obstructive sleep apnea (osa) is a common disorder in the general population and may present multiple clinical manifestations that include disrupted sleep. the behavior manisfestation is variable, ranging from talking, singing, to complex episodes of vigorous movements that are related to unpleasant and combative dreams that can be potentially harmful to patient and bedfellow(1,2). given the fact that osa is extremely common in the general population, it is therefore possible that several patients with clinical manifestations of rdb may in reality present osa and therefore should be classified as pseudo-rdb. in addition, we included 2 more articles that were not found in the search(9,10), but were quoted by all the selected articles figure 1. a summary of articles with rbd and osa evaluated with year and journal of publication, study design, number and characteristics of the patients and conclusions are described in table 1. the reports consisted mainly of case reports or case series. it has been reported that osa induced arousals detected in nrem and rem sleep or only in the rem sleep, with dream-related complex and violent behaviors occurred just at the end of obstructive sleep apneic events(8).
one study aimed to distinguish patients with the independent association of idiopathic rbd and osa (that can be present in the same patient) vs. patients with moderate to severe osa with pseudo rbd(13). clonazepam is the treatment of choice for rbd and may worsen coexisting osa(8) or may induce osa in some predisposed patients(14). rem sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in sleep. recent advances of the impact of obstructive sleep apnea on systemic hypertension. behaviors simulating rem behavior disorder in patients with severe obstructive sleep apnea. amelioration of obstructive sleep apnea in rem sleep behavior disorder: implications for the neuromuscular control of osa.
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 ( and ), respectively, duration of saturation below 90% ( for both), and saturation nadir ( and ), respectively. in this study, we aim to evaluate the differences of 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. the apnea-hypopnea index (ahi) was calculated as the total number of apneas and hypopneas per hour of total sleep time. all patients who were classified as having rem-related osa were included in the broad definition of rem-related osa.
upon comparing the severity of osa between the broad, strict, and those satisfying the broad but not the strict, significant differences were found between rem‐related osa and nrem‐related osa, as shown in table 3. for patients with rem-related osa according to the broad definition, the mean age was 52.2 years (±13.5). in our study, we investigated the effect of using broad and strict definitions of rem-related osa on saturation nadir and duration of saturation below 90%, and we showed that the broad definition of rem-related osa is associated with a higher mean difference in oxygen saturation nadir and a lower duration of saturation below 90% compared to nrem-related osa. in this study, we found significant differences between both nrem-related osa and rem-related osa according to the broad and rem-related osa according to the strict definitions for arousal index, duration of saturation below 90%, and saturation nadir, where rem-related osa patients had milder findings. article of the year award: outstanding research contributions of 2021, as selected by our chief editors.
although sleep apnea is often more pronounced during rapid eye movement (rem) sleep, the term “rem-related” sleep apnea has been used to label sleep-disordered moderate-to-severe rem related sleep-disordered breathing (rem-sdb) was significantly associated with metabolic syndrome and diabetes. diabetes, hypertension among those phenotypes, rem-related osa has been reported to account for 10–36% of patients with osa in sleep clinic cohorts (5), especially in patients, rem sleep apnea complications, rem sleep apnea complications, rem-related sleep apnea treatment, mild sleep apnea but severe in rem, why is sleep apnea worse in rem.
the term u201crem-relatedu201d osa has been coined to denote the occurrence of disordered breathing events that predominantly or exclusively manifest during rem sleepu2014an observation that is common in clinical practice and well recognized by healthcare professionals in sleep medicine. severe obstructive sleep apnea (osa) that occurs exclusively during rem sleep is associated with recurrent cardiovascular events in those despite two times lower ahi, patients with rem-osa present with similar day-time sleepiness as those with rem independent osa. daily sleepiness obstructive sleep apnea (osa) during rapid eye movement (rem) stage of sleep is gaining importance in recent years. this study was done to determine the, rem ahi vs ahi, rem sleep apnea symptoms.
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