Abstract
Rapid eye movement (REM)-related obstructive sleep apnea (OSA), a polysomnographic phenotype that affects 12–36% of OSA patients, is defined by apnea and hypopnea events that predominantly or exclusively occur during REM sleep. Recent studies indicated that REM-related OSA was associated with the development of nocturnal non-dipping of systolic and diastolic blood pressure, metabolic syndrome, diabetes, and depressive symptoms. However, to date, the association between REM-related OSA and insomnia still remains unclear. We investigated whether there was a difference between REM- and non-REM-related OSA in terms of insomnia-related sleep disturbance as measured by the Pittsburgh Sleep Quality Index (PSQI) in 1736 patients with OSA. REM-related OSA showed a significant association with increased PSQI in all adjusted models. In the subgroup analysis, the coefficients of all models were higher in female than in male patients with REM-related OSA. Insomnia should be considered an important complaint in patients with REM-related OSA, and its indicators, such as the PSQI, should be included in routine diagnostic testing.
Highlights
Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repetitive respiratory events, including apnea and hypopnea, due to total or partial upper airway obstruction
In a previous study of 3234 OSA patients examined at our institution between 2004 and 2013, we found that the main symptom of Rapid eye movement (REM)-related OSA was not excessive daytime sleepiness [2]
We found no direct association between REM-related OSA and insomnia, our results were consistent with these previous reports
Summary
Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repetitive respiratory events, including apnea and hypopnea, due to total or partial upper airway obstruction. The exact pathophysiology of REM-related OSA remains unclear to date, and its overall severity as defined by the apnea–hypopnea index (AHI) tends to be mild to moderate. It should be distinguished from non (N)-REM-related OSA because recent studies have indicated that REM-related OSA is associated with the development of nocturnal non-dipping of systolic and diastolic blood pressure, metabolic syndrome, and diabetes [4,5]. Other studies have indicated that REM-related OSA is more common in females, those presenting with depressive symptoms [6,7]
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