further research is needed to establish the duration of cpap needed to effectively treat rem osa and to evaluate patients with rem osa with an overall normal apnea-hypopnea index (ahi). our knowledge of the prevalence and clinical implications of rem osa has increased in recent years. the prevalence of osa during rem sleep is also similarly high in community-based cohorts. however, a recent report from an extended follow-up of the wisconsin sleep cohort demonstrated that rem osa is independently associated with prevalent hypertension in cross-sectional analysis and with incident hypertension in longitudinal analysis.
in contrast, and similar to the wisconsin sleep cohort analysis, nrem ahi was not associated with hypertension after adjusting for rem ahi. the mean glucose level was 38% higher during rem sleep in those with osa . these findings were confirmed in the human in a recent study where 18 subjects with severe osa on chronic cpap therapy underwent 1-night of cpap withdrawal only during rem sleep (i.e. in another randomized controlled trial of patients with osa and resistant hypertension, there was a significant positive correlation between hours of cpap use and the decrease in 24-hour mean bp . further research is needed to address treatment of patients with rem osa who have an overall normal ahi.
it is now well established that compared to nrem sleep, rem sleep is associated with greater sympathetic activity and cardiovascular instability in healthy human subjects and patients with osa.13,14 the hemodynamic and sympathetic changes during rem sleep cause a surge in the blood pressure and heart rate. in a retrospective observational study the authors evaluated a cohort of patients with rem-related osa and compared them to non-stage specific osa.
therefore, given the criteria used to define rem-related osa in this study, it remains an open question whether cpap therapy leads to any measurable benefit in patients with osa that is almost exclusively limited to rem sleep. it is important to elucidate whether patients with rem-related osa use cpap in the early morning hours when rem sleep is most prevalent. have just provided incremental evidence warranting such studies in the near future.
osa during rem sleep is a condition where hypopneas and apneas occur primarily during rem sleep. the clinical significance of rem osa the term rem-related obstructive sleep apnea (osa) is used loosely by sleep clinicians when the polysomnogram (psg) reveals obstructive deep sleep is highly refreshing, but sleep apnea can prevent you from getting it. there are three non-rem stages and one rem stage of sleep., .
although sleep apnea is often more pronounced during rapid eye movement (rem) sleep, the term u201crem-relatedu201d sleep apnea has been used to label sleep-disordered breathing, which is either significantly worse or exclusively present during rem sleep. 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 with recently, osa during rem-sleep has been suggested to have more severe adverse effects on the cardiovascular system than osa during nonrem-sleep, but the nocturnal respiratory events are usually more frequent and of longer duration in rem sleep compared with non-rem (nrem) sleep, probably due to greater, .
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