Rapid Eye Movement-Related Sleep-Disordered Breathing: Influence of Age and Gender

doi:10.1378/chest.08-1311

Chest

Volume 134, Issue 6, December 2008, Pages 1156-1161

https://doi.org/10.1378/chest.08-1311 Get rights and content

Background

Sleep-disordered breathing (SDB) occurring during rapid eye movement (REM) sleep occurs more frequently in women than men. We sought to characterize REM SDB prevalence by gender and age to identify factors that could account for this discrepancy.

Methods

Subjects with REM SDB were identified among 2,486 patients referred to a university sleep laboratory with an apnea-hypopnea index (AHI) ≥ 5 events per hour. REM SDB was defined as non-REM (NREM) AHI ≤ 15/h and REM AHI/NREM AHI ratio ≥ 2. Regression analyses were utilized to determine factors associated with REM SDB.

Results

REM SDB prevalence was 40.8% in women and 21.0% in men. After adjusting for age and obesity, female sex remained a risk factor for REM SDB (odds ratio, 3.0; 95% confidence interval [CI], 1.8 to 4.2). REM SDB prevalence waned with increasing age in both sexes, such that the odds of having REM SDB fell by 26.7% (95% CI, 15.2 to 38.2%) per decade. REM AHI/NREM AHI decreased with age only in women, falling 10.9% (95% CI, 5.5 to 16.3%) per decade. NREM AHI in women increased the most with age (16.0%; 95% CI, 11.1 to 20.9%) per decade, and least with body mass index (BMI) [13.0%; 9.1 to 16.9%] for every 5-unit BMI increase when compared to REM AHI for women and either index for men.

Conclusions

REM SDB prevalence decreases with age in women as does REM AHI/NREM AHI, perhaps secondary to a disproportionate age-dependent rise in NREM vs REM AHI in women. Younger women may be protected from SDB during NREM sleep, even in the face of obesity. These patterns may reflect age-related decreases in female hormones.

Section snippets

Patient Population

Patients referred for clinical sleep evaluation at St. Michael's Hospital (Toronto, ON), a tertiary care facility, who underwent overnight polysomnography between 2004 and 2006 were considered for this analysis. Inclusion criteria were as follows: (1) age ≥ 18 years; (2) AHI ≥ 5/h; and (3) total sleep time ≥ 100 min and REM sleep time ≥ 10 min. Of the 2,643 patients (878 women and 1,765 men), a total of 2,486 subjects were included in the analysis (817 women and 1,669 men). A total of 157

Results

Overall, 2,486 patients (32.9% women) were identified who met the inclusion criteria for the study. Table 1 presents demographic and polysomnographic characteristics of this cohort (mean ± SE). All subjects had the following characteristic means: age, 50.8 ± 0.3 years; BMI, 30.8 ± 0.1 kg/m²; and AHI, 29.7 ± 0.5/h. Women were significantly older, more obese, and had lower overall and NREM AHI than men; however, they had a higher REM AHI than men, resulting in a greater REM AHI/NREM AHI. The

Discussion

Our study affirms previous findings that REM SDB is more prevalent in women than men (40.8% vs 20.1%), while adding new information regarding the relations among REM SDB, gender, age, and obesity. According to our data, the female predilection toward REM SDB occurs irrespective of sleep position across all adult ages and ranges of BMI. There may be a greater discrepancy in the earlier decades because REM SDB prevalence decreases more rapidly with age in women than men (age and sex interaction,

Acknowledgment

The authors would like to acknowledge Jesse Dostal for his help with preliminary statistical analysis.

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The result of this stage specific susceptibility to disordered breathing may explain the predominance of REM-related OSA in females [14]. There is a complex interaction between age and sex when it comes to the prevalence of REM-related OSA [14,15]. Demographic characteristics of adult patients of either sex with REM-related OSA include younger age and lower body mass index compared with patients with non-REM-related OSA.
Rapid eye movement (REM) related obstructive sleep apnea (OSA) is defined by the presence of episodes of apnea or hypopnea predominantly or exclusively during REM sleep. Epidemiology of this disorder shows a complex interaction with age, sex, and body mass index. The prevalence is variable and depends on the criteria used to define this disorder. Moreover, the clinical significance of this entity remains poorly defined. However, episodes of apnea or hypopnea encountered during REM sleep are longer and are associated with a more profound drop in oxygen saturation than non-REM sleep. Likewise, this disorder may be independently associated with hypertension and poor glycemic control. More importantly, positive airway pressure therapy as currently prescribed may not treat the majority of apnea episodes during REM sleep. The treatment is further complicated by the different definitions used for the diagnosis of this disorder and the lack of consensus if patients with this diagnosis should be treated if their overall apnea-hypopnea index does not meet the threshold for the clinical diagnosis of OSA. The definition and treatment used for the diagnosis and management of REM-related OSA needs to be standardized. Moreover, a consensus needs to be developed as to whether patients with this disorder should be treated if their overall apnea-hypopnea index does not meet the threshold for the clinical diagnosis of OSA. Further investigation may help answer if this disorder is independently associated with neurocognitive and cardiometabolic adverse outcomes and help guide the therapeutic approach.
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The work was completed at Case Western Reserve University.

The authors have no disclosures or conflicts of interest to disclose.

: Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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Chest

Original ResearchSleep MedicineRapid Eye Movement-Related Sleep-Disordered Breathing: Influence of Age and Gender

Background

Methods

Results

Conclusions

Section snippets

Patient Population

Results

Discussion

Acknowledgment

Respir Med

Chest

Chest

The occurrence of sleep-disordered breathing among middle-aged adults

N Engl J Med

Gender differences in the polysomnographic features of obstructive sleep apnea

Am J Respir Crit Care Med

The effects of gender and age on REM-related sleep-disordered breathing

Sleep Breath

A new method for measuring daytime sleepiness: the Epworth sleepiness scale

Sleep

A manual of standardized terminology, techniques, and scoring system for sleep stages of human subjects. NIH Publication No. 204

Original Research
Sleep Medicine
Rapid Eye Movement-Related Sleep-Disordered Breathing: Influence of Age and Gender