Dreams and Nightmares in Patients With Obstructive Sleep Apnea: A Review.

Ahmed S Bahammam,Aljohara S Almeneessier

doi:10.3389/fneur.2019.01127

Abstract

Obstructive sleep apnea (OSA) can present with or provoke various psychological symptoms. In this article, we critically review studies that have examined dreams, dream recall, and dream content in patients with OSA. Obstructive events induce recurrent sleep fragmentation and intermittent desaturations in patients with OSA, which may trigger different parasomnias, including nightmares. Contradictory results have been reported concerning dreams in patients with OSA; while some investigators have reported less dreams in OSA patients, others have described that patients with OSA have increased dreams with emotional content, mainly violent and hostile content. Although there are reports of respiratory-related dream content in patients with OSA, most studies that have assessed the dream content of patients with OSA revealed that respiratory-related dream content was unusual. A clear association between post-traumatic stress disorders, comorbid OSA, and nightmares has been reported in several studies. Furthermore, an improvement in nightmare frequency with continuous positive airway pressure (CPAP) treatment has been shown. An inverse relationship between the severity of OSA reflected by the apnea-hypopnea index and dream recall has been demonstrated in several studies. Future studies should differentiate between patients with non-stage specific OSA and patients with rapid eye movement (REM) predominant OSA.

Highlights

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder (SRBD)
Despite an increase in rapid eye movement (REM) density, dream recall decreased the first months of continuous positive airway pressure (CPAP) and recovered 2 years later
Dream recall decreased with CPAP therapy and with normalization of sleep in OSA patients More patients recalled their dreams under CPAP than without CPAP Heightened dream recall frequency in patients compared to controls Both apnea hypopnea index (AHI) and arousal index were significantly higher for the grouping reporting infrequent nightmare recall

Summary

INTRODUCTION

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder (SRBD). Among the middle-aged population, the prevalence of OSA syndrome ranges from 3 to 18% in men and from 2 to 17% in women. One more study in patients with severe OSA reported that despite an increase in REM density after CPAP therapy, dream recall diminished after CPAP initiation both acutely and after 3 months [15]. This finding was independent of REM density and the amount of REM sleep. Possible explanations for the decreased recall of dreams in some patients with OSA include the possibility that time spent awake after respiratory event-induced arousals is too short to allow dream recall [27] Another possibility is that cognitive deficits in patients with OSA may offset the proposed effects of TABLE 1 | A summary of studies that assessed dream recall in patients with sleep-disordered breathing

Conclusions

Findings

CONCLUSION