Nocturnal Blood Pressure Fluctuations in Patients with Rapid Eye Movement-Related Obstructive Sleep Apnea.

Hajime Kumagai,Kengo Kawaguchi,Yuka Kiyohara,Yoko Haseda,Tetsuro Hoshino,Ryujiro Sasanabe,Toshiaki Shiomi,Noriyuki Konishi,Hiroko Tsuda,Hiroyuki Sawatari

doi:10.3390/jcm10215023

Hajime Kumagai, Kengo Kawaguchi + Show 8 more

Open Access

https://doi.org/10.3390/jcm10215023

Copy DOI

Abstract

Rapid eye movement-related obstructive sleep apnea (REM-related OSA) is a polysomnographic phenotype. Nocturnal blood pressure (BP) fluctuations remain unclear in patients with REM-related OSA. We studied 27 patients with REM-related OSA, categorized as having REM-apnea-hypopnea index (REM-AHI) ≥ 5/h, REM-AHI/non-REM-AHI ≥ 2, and non-REM-AHI < 15/h. Beat-to-beat systolic BP (SBP) variability and nocturnal SBP fluctuation patterns using pulse transit time (PTT) were investigated. The maximum increase and average nocturnal SBP were significantly higher in males than in females (p = 0.003 and p = 0.008, respectively). The rate of non-dipping patterns in nocturnal SBP fluctuations was 63% in all patients (males, 70%; females, 50%). Epworth Sleepiness Scale (ESS) and Self-rating Depression Scale (SDS) scores in females were higher than those in males (8.4 ± 6.1 vs. 13.4 ± 5.4 points, p = 0.04; 43.8 ± 7.9 vs. 52 ± 11.6 points, p = 0.04, respectively). A high proportion of patients with REM-related OSA had a non-dipping pattern. Using PPT, we observed that in patients with REM-related OSA, SBP variability was greater in males. Despite clinical symptoms being slightly more severe in females, nocturnal SBP fluctuations should be considered in male patients with REM-related OSA.

Highlights

Rapid eye movement-related obstructive sleep apnea (REM-related OSA) is a polysomnographic phenotype in OSA that predominantly or exclusively occurs during rapid eye movement (REM) sleep
All patients with REMrelated OSA slept in a REM sleep for ≥30 min
Regarding patients with REM-related OSA, the mean age and body mass index (BMI) were 46.0 years and 24.4 kg/m2 respectively, and there were no significant differences in age and BMI between males and females

Summary

Introduction

Rapid eye movement-related obstructive sleep apnea (REM-related OSA) is a polysomnographic phenotype in OSA that predominantly or exclusively occurs during rapid eye movement (REM) sleep. REM-related OSA has been observed in approximately 10%. To 37% of patients with OSA, and REM-related OSA is common in females and young individuals [1,2,3,4,5]. Patients with OSA have more frequent respiratory events, and their cardiovascular system is likely to be unstable due to respiratory events during REM sleep [6]. It has been reported that, after only two weeks, apnea during REM sleep resulted in an increase in blood pressure (BP). Sympathetic nerve activity significantly increases during REM sleep [6]. In patients with OSA, sympathetic nerve activity is high during both awake and sleep periods [6,10]

Methods

Results

Discussion

Conclusion