Abstract
Obstructive sleep apnea (OSA) is a common disorder that includes an intermittent mechanical obstruction of the upper airway during sleep, which can occur either during rapid eye movement (REM) phase or non-REM (NREM) phase. In this study, we aim to evaluate the differences in demographic and polysomnographic features between REM- and NREM-related OSA in a Jordanian sample, using both the broad and the restricted definitions of REM-related OSA. All patients who were referred due to clinical suspicion of OSA and underwent sleep study were screened. We included patients with a diagnosis of OSA who had Apnea-Hypopnea Index (AHI) greater than or equal to five. We classified patients into REM-related OSA according to either the broad definition (AHIREM/AHINREM ≥ 2) or the strict definition (AHIREM > 5 and AHINREM < 5 with a total REM sleep duration of at least 30 minutes), and patients with AHIREM/AHINREM less than two were classified as NREM-related OSA. A total of 478 patients were included in this study with a mean age of 55.3 years (±12.6). According to the broad definition of REM-related OSA, 86 (18%) of OSA patients were classified as having REM-related OSA compared to only 13 (2.7%) patients according to the strict definition. Significant differences were found between both NREM-related OSA and REM-related OSA according to the broad and to the strict definitions for arousal index (p < 0.001 and p < 0.032), respectively, duration of saturation below 90% (p < 0.001 for both), and saturation nadir (p < 0.036 and p < 0.013), respectively. No significant differences were found between this group and other OSA patients regarding age, BMI, ESS, and snoring. Our study showed that the stricter the definition for REM-related OSA, the milder the associated clinical changes.
Highlights
Sleep disordered breathing (SDB) spans a spectrum of disorders that includes obstructive sleep apnea (OSA), which implies an intermittent mechanical obstruction of the upper airway during sleep, leading to reduced airflow to the lungs [1]
According to the broad definition of rapid eye movement (REM)-related Obstructive sleep apnea (OSA), 86 (18%) of OSA patients were classified as having REMrelated OSA compared to only 13 (2.7%) patients according to the strict definition
All patients who were classified as having REM-related OSA were included in the broad definition of REM-related OSA. 73 (15.3%) patients were REMrelated OSA included in the broader, but not in the strict definition
Summary
Sleep disordered breathing (SDB) spans a spectrum of disorders that includes obstructive sleep apnea (OSA), which implies an intermittent mechanical obstruction of the upper airway during sleep, leading to reduced airflow to the lungs [1]. Obstructive sleep apnea (OSA) is a common disorder affecting between 6% and 13% of the industrialized world [2, 3]. Fatigue, snoring, early morning headache, and witnessed apnea are the most common presenting symptoms [4, 5]. Among the risk factors for OSA, obesity is the most important [6], as OSA is present in 40% of obese individuals and 70% of OSA patients are obese [7]. In patients with SDB, OSA events may occur throughout nonrapid eye movement (NREM) and rapid eye movement (REM) sleep. In REM sleep, hypotonia of upper airway muscles increases the risk for upper airway obstruction [8]
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