Obstructive sleep apnea during REM sleep: effects on morning and evening blood pressure

Abstract

Study Objectives Obstructive sleep apnea (OSA) is linked to the emergence and progression of cardiovascular complications including hypertension, stroke, arrhythmias, coronary artery disease and heart failure. Epidemiological studies have reported that hypertension is associated with respiratory events during REM sleep. We examined the relationship between respiratory events during REM and morning and evening hypertensive blood pressure (BP) levels in a clinical sleep population. Methods This study included data from in-laboratory diagnostic polysomnographic studies (n=797) from adults attending for investigation of OSA. Hypertensive BP levels were defined using BP measurements taken in the evening before and morning after polysomnography, and use of anti-hypertensive medication. Regression modelling was undertaken to examine the probability of evening and morning hypertensive BP levels according to REM apnea hypopnea index (AHI), NREM AHI, gender, age, body mass index (BMI), alcohol use, total sleep time (TST), sleep time SpO2 <90%, and smoking status. Results The probability of morning hypertensive BP levels was significantly independently associated with age (p<0.001), BMI (p<0.001) and REM AHI (p<0.001). No significant effect was found for male gender, NREM AHI, alcohol use, TST, sleep time SpO2 <90%, or smoking (p>0.05 for all). The probability of evening hypertensive BP levels was only significantly associated with age (p<0.001), male gender (p = 0.012), BMI (p<0.001) and TST (p= 0.032). Conclusions Respiratory events during REM sleep are significantly associated with morning hypertensive BP levels. Future research is needed to determine whether treatment of these events can prevent or reverse morning hypertensive BP levels.

Sleep status of older adults with sleep apnoea syndrome may vary by body mass index

“…Overall, the AHI tended to increase with increasing BMI in all states of sleep, with REM sleep and sleeping in the supine position showing the highest correlation with BMI; these findings are consistent with those of other studies ( Oksenberg et al, 2010 ; Koo et al, 2018 ; Park et al, 2022 ). In addition, the REM-AHI was found to be the most strongly positively correlated with BMI, which was similar to findings reported in other studies ( Acosta-Castro et al, 2018 ; Falla et al, 2023 ). In contrast, the current study showed that patients with SAS who have high BMI tend to have shallow sleep without awakenings and that the sleep of patients with SAS who have low BMI tends to be fragmented with awakenings, although deep sleep is achieved.…”

Impact of sleep chronotype on in‐laboratory polysomnography parameters

“…As a result, REM rebound may be detected on a multiple sleep latency test conducted the day after an iPSG with short sleep duration (Endo et al, 1998); however, this would likely be insufficient to cause two sleep onset REM periods. Additionally, the likelihood of detecting respiratory events may be reduced since they occur most frequently during REM sleep (Aurora et al, 2018; Falla et al, 2022; Mokhlesi et al, 2014). Similarly, the chance of detecting RBD in evening type patients may also be decreased since lowered REM sleep would provide a shorter time frame to display dream enactment behaviour (St Louis & Boeve, 2017).…”

REM sleep obstructive sleep apnoea

“…Associations between REM OSA and hypertension have also been demonstrated in patient populations. One study assessed REM AHI and morning versus evening BP levels in a patient sample [ 88 ]. The probability of morning hypertensive BP levels was significantly and independently associated with age, BMI and REM AHI, but not NREM AHI.…”