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REM obstructive sleep apnea: risk for adverse health outcomes and novel treatments

  • Sleep Breathing Physiology and Disorders • Review
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Abstract

Rapid eye movement (REM) sleep was discovered nearly 60 years ago. This stage of sleep accounts for approximately a quarter of total sleep time in healthy adults, and it is mostly concentrated in the second half of the sleep period. The majority of research on REM sleep has focused on neurocognition. More recently, however, there has been a growing interest in understanding whether obstructive sleep apnea (OSA) during the two main stages of sleep (REM and non-REM sleep) leads to different cardiometabolic and neurocognitive risk. In this review, we discuss the growing evidence indicating that OSA during REM sleep is a prevalent disorder that is independently associated with adverse cardiovascular, metabolic, and neurocognitive outcomes. From a therapeutic standpoint, we discuss limitations of continuous positive airway pressure (CPAP) therapy given that 3 or 4 h of CPAP use from the beginning of the sleep period would leave 75% or 60% of obstructive events during REM sleep untreated. We also review potential pharmacologic approaches to treating OSA during REM sleep. Undoubtedly, further research is needed to establish best treatment strategies in order to effectively treat REM OSA. Moreover, it is critical to understand whether treatment of REM OSA will translate into better patient outcomes.

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Abbreviations

AHI:

Apnea-hypopnea index

AHI4%:

Apnea-hypopnea index using 4% oxygen desaturation criteria

AHI3%a:

Apnea-hypopnea index using 3% oxygen desaturation criteria and/or arousal

BMI:

Body mass index

CPAP:

Continuous positive airway pressure

DREADD:

Designer receptor exclusively activated by designer drugs

EDS:

Excessive daytime sleepiness

EPAP:

Expiratory positive airway pressure

GIRK:

G protein coupled inward rectifying potassium channels

MSLT:

Multiple sleep latency test

Non-REM:

Non-rapid eye movement sleep

PSG:

Polysomnography

REM:

Rapid eye movement

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Acknowledgements

We thank Ward D. Pettibone for assistance in creation of the figures.

Funding

A.W.V is supported by the American Sleep Medicine Foundation Junior Faculty Award, an American Thoracic Society Foundation Unrestricted Grant, the Friedman Brain Institute Saint-Amand Award, and NIA awards R01AG056682 and R21AG059179. B.M. is supported by National Institutes of Health grant R01HL119161 and by the Merck Investigator Studies Program. These sponsors had no role in the design or conduct of this research.

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Authors and Affiliations

  1. Mount Sinai Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, Annenberg 21-44, One Gustave L. Levy Place, New York, NY, 10029, USA

    Andrew W. Varga

  2. Section of Pulmonary and Critical Care Medicine, Sleep Disorders Center, University of Chicago, Chicago, IL, USA

    Babak Mokhlesi

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  1. Andrew W. Varga
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  2. Babak Mokhlesi
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Correspondence to Andrew W. Varga.

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Varga, A.W., Mokhlesi, B. REM obstructive sleep apnea: risk for adverse health outcomes and novel treatments. Sleep Breath 23, 413–423 (2019). https://doi.org/10.1007/s11325-018-1727-2

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  • DOI: https://doi.org/10.1007/s11325-018-1727-2

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