Prevalence and Clinical Features of Rapid Eye Movement-related Obstructive Sleep Apnea: A Cross-sectional Analysis of Clinical Population from South India
Keywords :
Gender, Obstructive sleep apnea, Rapid eye movement
Citation Information :
Haridas N, Sudhakar N, Ashok A, Kunoor A, Bhaskaran R. Prevalence and Clinical Features of Rapid Eye Movement-related Obstructive Sleep Apnea: A Cross-sectional Analysis of Clinical Population from South India. Indian Sleep Med 2023; 18 (1):11-14.
Introduction: Rapid eye movement (REM)-related obstructive sleep apnea (OSA) is a condition where apneas and hypopneas occur predominately during REM sleep. There is limited data on the prevalence of REM-related breathing disorders in the Indian population. Aim of the study: To estimate the prevalence of REM-related OSA in a clinic-based population in South India. Methodology: This cross-sectional observational study was done in a tertiary care center in South India from January 2017 to December 2019. Consecutive adult patients who underwent level-I polysomnography were enrolled. Apnea–Hypopnea Index (AHI) was computed as the total number of apneas and hypopneas per hour of total sleep time. Sleep-state-dependent indices were also determined by dividing the number of events in nonrapid eye movement (NREM) and REM sleep by the amount of NREM and REM time, respectively. Patients with an AHI greater than five were diagnosed with OSA and included in this study. Rapid eye movement-related obstructive sleep apnea was defined as overall AHI ≥5 and AHI REM/AHI NREM ≥2. Nonrapid eye movement-related OSA was defined as overall AHI ≥5 and AHI REM/AHI NREM ≥2. Statistical analysis was performed using IBM SPSS version 21.0. Results: One hundred ninety-nine patients diagnosed with OSA were included in the study. Rapid eye movement OSA has a prevalence of 24.12% in this population. Age >50 years and female sex were the factors associated with REM-predominant OSA, while T88% >20% was associated with NREM OSA. Conclusion: Rapid eye movement-related OSA is prevalent in South Indian patients referred for evaluation of sleepiness.
Conwell W, Patel B, Doeing D, et al. Prevalence, clinical features, and CPAP adherence in REM-related sleep-disordered breathing: A cross-sectional analysis of a large clinical population. Sleep Breath 2012;16(2):519–526. DOI: 10.1007/s11325-011-0537-6.
Grace KP, Hughes SW, Horner RL. Identification of the mechanism mediating genioglossus muscle suppression in REM sleep. Am J Respir Crit Care Med 2013;187(3):311–319. DOI: 10.1164/rccm.201209-1654OC.
Acosta-Castro P, Hirotsu C, Marti-Soler H, et al. REM-associated sleep apnoea: prevalence and clinical significance in the HypnoLaus cohort. Eur Respir J 2018;52(2):170248. DOI: 10.1183/13993003.02484-2017.
Berry RB, Brooks R, Gamaldo C, et al. AASM scoring manual updates for 2017 (version 2.4). J Clin Sleep Med 2017;13(5):665–666. DOI: 10.5664/jcsm.6576.
Sharma SK, Kumpawat S, Banga A, et al. Prevalence and risk factors of obstructive sleep apnoea syndrome in a population of Delhi, India. Chest 2006;130(1):149–156. DOI: 10.1378/chest.130.1.149.
Reddy EV, Kadhivaran T, Mishra HK, et al. Prevalence and risk factors of obstructive sleep apnoea among middle-aged urban Indians: A community-based study. Sleep Med 2009;10(8):913–918. DOI: 10.1016/j.sleep.2008.08.011.
Vijayan VK, Patial K. Prevalence of obstructive sleep apnoea syndrome in Delhi, India. Chest 2006;130(4):92S. DOI: 10.1378/chest.130.4_MeetingAbstracts.92S-c.
Udwadia ZF, Doshi AV, Onkar SG, et al. Prevalence of sleep-disordered breathing and sleep apnoea in middle-aged urban Indian men. Am J Respir Crit Care Med 2004;169(2):168–173. DOI: 10.1164/rccm.200302-265OC.
Koo BB, Dostal J, Ioachimescu O, et al. The effects of gender and age on REM-related sleep-disordered breathing. Sleep Breath 2008;12(3):259–264. DOI: 10.1007/s11325-007-0161-7.
Koo BB, Patel SR, Strohl K, et al. Rapid eye movement-related sleep-disordered breathing: Influence of age and gender. Chest 2008;134(6):1156–1161. DOI: 10.1378/chest.08-1311.
Resta O, Carpanano GE, Lacedonia D, et al. Gender difference in sleep profile of severely obese patients with obstructive sleep apnea (OSA). Respir Med 2005;99(1):91–96. DOI: 10.1016/j.rmed.2004.05.014.
Nair SC, Arjun P, Azeez AK, et al. Proportion of rapid eye movement sleep-related obstructive sleep apnea (REM-related OSA) in patients with sleep-disordered breathing: A cross-sectional study. Lung India 2022;39(1):38–43. DOI: 10.4103/lungindia.lungindia_64_21.
Al Oweidat K, AlRyalat SA, Al-Essa M, et al. Comparing REM- and NREM-related obstructive sleep apnea in Jordan: A cross-sectional study. Can Respir J 2018;2018:9270329. DOI: 10.1155/2018/9270329.
Gabryelska A, Białasiewicz P. Association between excessive daytime sleepiness, REM phenotype and severity of obstructive sleep apnea. Sci Rep 2020;10(1):34. DOI: 10.1038/s41598-019-56478-9.
Nishio Y, Hoshino T, Murotani K, et al. Treatment outcome of oral appliance in patients with REM-related obstructive sleep apnea. Sleep Breath 2020;24(4):1339–1347. DOI: 10.1007/s11325-019-01966-5.
Muraki M, Kitaguchi S, Ichihashi H, et al. Apnoea–hypopnoea index during rapid eye movement and non-rapid eye movement sleep in obstructive sleep apnoea. J Int Med Res 2008;36(5):906–913. DOI: 10.1177/147323000803600506.
Su CS, Liu KT, Panjapornpon K, et al. Functional outcomes in patients with rem-related obstructive sleep apnea treated with positive airway pressure therapy. J Clin Sleep Med 2012;8(3):243–247. DOI: 10.5664/jcsm.1902.
