The association between obstructive sleep apnea during REM sleep and autonomic dysfunction as measured by heart rate variability

  • Seong Min Oh
  • Sang Ho Choi
  • Hyun Jik Kim
  • Kwang Suk Park
  • Yu Jin LeeEmail author
Sleep Breathing Physiology and Disorders • Original Article



To determine the effect of obstructive sleep apnea (OSA) during rapid eye movement (REM) sleep on autonomic dysfunction using heart rate variability (HRV) analysis.


The medical records of adults who underwent nocturnal polysomnography at the Sleep and Chronobiology Center at Seoul National University Hospital were retrospectively reviewed. HRV parameters (mean RR interval, the standard deviation of all normal RR intervals [SDNN], square root of the mean squared differences of adjacent RR intervals [RMSSD], normalized low frequency [LF], normalized high frequency [HF], and the ratio of LF to HF [LF/HF]) were measured in 5-min electrocardiogram recordings obtained during W, N2, and R sleep stages. Comparisons were made among the control (apnea–hypopnea index (AHI < 15 and AHI during REM sleep (AHIREM) < 15, n = 27), REM-associated OSA (AHI < 15 and AHIREM ≥ 15, n = 27), and OSA (AHI ≥ 15, n = 27) groups. The groups were matched for age, sex, and body mass index.


No significant differences were observed between the control and the REM-associated OSA groups for any of the HRV parameters. In contrast, compared with controls, the OSA group showed significantly lower normalized HF (p = 0.031) and higher LF/HF (p = 0.018) in stage W and a significantly shorter mean RR interval (p = 0.046) and lower RMSSD (p = 0.034) in stage N2.


Our findings suggest that OSA during REM sleep is not a major contributor to autonomic dysfunction.


Sleep, REM Sleep apnea, obstructive Heart rate variability Autonomic nervous system 


Compliance with ethical standards

Ethical approval

All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Conflict of interest

All authors declare that they have no conflict of interest.

Informed consent

The Institutional Review Board of Seoul National University Hospital approved this retrospective study (IRB number 1708-081-877) and waived the requirement for informed consent.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Psychiatry and Center for Sleep and ChronobiologySeoul National University HospitalSeoulRepublic of Korea
  2. 2.Interdisciplinary Program in BioengineeringSeoul National UniversitySeoulRepublic of Korea
  3. 3.Department of OtorhinolaryngologySeoul National University College of MedicineSeoulRepublic of Korea
  4. 4.Department of Biomedical Engineering, College of MedicineSeoul National UniversitySeoulRepublic of Korea

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