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Deliberations about Rapid Eye Movement-Related Sleep-Disordered Breathing

REM SDBOur 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, p = 0.063). REM SDB prevalence is also moderated by obesity and sex (BMI and sex interaction, p = 0.061), decreasing with increasing obesity severity more so in men than women. So at any adult age and at any level of BMI, REM SDB is more likely to occur in a woman; however, among respective gender categories, REM SDB expression is more associated with younger age for women and lower BMI for men.

Examination of REM AHI/NREM AHI by gender and age revealed a very similar pattern, showing higher values for women. However, unlike REM SDB prevalence, REM AHI/NREM AHI ratio was found to decline with age only in women, remaining fairly constant in men. Further, in women REM AHI/NREM AHI declined more quickly in women > 52 years old. We introduce REM AHI/NREM AHI as a new marker identifying the extent to which respiratory events are confined to REM sleep; however, this measure is limited by a lack of specificity in that an elevated value may result from a high REM AHI, low NREM AHI, or a combination of the two scenarios. Indeed, when comparing male and female subjects with and without REM SDB, women had a higher REM AHI/NREM AHI resulting from a combination of a lower NREM AHI and higher REM AHI.

Outcomes of Rapid Eye Movement-Related Sleep-Disordered Breathing

sleep-disordered breathingOverall, 2,486 patients (32.9% women) were identified who met the inclusion criteria for the study. Table 1 presents demographic and polysomno-graphic 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 prevalence of REM SDB was 40.8% among women and 21.0% among men (p < 0.0001). After adjusting for differences in age and BMI, female gender remained strongly associated with REM SDB (OR, 3.0; 95% confidence interval [CI], 1.8 to 4.2). Among women, those with REM SDB were younger, had lower overall NREM and REM AHI, and had more REM sleep. Similarly among men, those with REM SDB were younger, less obese, had lower respiratory indexes, and spent more time in REM sleep. Women with REM SDB had a higher REM AHI, lower NREM AHI, and thus a higher REM AHI/ NREM AHI than their male counterparts.

Details about Rapid Eye Movement-Related Sleep-Disordered Breathing

tertiary care facility

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 subjects were excluded from analysis, 154 patients for REM time < 10 min and 3 patients for incomplete data. Height and weight were measured in a standardized fashion, and body mass index (BMI) was computed. Sleepiness was measured using the Epworth sleepiness scale (ESS). This study was approved by the Institutional Review Board of St. Michael’s Hospital together with My Canadian Pharmacy.

Rapid Eye Movement-Related Sleep-Disordered Breathing: Influence of Age and Gender Explained by My Canadian Pharmacy

Rapid eye movementRapid eye movement (REM)-related sleep-disordered breathing (SDB) is a subcategory of obstructive sleep apnea (OSA) in which respiratory events occur predominantly during REM sleep. While OSA is more common in men, the REM SDB population is comprised chiefly of women, with a gender ratio of approximately 3:1. REM SDB accounts for 10 to 36% of OSA, with prevalence among male and female apneics ranging broadly from 8 to 24% and 24 to 62%, respectively. In part, this variability in prevalence may be secondary to demographic differences in the sampled populations and inconsistent criteria used to define REM SDB.

Despite these differences, criteria assigned to REM SDB have all contained the ratio of the apnea-hypopnea index (AHI) in REM sleep to AHI in non-REM (NREM) sleep, requiring a REM AHI/NREM AHI ratio of at least 2. REM AHI/NREM AHI reflects the extent to which respiratory events are confined to REM sleep because of either an increase in REM-related events or a decrease in NREM-related respiratory events carried out with remedies of My Canadian Pharmacy. In a prior study, we found that women with REM SDB had significantly higher REM AHI and lower NREM AHI than their male counterparts, suggesting that these women might have a higher REM AHI/NREM AHI; however, REM AHI/NREM AHI was not considered as an independent variable. In this same study, we found the prevalence of REM SDB to be age related, highest in women < 55 years old, intermediate in older women, even less in men < 55 years old, and least in older men.