0559 Association of Rapid Eye Movement Sleep with Insulin Resistance in Han Chinese Patients With Obstructive Sleep Apnea

Abstract Introduction Obstructive sleep apnea (OSA) is increasingly associated with insulin resistance. The underlying pathophysiology remains unclear but rapid eye movement (REM) sleep has been hypothesized to play a key role. To investigate the associations of insulin resistance with respiratory events and sleep duration during REM sleep, 4,062 Han Chinese individuals with suspected OSA were screened and 2,899 were analyzed. Methods We screened 4,062 participants with suspected OSA who underwent polysomnography in our sleep center from 2009 to 2016. Polysomnographic variables, biochemical indicators, and physical measurements were collected. Logistic regression analyses were conducted to determine the odds ratios (ORs) and 95% confidence intervals (95% CIs) for insulin resistance as assessed by hyperinsulinemia, the homeostasis model assessment of insulin resistance (HOMA-IR), fasting insulin resistance index (FIRI), and Bennet’s insulin sensitivity index (ISI). Results The final analyses included 2,899 participants. After adjusting for age, gender, body mass index, waist circumference, mean arterial pressure, smoking status, alcohol consumption, and the apnea and hypopnea index during non-REM sleep (AHINREM), the results revealed that AHI during REM sleep (AHIREM) was independently associated with insulin resistance; across higher AHIREM quartiles, the ORs (95% CIs) for hyperinsulinemia were 1.340 (1.022, 1.757), 1.210 (0.882, 1.660), and 1.632 (1.103, 2.416); those for abnormal HOMA-IR were 1.287 (0.998, 1.661), 1.263 (0.933, 1.711), and 1.556 (1.056, 2.293); those for abnormal FIRI were 1.386 (1.048, 1.835), 1.317 (0.954, 1.818), and 1.888 (1.269, 2.807); and those for abnormal Bennet’s ISI were 1.297 (1.003, 1.678), 1.287 (0.949, 1.747), and 1.663 (1.127, 2.452) (P < 0.01 for all linear trends). Additionally, the results showed that for every 1-h increase in REM duration, the risk of hyperinsulinemia decreased by 22.3% (P < 0.05). Conclusion The present study demonstrated that AHIREM was independently associated with hyperinsulinemia and abnormal HOMA-IR, FIRI, and Bennet’s ISI. Additionally, REM sleep duration was independently associated with hyperinsulinemia. Support This study was supported by Grants-in-aid from Shanghai Municipal Commission of Science and Technology (No.18DZ2260200).

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Upper airway closing pressures in obstructive sleep apnea

Journal of Applied Physiology ◽

10.1152/jappl.1984.57.2.520 ◽

1984 ◽

Vol 57 (2) ◽

pp. 520-527 ◽

Cited By ~ 145

Author(s):

F. G. Issa ◽

C. E. Sullivan

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Eye Movement ◽

Rem Sleep ◽

Upper Airway ◽

Nrem Sleep ◽

Stage I ◽

Stage Iii ◽

Rapid Eye Movement ◽

Obstructive Sleep

We studied 18 patients with obstructive sleep apnea (OSA). Each subject slept while breathing through the nose with a specially designed valveless breathing circuit. Low levels of continuous positive airway pressure (CPAP) applied through the nose (2.5–15.0 cmH2O) prevented OSA and allowed long periods of stable stage III/IV sleep and rapid-eye-movement (REM) sleep. Externally applied complete nasal occlusion while the upper airway was patent resulted in upper airway closure during inspiration which was identified by a sudden deviation of nasal pressure from tracheal or esophageal pressure. The level of upper airway closing pressure (UACP) did not change throughout the occlusion test, suggesting that upper airway dilator muscles do not respond to asphyxia during sleep. The upper airway was more collapsible during stage I/II non-rapid-eye-movement (NREM) and REM sleep compared with stage III/IV NREM sleep. The pooled mean UACP was 3.1 +/- 0.4 cmH2O in stage I/II NREM, 4.2 +/- 0.2 cmH2O in stage III/IV NREM, and 2.4 +/- 0.2 cmH2O in REM sleep. Nasal occlusion at successively higher levels of CPAP did not alter the level of UACP in stage I/II NREM and REM sleep but resulted in the upper airway becoming more stable in stage III/IV NREM sleep, suggesting a reflex which augments the tone of upper airway dilator muscles.

