Abstract
This study aimed to investigate the clinical characteristics and predictors of increased rapid eye movement (REM) sleep or slow wave sleep (SWS) in patients with obstructive sleep apnea (OSA) following positive airway pressure (PAP) therapy. The study retrospectively analyzed data from patients with OSA who underwent both diagnostic polysomnography (PSG) and pressure titration PSG at the Tangdu Hospital Sleep Medicine Center from 2011–2016. Paired diagnostic PSG and pressure titration studies from 501 patients were included. REM rebound was predicted by a higher oxygen desaturation index, lower REM proportion, higher arousal index, lower mean pulse oxygen saturation (SpO2), higher Epworth sleepiness score and younger age (adjusted R2 = 0.482). The SWS rebound was predicted by a longer total duration of apneas and hypopneas, lower N3 duration, lower SpO2 nadir, lower REM proportion in diagnostic PSG and younger age (adjusted R2 = 0.286). Patients without REM rebound or SWS rebound had a high probability of comorbidities with insomnia and mood complaints. Some parameters (subjective and objective insomnia, excessive daytime sleepiness, age and OSA severity) indicate changes in REM sleep and SWS between diagnostic and titration PSG tests. Treatment of insomnia and mood disorders in patients with OSA may helpful to improve the use PAP.
Highlights
This study aimed to investigate the clinical characteristics and predictors of increased rapid eye movement (REM) sleep or slow wave sleep (SWS) in patients with obstructive sleep apnea (OSA) following positive airway pressure (PAP) therapy
The combination of at least a 6% increase in %REM and 16% REM sleep during the pressure titration study reflected a significant REM rebound
REM rebound was predicted by a higher oxygen desaturation index (ODI), lower %REM, higher arousal index and lower baseline SpO2 in the diagnostic PSG, higher Epworth Sleepiness Scale (ESS), and younger age
Summary
This study aimed to investigate the clinical characteristics and predictors of increased rapid eye movement (REM) sleep or slow wave sleep (SWS) in patients with obstructive sleep apnea (OSA) following positive airway pressure (PAP) therapy. Insomnia, anxiety, and depression are common comorbidities of O SA12–15 that may lead to changes in sleep architecture, such as a long sleep latency, long WASO, increased N1 and N2 sleep stages, decreased SWS, and decreased or variable REM s leep[16,17]. PAP therapy only reduces respiratory events by providing positive airway pressure, reducing the awakening caused by respiratory events and promoting the recovery of sleep architecture, but has no immediate therapeutic effect on insomnia, anxiety, and depression.
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