American journal of respiratory and critical care medicine 2017 11 07() doi 10.1164/rccm.201706-1112OC
Obstructive sleep apnea (OSA) during rapid eye movement (REM) sleep is a common disorder. Data on whether OSA that occurs predominantly during REM sleep is associated with health outcomes are limited. The present study examined the association between OSA during REM sleep and a composite cardiovascular endpoint in a community sample with and without prevalent cardiovascular disease.
Full montage home polysomnography was conducted as part of the Sleep Heart Health Study. The study cohort was followed for an average of 9.5 years during which cardiovascular events were assessed. Only participants with a non-REM (NREM) apnea-hypopnea index (AHI) < 5 events/h were included. A composite cardiovascular endpoint was determined as the occurrence of nonfatal or fatal events including myocardial infarction, coronary artery revascularization, congestive heart failure, and stroke. Proportional hazards regression was used to derive the adjusted hazards ratios for the composite cardiovascular endpoint. RESULTS
The sample consisted of 3,265 subjects with a NREM-AHI < 5.0 events/h. Using a REM-AHI < 5.0 events/h as the reference group (N=1759), the adjusted hazards ratios for the composite cardiovascular endpoint for severe REM OSA (≥30 events/h; N=180) was 1.35 (95%: 0.98-1.85). Stratified analyses demonstrated that the association was most notable in those with prevalent cardiovascular disease and severe OSA during REM sleep with an adjusted hazards ratio of 2.56 (95% CI: 1.46-4.47). CONCLUSIONS
Severe OSA that occurs primarily during REM sleep is associated with higher incidence of a composite cardiovascular endpoint but in only those with prevalent cardiovascular disease.