Karuga Filip Franciszek, Kaczmarski Piotr, Białasiewicz Piotr, Szmyd Bartosz, Jaromirska Julia, Grzybowski Filip, Gebuza Piotr, Sochal Marcin, Gabryelska Agata
Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Mazowiecka St. 6/8, 92-251 Lodz, Poland.
Department of Pediatrics, Oncology and Hematology, Medical University of Lodz, Sporna St. 36/50, 91-738 Lodz, Poland.
J Clin Med. 2023 Sep 12;12(18):5907. doi: 10.3390/jcm12185907.
Sleep is a complex physiological state, which can be divided into the non-rapid eye movement (NREM) phase and the REM phase. Both have some unique features and functions. This difference is best visible in electroencephalography recordings, respiratory system activity, arousals, autonomic nervous system activity, or metabolism. Obstructive sleep apnea (OSA) is a common condition characterized by recurrent episodes of pauses in breathing during sleep caused by blockage of the upper airways. This common condition has multifactorial ethiopathogenesis (e.g., anatomical predisposition, sex, obesity, and age). Within this heterogenous syndrome, some distinctive phenotypes sharing similar clinical features can be recognized, one of them being REM sleep predominant OSA (REM-OSA). The aim of this review was to describe the pathomechanism of REM-OSA phenotype, its specific clinical presentation, and its consequences. Available data suggest that in this group of patients, the severity of specific cardiovascular and metabolic complications is increased. Due to the impact of apneas and hypopneas predominance during REM sleep, patients are more prone to develop hypertension or glucose metabolism impairment. Additionally, due to the specific function of REM sleep, which is predominantly fragmented in the REM-OSA, this group presents with decreased neurocognitive performance, reflected in memory deterioration, and mood changes including depression. REM-OSA clinical diagnosis and treatment can alleviate these outcomes, surpassing the traditional treatment and focusing on a more personalized approach, such as using longer therapy of continuous positive airway pressure or oral appliance use.
睡眠是一种复杂的生理状态，可分为非快速眼动（NREM）阶段和快速眼动（REM）阶段。两者都有一些独特的特征和功能。这种差异在脑电图记录、呼吸系统活动、觉醒、自主神经系统活动或新陈代谢中最为明显。阻塞性睡眠呼吸暂停（OSA）是一种常见病症，其特征是睡眠期间因上呼吸道阻塞而反复出现呼吸暂停发作。这种常见病症具有多因素病因发病机制（例如，解剖学易感性、性别、肥胖和年龄）。在这种异质性综合征中，可以识别出一些具有相似临床特征的独特表型，其中之一是以快速眼动睡眠为主的阻塞性睡眠呼吸暂停（REM-OSA）。本综述的目的是描述REM-OSA表型的发病机制、其特定的临床表现及其后果。现有数据表明，在这组患者中，特定心血管和代谢并发症的严重程度增加。由于快速眼动睡眠期间呼吸暂停和呼吸浅慢占优势的影响，患者更容易患高血压或葡萄糖代谢受损。此外，由于快速眼动睡眠的特定功能，在REM-OSA中主要是碎片化的，这组患者表现出神经认知功能下降，表现为记忆力减退和包括抑郁在内的情绪变化。REM-OSA的临床诊断和治疗可以缓解这些结果，超越传统治疗，侧重于更个性化的方法，例如使用更长时间的持续气道正压通气治疗或使用口腔矫治器。