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Cardiovascular changes associated with obstructive sleep apnea syndrome

Journal of Applied Physiology ◽

10.1152/jappl.1992.72.2.583 ◽

1992 ◽

Vol 72 (2) ◽

pp. 583-589 ◽

Cited By ~ 114

Author(s):

R. Stoohs ◽

C. Guilleminault

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Eye Movement ◽

Rem Sleep ◽

Sleep Apnea Syndrome ◽

Nrem Sleep ◽

Rapid Eye Movement ◽

Significant Drop ◽

Obstructive Sleep ◽

The Impact

Five men free of lung or cardiovascular diseases and with severe obstructive sleep apnea participated in a study on the impact of sleep states on cardiovascular variables during sleep apneas. A total of 128 obstructive apneas [72 from stage 2 non-rapid-eye-movement (NREM) sleep and 56 from rapid-eye-movement (REM) sleep] were analyzed. Each apnea was comprised of an obstructive period (OP) followed by a hyperventilation period, which was normally associated with an arousal. Heart rate (HR), stroke volume (SV), cardiac output (CO) (determined with an electrical impedance system), radial artery blood pressures (BP), esophageal pressure nadir, and arterial O2 saturation during each OP and hyperventilation period were calculated for NREM and REM sleep. During stage 2 NREM sleep, the lowest HR always occurred during the first third of the OP, and the highest was always seen during the last third. In contrast, during REM sleep the lowest HR was always noted during the last third of the OP. There was an inverse correlation when the percentage of change in HR over the percentage of change in SV during an OP was considered. The HR and SV changes during NREM sleep allowed maintenance of a near-stable CO during OPs. During REM sleep, absence of a compensatory change in SV led to a significant drop in CO. Systolic, diastolic, and mean BP always increased during the studied OPs.(ABSTRACT TRUNCATED AT 250 WORDS)

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296 OBSTRUCTIVE SLEEP APNEA (OSA) AND ITS RELATIONSHIP WITH RAPID EYE MOVEMENT (REM) SLEEP

Sleep Medicine ◽

10.1016/s1389-9457(09)70298-9 ◽

2009 ◽

Vol 10 ◽

pp. S80

Author(s):

C. Torres ◽

J. Santin ◽

G. Vidal ◽

N. Valencia ◽

J. Godoy

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Eye Movement ◽

Rem Sleep ◽

Rapid Eye Movement ◽

Obstructive Sleep

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Comparison of Polysomnographic and Cephalometric Parameters Based on Positional and Rapid Eye Movement Sleep Dependency in Obstructive Sleep Apnea

10.21203/rs.3.rs-1103666/v1 ◽

2021 ◽

Author(s):

Jung-Hwan Jo ◽

Sung-Hun Kim ◽

Ji-Hee Jang ◽

Ji-Woon Park ◽

Jin-Woo Chung

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Eye Movement ◽

Rem Sleep ◽

Upper Airway ◽

Apnea Hypopnea Index ◽

Rapid Eye Movement ◽

Maximum Width ◽

Obstructive Sleep ◽

Positional Dependency

Abstract The aim of this study is to investigate the differences in polysomnographic and cephalometric features according to positional and rapid eye movement (REM) sleep dependencies in obstructive sleep apnea patients. Standard polysomnography and cephalometric analyses were performed on 133 OSA patients. The subjects were categorized into positional and non-positional, and REM-related and not-REM-related OSA groups according to positional and REM sleep dependency on severity of sleep apnea. Polysomnographic and cephalometric parameters were compared between groups. Positional and REM-related OSA patients showed significantly lower non-supine apnea-hypopnea index (AHI), non-REM (NREM) AHI and overall AHI and higher NREM oxygen saturation (SpO2) and mean SpO2 compared to non-positional and not-REM-related OSA patients, respectively. Cephalometric features between positional and non-positional OSA patients did not show any significant differences. However, REM-related OSA patients showed significantly larger inferior oral airway space and shorter perpendicular distance between mandibular plane and anterior hyoid bone and the distance between uvula and posterior nasal spine, and narrower maximum width of soft palate than not-REM-related OSA patients. Positional and REM-related OSA patients have lower severity of sleep apnea, suggesting the possibility of lower collapsibility of the upper airway. Anatomical factors maybe more closely related to REM sleep than positional dependency.

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