (OR: 0.97 [0.95-0.98], p<0.01), female sex (OR: 6.95 [4.86-9.93], p>0.01), REM sleep duration (min) (OR: 1.02 [1.02-1.03], < 0.01), and time with SpO2 <90% (mins) (OR: 0.97 [0.95-0.99], < 0.01), hypertension (OR:0.67 [0.45-0.99], 0.04) and asthma (OR: 2.19 [1.56-3.07], < 0.01). The prevalence of REM-predominant OSA in premenopausal and postmenopausal women was 35% and 18.6% (p< 0.01), respectively. Among women, age was an independent correlate (OR: 0.97 [0.94-0.99], p=0.03; however, menopausal status was not. Conclusion: REM-predominant OSA is prevalent among clinic-based patients with OSA. A younger age and female sex were independent correlates of REM-predominant OSA. Among women, a younger age but not menopausal status was a correlate of REMpredominant OSA. Asthma was independently associated with REM-predominant OSA.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Bahammam¹,

Alqahtani²,

Aleissi³

et al. 2020

NSS

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“…However, it is difficult to determine the appropriate course of management due to the lack of clinical data regarding the aforementioned treatment options for REM-related OSA. Moreover, two recent clinical studies have indicated that it is difficult for patients with REM-related OSA to achieve good adherence, and these patients are occasionally intolerant to continuous positive airway pressure (CPAP) therapy, which is the standard OSA treatment option [7,8]. Hence, we consider it an urgent challenge to collect clinical data for each treatment option for this specific type of OSA.…”

Section: Introductionmentioning

confidence: 99%

Treatment outcome of oral appliance in patients with REM-related obstructive sleep apnea

et al. 2019

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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.

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“…Interaction of several factors leads to longer duration and greater severity of oxygen desaturation during obstructive events in REM sleep than in NREM sleep. REM-predominant or REM-only OSA occurs in one-third of patients presenting to clinical sleep disorder services 2,3 .…”

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confidence: 99%

Comparison between blood pressure during obstructive respiratory events in REM and NREM sleep using pulse transit time

Almeneessier

Alshahrani

Aleissi

et al. 2020

Sci Rep

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Rapid eye movement-predominant obstructive sleep apnea has been shown to be independently associated with hypertension. this study aimed to non-invasively measure blood pressure during the rapid eye movement (ReM) and non-rapid eye movement (nReM) obstructive events and the postobstructive event period. thirty-two consecutive continuous positive airway pressure-naïve obstructive sleep apnea patients (men, 50%) aged 50.2 ± 12 years underwent overnight polysomnography. Blood pressure was assessed indirectly using a validated method based on the pulse transit time and pulse wave velocity during the nReM and ReM obstructive events (both apneas and hypopneas) and the postobstructive event period. Among the recruited patients, 10 (31.3%) had hypertension. Mean apneahypopnea index was 40.1 ± 27.6 events/hr. Apnea-hypopnea indexes were 38.3 ± 30.6 and 51.9 ± 28.3 events/hr for NREM and REM sleep, respectively. No differences were detected in obstructive respiratory event duration or degree of desaturation between REM and NREM sleep. Additionally, no difference in blood pressure (systolic and diastolic) was detected between REM and NREM sleep during obstructive events and post-obstructive event period. Simple linear regression identified history of hypertension as a predictor of increased systolic blood pressure during obstructive events and postobstructive event period in both rapid eye movement and non-rapid eye movement sleep. oxygen desaturation index was also a predictor of increased systolic blood pressure during obstructive events and post-obstructive event period in REM sleep. When obstructive event duration and the degree of desaturation were comparable, no difference in blood pressure was found between REM and NREM sleep during obstructive events and post-obstructive event period.

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Long-term adherence to continuous positive airway pressure in patients with rapid eye movement-only obstructive sleep apnea: a prospective cohort study

Abstract: CPAP adherence is lower among patients with REM-only OSA compared to patients with non-stage specific OSA.

Cited by 23 publications

References 28 publications

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

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

Treatment outcome of oral appliance in patients with REM-related obstructive sleep apnea

Comparison between blood pressure during obstructive respiratory events in REM and NREM sleep using pulse transit time

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