NREM-AHI greater than REM-AHI versus REM-AHI greater than NREM-AHI in patients with obstructive sleep apnea: clinical and polysomnographic features

Liu, Yu; Su, Changjun; Liu, Rui; Lei, Gesheng; Zhang, Wei; Yang, Ting; Miao, Jianting; Li, Zhuyi

doi:10.1007/s11325-010-0358-z

Cited by 40 publications

(45 citation statements)

References 34 publications

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“…These percentages were selected from a normal distribution of the ratio of time spent in the supine versus lateral position. The mean and SD of 1.13 (0.16) were approximated based on those found in the literature, 13,14 and were similar to the percent time spent in the supine position in our cohort. In the next step, we imposed a 2-fold worsening of AHI while supine, using the baseline AHI value and the portion of the night spent supine assigned previously to each subject.…”

Section: Methodssupporting

confidence: 77%

“…[13][14][17][18][19] In our study, the distribution of stage dependence was quite large and non-normally distributed (Figure 3). Some individuals had quite large REM: NREM AHI ratios: 27% of subjects had a ratio > 5.…”

Section: Sleep Stage Dependence Of Osamentioning

confidence: 96%

“…Supine versus non-supine time ratios were drawn from a normal distribution of ratios (1.13 ± 0.16), based on prior work. [13][14][15][16] The supine-dominance of AHI was taken to be 2:1. Thus, each subject had their AHI value reassigned based on position dependence imposed upon their previously assigned portion of the TST spent supine.…”

Section: Phenotypic Misclassification In a Simulated Populationmentioning

confidence: 99%

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The Impact of Body Posture and Sleep Stages on Sleep Apnea Severity in Adults

Eiseman

Westover

Ellenbogen

et al. 2012

Journal of Clinical Sleep Medicine

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Study Objectives: Determining the presence and severity of obstructive sleep apnea (OSA) is based on apnea and hypopnea event rates per hour of sleep. Making this determination presents a diagnostic challenge, given that summary metrics do not consider certain factors that infl uence severity, such as body position and the composition of sleep stages. Methods: We retrospectively analyzed 300 consecutive diagnostic PSGs performed at our center to determine the impact of body position and sleep stage on sleep apnea severity. Results:The median percent of REM sleep was 16% (reduced compared to a normal value of ~25%). The median percent supine sleep was 65%. Fewer than half of PSGs contained > 10 min in each of the 4 possible combinations of REM/NREM and supine/non-supine. Half of patients had > 2-fold worsening of the apnea-hypopnea index (AHI) in REM sleep, and 60% had > 2-fold worsening of AHI while supine. Adjusting for body position had greater impact on the AHI than adjusting for reduced REM%. Misclassifi cation-specifi cally underestimation of OSA severity-is attributed more commonly to body position (20% to 40%) than to sleep stage (~10%). Conclusions: Supine-dominance and REM-dominance commonly contribute to AHI underestimation in single-night PSGs. Misclassifi cation of OSA severity can be mitigated in a patientspecifi c manner by appropriate consideration of these vari- S C I E N T I F I C I N V E S T I G A T I O N ST he diagnosis of obstructive sleep apnea (OSA) and its severity categorization are typically based on the apneahypopnea index (AHI) obtained from a single overnight laboratory polysomnogram (PSG). Large studies have shown that OSA is associated with cerebrovascular and cardiovascular morbidity and mortality in proportion to severity.1-3 Accurate assignment of apnea severity is therefore important to establish the diagnosis and to motivate treatment decisions. In addition to patient-specifi c considerations for individual care, accurate assessment of OSA severity is important at the population level for establishing genetic, epidemiological, and medical associations with OSA. Despite the importance of accurate diagnostic assessment, obtaining this information is challenging given that sleep apnea is a complex process with multiple contributing factors, some of which vary over time. Providers may thus be left uncertain about how to interpret the presence or severity of OSA after a single night's examination of sleep.Current guidelines suggest offering treatment to patients with AHI values ≥ 5/h (with daytime symptoms or snoring), or > 15/h regardless of symptoms.4,5 The AHI does not capture other details about apnea physiology such as event duration or depth of desaturation but has been accepted as a gateway to diagnosis and treatment. One important question arises with respect to the AHI from a single night: what is the likelihood that an observed AHI value < 5/h or < 15/h would have been higher if more REM sleep or more supine sleep had occurred? A single "negative" study may not be suffi c...

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Section: Methodssupporting

confidence: 77%

Section: Sleep Stage Dependence Of Osamentioning

confidence: 96%

Section: Phenotypic Misclassification In a Simulated Populationmentioning

confidence: 99%

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The Impact of Body Posture and Sleep Stages on Sleep Apnea Severity in Adults

Eiseman

Westover

Ellenbogen

et al. 2012

Journal of Clinical Sleep Medicine

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“…Uyku sırasında üst hava yolunda gelişen tıkanıklıkların hipoksemi, hiperkapni, otonomik sinir sistemi değişiklikleri ve uykuda bölünmeye yol açması OUA patofizyolojisinde belirleyicidir (1). REM ile ilişkili OUA ise apne ve hipopnelerin REM uykusu esnasında daha yoğun olduğu bir durumdur.…”

