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

Simple Summary Obstructive sleep apnea is the most common breathing-related sleep disorder. In addition to the quantitatively dominant obstructive apneas, patients may also be affected by central apneas. This study investigates the frequency of occurrence of central apneas in REM and NREM sleep in patients suffering from OSA of varying severity. When adjusted for the respective REM and NREM sleep duration, a significantly increased frequency of CAEs in NREM was found only in severely affected OSA patients. 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.

Automated summary

This study investigates the frequency of occurrence of central apneas in REM and NREM sleep in patients suffering from OSA of varying severity. It was found that a significantly increased frequency of central apneas in NREM was only observed in severely affected OSA patients. This study is important for understanding the pathophysiological mechanisms of obstructive sleep apnea.