Journal Article

Obstructive Sleep Apnea and Cardiovascular Disease. REM Sleep Matters

Mokhlesi, Babak, Varga, Andrew W.

2018

Overview

During REM sleep, several factors coalesce to result in longer duration and greater severity of oxygen desaturation during obstructive apneas and hypopneas versus non-REM sleep (1), including cholinergic-mediated inhibition of the hypoglossal nerve, resulting in suppression of genioglossus muscle tone and increased propensity for upper airway collapse (2), as well as a reduction in the hypoxic and hypercapnic ventilatory drive (3). The analysis revealed that in participants with prevalent cardiovascular disease at baseline, the hazard ratio for the composite cardiovascular endpoint was 2.56 (95% confidence interval, 1.46-4.47) for severe REM OSA compared with no OSA during REM sleep (REM AHI <5 events/h), after adjusting for age, sex, race, body mass index, smoking status, prevalent hypertension, and diabetes. The study by Aurora and colleagues suggests that in patients who have cardiovascular disease at baseline (i.e., prior myocardial infarction, coronary revascularization, stroke, and heart failure), severe OSA isolated to REM sleep more than doubles the risk for recurrent cardiovascular events. Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial.

• Publisher: American Thoracic Society
• Subject: Atherosclerosis / Body mass index / Cardiovascular disease / Clinical trials / Continuous positive airway pressure / Diabetes / Eye movements / Glucose / Health risk assessment / Heart attacks / Heart failure / Hypertension / Metabolism / Sleep apnea / Sleep disorders / Stroke