Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Rapid Eye Movement-Related Obstructive Sleep Apnea: A Study on the Pathogenesis through Clinical and Polysomnographic Features

  • Jang, Ji Hee (Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University) ;
  • Chung, Jin Woo (Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University)
  • Received : 2016.12.01
  • Accepted : 2016.12.12
  • Published : 2016.12.30
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Abstract

Purpose: The aims of this study were to evaluate the differences of clinical and polysomnographic features between rapid eye movement (REM)-related obstructive sleep apnea (OSA) and not-REM-related OSA, and to suggest the pathogenesis according to the REM dependency of OSA. Methods: One hundred ninety consecutive patients diagnosed with OSA were evaluated clinical features and performed full night polysomnography. The patients were divided into REM-related (REM apnea-hypopnea index [AHI] at least two times higher than their non-REM AHI) and not-REM-related (a REM AHI less than two times higher than their non-REM AHI) OSA groups and evaluated the differences in age, body mass index (BMI), neck circumference, Ep-worth Sleepiness Scale score, and parameters of polysomnography. Results: REM-related patients were younger and showed higher sleep efficacy, low percentage of light sleep stage (stage 1 sleep), and low rate of positional OSA. Age was significantly associated with REM dependency of OSA and REM AHI were significant correlated with BMI, neck circumference, percentage of sleep in supine position, and percentage time of snoring. Conclusions: Our results showed that REM-related OSA patients showed less severe polysomnographic parameters than not-REM-related patients. However, significant risk factors were differed depending on the REM dependency and OSA severity, and the clinical features correlated with REM AHI and non-REM AHI were also showed differently. We suggest that the occurrence of OSA according to the REM dependency can be based on different mechanisms.

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References

  1. American Academy of Sleep Medicine. The international classification of sleep disorders, revised: diagnostic and coding manual. 2nd ed. Westchester (IL): American Academy of Sleep Medicine; 2005.
  2. Pack AI. Advances in sleep-disordered breathing. Am J Respir Crit Care Med 2006;173:7-15. https://doi.org/10.1164/rccm.200509-1478OE
  3. Grace KP, Hughes SW, Horner RL. Identification of the mechanism mediating genioglossus muscle suppression in REM sleep. Am J Respir Crit Care Med 2013;187:311-319. https://doi.org/10.1164/rccm.201209-1654OC
  4. Ayas NT, Owens RL, Kheirandish-Gozal L. Update in sleep medicine 2014. Am J Respir Crit Care Med 2015;192:415-420. https://doi.org/10.1164/rccm.201503-0647UP
  5. Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 2012;8:597-619.
  6. Cartwright RD. Effect of sleep position on sleep apnea severity. Sleep 1984;7:110-114. https://doi.org/10.1093/sleep/7.2.110
  7. Koo BB, Dostal J, Ioachimescu O, Budur K. The effects of gender and age on REM-related sleep-disordered breathing. Sleep Breath 2008;12:259-264. https://doi.org/10.1007/s11325-007-0161-7
  8. O'Connor C, Thornley KS, Hanly PJ. Gender differences in the polysomnographic features of obstructive sleep apnea. Am J Respir Crit Care Med 2000;161:1465-1472. https://doi.org/10.1164/ajrccm.161.5.9904121
  9. Moon HJ, Lim SH, Kim DH, Kim DE, Hwang SH, Cho YW. Clinical characteristics of REM-dependent obstructive sleep apnea in Korean adults. J Korean Neurol Assoc 2016;34:124-129. https://doi.org/10.17340/jkna.2016.2.6
  10. Haba-Rubio J, Janssens JP, Rochat T, Sforza E. Rapid eye movement-related disordered breathing: clinical and polysomnographic features. Chest 2005;128:3350-3357. https://doi.org/10.1378/chest.128.5.3350
  11. Wellman A, Eckert DJ, Jordan AS, et al. A method for measuring and modeling the physiological traits causing obstructive sleep apnea. J Appl Physiol (1985) 2011;110:1627-1637. https://doi.org/10.1152/japplphysiol.00972.2010
  12. Wellman A, Edwards BA, Sands SA, et al. A simplified method for determining phenotypic traits in patients with obstructive sleep apnea. J Appl Physiol (1985) 2013;114:911-922. https://doi.org/10.1152/japplphysiol.00747.2012
  13. Eckert DJ, Younes MK. Arousal from sleep: implications for obstructive sleep apnea pathogenesis and treatment. J Appl Physiol (1985) 2014;116:302-313. https://doi.org/10.1152/japplphysiol.00649.2013
  14. Yamauchi M, Fujita Y, Kumamoto M, et al. Nonrapid eye movement-predominant obstructive sleep apnea: detection and mechanism. J Clin Sleep Med 2015;11:987-993.
  15. Campos-Rodriguez F, Fernandez-Palacin A, Reyes-Nunez N, Reina-Gonzalez A. Clinical and polysomnographic features of rapid-eye-movement-specific sleep-disordered breathing. Arch Bronconeumol 2009;45:330-334.
  16. Sakao S, Sakurai T, Yahaba M, et al. Features of REM-related sleep disordered breathing in the Japanese population. Intern Med 2015;54:1481-1487. https://doi.org/10.2169/internalmedicine.54.4248
  17. Oh JT, Jang JF, Chung JW. Treatment outcomes of mandibular advancement devices between rapid-eye-movement (REM)-related and not-REM-related OSA patients. J Oral Med Pain 2016;41:54-60. https://doi.org/10.14476/jomp.2016.41.2.54