Nature and Science of Sleep (Oct 2020)

The Associations of Gender, Menopause, Age, and Asthma with REM-Predominant Obstructive Sleep Apnea: A Prospective Observational Study

  • Bahammam RA,
  • Al-Qahtani KM,
  • Aleissi SA,
  • Olaish AH,
  • Almeneessier AS,
  • Bahammam AS

Journal volume & issue
Vol. Volume 12
pp. 721 – 735

Abstract

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Rakan A Bahammam,1 Khalid M Al-Qahtani,1 Salih A Aleissi,1 Awad H Olaish,1 Aljohara S Almeneessier,1,2 Ahmed S Bahammam1 1Department of Medicine, College of Medicine, The University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia; 2Family Medicine, College of Medicine, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Ahmed S BahammamDepartment of Medicine, College of Medicine, The University Sleep Disorders Center, King Saud University, Box 225503, Riyadh 11324, Saudi ArabiaTel +966-11-467-9495Fax +966-11-467-9179Email [email protected]: The study sought to assess demographics, clinical features, comorbidities, and polysomnographic features of a large cohort of clinic-based patients with rapid eye movement-predominant obstructive sleep apnea (REM-predominant-OSA) in both genders, while assessing the relationship between REM-predominant OSA in one hand and menopausal status and age on the other.Methods: This prospective observational study was conducted between January 2003 and December 2017. REM-predominant OSA diagnostic criteria included an AHI of ≥ 5/h, with REM-AHI/non-REM-AHI of > 2, a non-REM-AHI of < 15/h, and a minimum of 15 min of REM sleep. Patients who had an AHI> 5 events/h and did not meet the criteria for REM-predominant OSA were included in the non-stage-specific OSA group (NSS).Results: The study consisted of 1346 men and 823 women (total=2169). REM-predominant OSA was diagnosed in 17% (n=369). The prevalence of REM-predominant OSA in women was 25% compared with 12% in men. Several independent associations of REM-predominant OSA were identified in the whole group, including age (OR: 0.97 [0.95– 0.98], p< 0.01), female sex (OR: 6.95 [4.86– 9.93], p> 0.01), REM sleep duration (min) (OR: 1.02 [1.02– 1.03], < 0.01), and time with SpO2 < 90% (mins) (OR: 0.97 [0.95– 0.99], < 0.01), hypertension (OR:0.67 [0.45– 0.99], 0.04) and asthma (OR: 2.19 [1.56– 3.07], < 0.01). The prevalence of REM-predominant OSA in premenopausal and postmenopausal women was 35% and 18.6% (p< 0.01), respectively. Among women, age was an independent correlate (OR: 0.97 [0.94– 0.99], p=0.03; however, menopausal status was not.Conclusion: REM-predominant OSA is prevalent among clinic-based patients with OSA. A younger age and female sex were independent correlates of REM-predominant OSA. Among women, a younger age but not menopausal status was a correlate of REM-predominant OSA. Asthma was independently associated with REM-predominant OSA.Keywords: female sex, phenotype, rapid eye movement sleep, hypertension, menopause, apnea-hypopnea index

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