Section: Introductionunclassified

“…BKİ ve ek hastalıklar açı-sından ise diğer çalışmalara benzer sonuçlar elde edildi. Literatüre bakıldığında REM ile ilişkili OUA prevalansı %7-36 arasında değişmektedir (1,4,14). Bizim ça-lışmamızda bulunan %59 yüksek görünebilir ancak bu oran sadece hafif OUA hastalarındaki oranı vermektedir.…”

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The frequency and properties of REM related obstructive sleep apnea among the patients with mild related obstructive sleep apnea

Özçelik

Akkoyunlu²,

Bostanlı³

et al. 2013

Tuberk Toraks

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ÖZET Hafif obstrüktif uyku apneli hastalarda REM ile ilişkili obstrüktif uyku apne sıklığı ve özellikleri GİRİŞObstrüktif uyku apne (OUA); üst hava yolunda tekrarlayan tıkanmalarla karakterize, erişkin popülasyonun %2-4'ünü etkileyen uykuyla ilişkili solunum hastalıkları-nın yaygın bir formudur. Uyku sırasında üst hava yolunda gelişen tıkanıklıkların hipoksemi, hiperkapni, otonomik sinir sistemi değişiklikleri ve uykuda bölünmeye yol açması OUA patofizyolojisinde belirleyicidir (1). REM ile ilişkili OUA ise apne ve hipopnelerin REM uykusu esnasında daha yoğun olduğu bir durumdur. REM ile ilişkili OUA prevalansının sınırlı sayıda yapılan klinik çalışma-larda tüm OUA'lı popülasyon içinde %10-36 arasında olduğu ve daha çok kadınlarda görüldüğü gösterilmiştir. Üst hava yolu tonusu non-REM uykuda azalır ve REM uykuda da azalmaya devam eder, böylece üst hava yolu rezistansında ve kollapsında artış meydana gelir. Ayrıca, uykunun REM evresinde hipoksi ve hiperkapniye meduller duyarlılık azalır ve tüm bunların sonucunda REM'de daha fazla solunumsal olayların yanında daha fazla oksijen desatürasyonu olur (2-5).REM ile ilişkili OUA, "Hafif ve orta OUA olgularında daha fazla görülmesi nedeniyle uykuda solunum bozuklukları spektrumunun erken bir işareti midir?" yoksa "Tamamen ayrı bir antite midir?"sorusu araştırmacıla-rın son zamanlarda oldukça dikkatini çekmektedir. Bu çalışmada, hafif OUA tanılı hastalar arasında REM ile ilişkili OUA hastalarının sıklığını ve diğer hafif OUA tanılı hastalardan farkını görmek; ayrıca REM ile ilişkili OUA hastalarında gündüz aşırı uykululuk ile AHİ ilişki-sini değerlendirmek amaçlanmıştır. MATERYAL ve METOD

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Does CPAP treatment lead to gastroesophageal reflux in patients with moderate and severe OSA?

Özçelik

Kayar

Danalıoğlu

et al. 2016

Eur Arch Otorhinolaryngol

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Obstructive sleep apnea (OSA) leads to upper respiratory tract obstruction, causing increased abdominal-gastric pressure and decreased lower esophageal sphincter (LES) pressure and thus gastroesophageal reflux (GER). Continuous positive airway pressure (CPAP) is known to be an effective method for OSA treatment, but its effect on GER is still controversial. There are a very few studies investigating CPAP and GER relationship and performed based on pre- and post-treatment objective parameters of GER in patients with OSA. The study investigated the effect of CPAP treatment in patients with moderate and severe OSA without GER complaints on pre- and post-treatment objective GER parameters. The study included 25 patients with respiratory disturbance indices >15 without reflux symptoms who had undergone polysomnography at sleep laboratory. Age, sex, body mass index (BMI), waist, and neck circumference of the patients were documented. DeMeester score, LES pressure, and polysomnography parameters were evaluated pre- and post-CPAP. The results were statistically evaluated, and p value <0.05 is considered significant. Out of 25 patients, 21 were male (84 %) and mean age was 49.2 ± 8.6 (range 31-66). At the pre-CPAP phase, mean sphincter pressure was 22.2 ± 1.2 (range 8-73), and mean DeMeester score was 18 ± 15.5 (range 0.2-57). At the post-CPAP, mean sphincter pressure was 22.9 ± 1.6 (range 9-95), and mean DeMeester score was 16.3 ± 14.8 (range 0.2-55). No significant difference (p > 0.05) was found comparing pre-CPAP and post-CPAP measurements. Objective criteria show that CPAP treatment does not cause reflux in patients with OSA. Unlike studies reported in the literature, this conclusion has been reached by pre- and post-CPAP assessments.

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NREM-AHI greater than REM-AHI versus REM-AHI greater than NREM-AHI in patients with obstructive sleep apnea: clinical and polysomnographic features

Cited by 40 publications

References 34 publications

The Impact of Body Posture and Sleep Stages on Sleep Apnea Severity in Adults

The Impact of Body Posture and Sleep Stages on Sleep Apnea Severity in Adults

The frequency and properties of REM related obstructive sleep apnea among the patients with mild related obstructive sleep apnea

Does CPAP treatment lead to gastroesophageal reflux in patients with moderate and severe OSA?

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