Case Western Reserve University School of Medicine, USA.
Sleep Med. 2012 Aug;13(7):864-8. doi: 10.1016/j.sleep.2012.03.019. Epub 2012 Jun 15.
OBJECTIVE/BACKGROUND: The objective of this study was establish if rapid-eye-movement (REM) rebound on first exposure to continuous positive airway pressure (CPAP) is associated with CPAP compliance. A rebound or drastic increase in REM sleep in response to initial CPAP exposure is associated with improvement in the subjective quality of sleep. We wished to determine if REM rebound was also associated with increased CPAP compliance.
Split night polysomnographic studies carried out in a one-and-a-half year period were examined for REM rebound and slow wave sleep (SWS) rebound. Compliance with CPAP according to percentage of days used and percentage of days used for more than 4h was determined at 30, 60, and 120 days and compared between groups with and without REM rebound and then between groups with and without SWS rebound. Multivariate regression models were constructed to determine factors that were associated with increasing CPAP compliance.
CPAP compliance was greater for those with REM rebound than those without REM rebound at all time periods, but significantly so only for total percentage of days used at 30 days (86.7±46.7, 96.7 vs. 56.7 [median±1st quartile, 3rd quartile]±32.5, 90.0; p=0.04) and 60 days (78.3±37.5, 93.4 vs. 50.0±25.0, 80.9; p=0.03). There was no difference in CPAP compliance for SWS rebound and there were no SWS rebound groups. Only the presence of REM rebound was associated with increased compliance with CPAP with neither SWS rebound nor diagnostic AHI being significantly associated with CPAP compliance.
The presence of REM rebound, but not SWS rebound, on initial CPAP exposure is associated with early CPAP compliance. This increased compliance is not explained by severity of sleep apnea as measured by AHI.
目的/背景：本研究的目的是确定快速眼动 (REM) 反弹是否与持续气道正压通气 (CPAP) 的顺应性相关。最初 CPAP 暴露时 REM 睡眠的反弹或急剧增加与睡眠主观质量的改善有关。我们希望确定 REM 反弹是否也与 CPAP 顺应性的增加相关。
在一年半的时间内进行了分夜多导睡眠图研究，以检查 REM 反弹和慢波睡眠 (SWS) 反弹。根据使用天数的百分比和使用超过 4 小时的天数的百分比，在 30、60 和 120 天时确定 CPAP 顺应性，并在有和没有 REM 反弹的组之间以及在有和没有 SWS 反弹的组之间进行比较。构建多变量回归模型以确定与 CPAP 顺应性增加相关的因素。
在所有时间段内，有 REM 反弹的患者的 CPAP 顺应性均大于无 REM 反弹的患者，但在 30 天（86.7±46.7、96.7 与 56.7[中位数±1 四分位数，3 四分位数]±32.5、90.0；p=0.04）和 60 天（78.3±37.5、93.4 与 50.0±25.0、80.9；p=0.03）时差异有统计学意义。SWS 反弹与 CPAP 顺应性无差异，也没有 SWS 反弹组。只有 REM 反弹的存在与 CPAP 顺应性的增加相关，而 SWS 反弹和诊断性 AHI 均与 CPAP 顺应性无显著相关。
在初始 CPAP 暴露时出现 REM 反弹，但不是 SWS 反弹，与早期 CPAP 顺应性相关。这种增加的顺应性不能用 AHI 测量的睡眠呼吸暂停严重程度来解释。
