REM-predominant Obstructive Sleep Apnea: an Unmet Clinical Need

Overview

Journal Sleep Breath

Publisher Springer

Date 2025 Feb 11

PMID 39934482

Authors

Shauni Wellekens

Eef Vanderhelst

Sylvia Verbanck

Sonia De Weerdt

Affiliations

Soon will be listed here.

Abstract

Purpose: Obstructive sleep apnea (OSA) and rapid eye movement (REM) sleep fragmentation are associated with increased fatigue, sleepiness, anxiety and depressive symptoms. However, the clinical significance of REM-predominant OSA (REM-OSA) remains less clear.

Aim: To determine any differences in symptom-burden between REM-OSA and non-REM (NREM) OSA.

Methods: Patients diagnosed with OSA at a University Hospital in Brussels between 25-11-2019 and 19-09-2020 were eligible. REM-OSA was defined as an apnea hypopnea index REM/NREM ratio of at least 2 with a minimum REM-time of 30 min. Severe OSA was excluded due to the expectedly lower prevalence of REM-OSA in this group. All patients completed the Hospital Anxiety and Depression Scale, Big Five Inventory-2, DS-14 questionnaire, SF-36 Health Survey Questionnaire, Pittsburgh Sleep Quality Index, Insomnia Severity Index, Fatigue Assessment Scale, Checklist Individual Strength, Epworth Sleepiness Scale and Stanford Sleepiness Scale at diagnosis.

Results: 209 patients with REM-OSA (112 mild and 97 moderate) and 132 with NREM-OSA (48 mild and 84 moderate) were included. Patients with mild REM-OSA were twice as likely to have a SSS score of 3 or more (defined as excessive daytime sleepiness) compared to NREM-OSA (odds ratio 2.1591, p-value 0.0359). There was no significant difference in anxiety, depression, personality traits, fatigue or sleep quality.

Conclusion: For mild OSA, a predominance of obstructive respiratory events during the REM phase results in a greater impact on excessive daytime sleepiness. To address this symptom, a lower treatment threshold to include symptomatic mild REM-OSA patients may be warranted.

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