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. 2025 Jul 15:16:1607963.
doi: 10.3389/fneur.2025.1607963. eCollection 2025.

Differential analysis of clinical outcomes in cerebral infarction associated with REM-OSA and NREM-OSA: a retrospective database study

Liwen Xu #  1   2 , Wenyi Yu #  1   2 , Shutong Sun  1 , Yixi Zheng  1 , Tianyu Jing  2 , Gang Xu  1 , Tieyu Tang  1 , Cheng Chu  1   2
Affiliations

Differential analysis of clinical outcomes in cerebral infarction associated with REM-OSA and NREM-OSA: a retrospective database study

Liwen Xu et al. Front Neurol. .

Abstract

Background: Obstructive sleep apnea (OSA) is one of the factors that affect the prognosis of cerebral infarction. Rapid eye movement-related obstructive sleep apnea (REM-OSA) has been confirmed as an important clinical subtype of OSA, yet it is frequently overlooked in clinical practice. REM-OSA is an important but underrecognized clinical issue in the study of improving the prognosis of cerebral infarction.

Objective: To investigate the relationships among REM-OSA and cerebral infarction clinical prognosis.

Methods: In this retrospective cohort study, 318 cerebral infarction patients with OSA (AHI ≥ 5) were enrolled from February 2022 to January 2025 at the Department of Neurology, Affiliated Hospital of Yangzhou University. Participants were stratified into REM-OSA (n = 71) and NREM-OSA (n = 247) groups using stringent criteria (AHIREM/AHINREM ≥ 2, REM duration ≥30 min). Data included polysomnography, neurological assessments (NIHSS, MRS), inflammatory markers (WBC, hs-CRP), and neuroimaging. Statistical analyses comprised logistic regression and Pearson correlation tests.

Results: Compared to NREM-OSA, REM-OSA patients exhibited: (1) Poorer prognosis: Higher 3-month mRS scores (OR = 1.543, p = 0.032), independent of total AHI. (2) Enhanced inflammation: Elevated WBC (7.45 vs. 6.50 × 109/L, p = 0.011) and hs-CRP (3.95vs.1.16 mg/L, p < 0.001), correlating with AHIREM (r = 0.234-0.268, p < 0.001). (3) Unique neuroanatomical vulnerability: Higher basal ganglia infarction prevalence (83.1% vs. 64.8%, p = 0.003; OR = 2.359). (4) Severe REM-specific hypoxia: Lower minimum SpO₂ (81.62% vs. 84.31%, p < 0.001) and prolonged apneas. (5) Sleep architecture disruption: Reduced sleep efficiency and prolonged latency (PSQI: 10.18 vs. 8.52, p = 0.004). (6) Age inversely correlated with REM-OSA severity (r = -0.154, p = 0.020).

Conclusion: REM-OSA is independently associated with poorer prognosis in cerebral infarction patients. Potential explanatory mechanisms include REM-specific hypoxia, systemic inflammation, and basal ganglia vulnerability.

Keywords: basal ganglia; cerebral infarction; hypoxia; inflammation; obstructive sleep apnea; prognosis; rapid eye movement phase.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Consort flow chart of the study sample. PSG, polysomnography; AHI, apnea-hypopnea index; OSA, obstructive sleep apnea; REM, rapid eye movements; NREM, non-rapid eye movements.
Figure 2
Figure 2
Differences in MRS between NREM-OSA and REM-OSA.
Figure 3
Figure 3
Pearson correlation between variables and REM-AHI.
See this image and copyright information in PMC

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