Central Apneic Event Prevalence in REM and NREM Sleep in OSA Patients: A Retrospective, Exploratory Study

Abstract

Patients with sleep-disordered breathing show a combination of different respiratory events (central, obstructive, mixed), with one type being predominant. We observed a reduced prevalence of central apneic events (CAEs) during REM sleep compared to NREM sleep in patients with predominant obstructive sleep apnea (OSA). The aim of this retrospective, exploratory study was to describe this finding and to suggest pathophysiological explanations. The polysomnography (PSG) data of 141 OSA patients were assessed for the prevalence of CAEs during REM and NREM sleep. On the basis of the apnea-hypopnea index (AHI), patients were divided into three OSA severity groups (mild: AHI < 15/h; moderate: AHI = 15-30/h; severe: AHI > 30/h). We compared the frequency of CAEs adjusted for the relative length of REM and NREM sleep time, and a significantly increased frequency of CAEs in NREM was found only in severely affected OSA patients. Given that the emergence of CAEs is strongly associated with the chemosensitivity of the brainstem nuclei regulating breathing mechanics in humans, a sleep-stage-dependent chemosensitivity is proposed. REM-sleep-associated neuronal circuits in humans may act protectively against the emergence of CAEs, possibly by reducing chemosensitivity. On the contrary, a significant increase in the chemosensitivity of the brainstem nuclei during NREM sleep is suggested.

Keywords: REM sleep; central sleep apnea; chemosensitivity; obstructive sleep apnea; polysomnography; sleep stages.

Figure 1

Single factorial analysis of the number of central apneic events (CAEs) in relation to the respective REM sleep duration by group (severity of OSA: mild, moderate, severe) and sleep phase (REM, NREM). In the group of severely affected OSA patients, the frequency of CAEs was significantly increased in the NREM phase when compared to the one in the REM phase, when adjusted for the duration of the REM phase. This was not the case in the group of moderately and mildly affected OSA patients. The symbols overlap in many cases, and most data points were at the value 0. Unfortunately, it is difficult to present this clearly without distorting the intended message of the plot. Due to the overlay, not all data points are clearly visible.