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

Abstract

Purpose

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

Abbreviations

REM, rapid eye movement; NSS, non-stage-specific; OSA, obstructive sleep apnea; NREM, non-rapid eye movement; PSG, polysomnography; MSLT, multiple sleep latency test; BMI, body mass index; ESS, Epworth sleepiness scale; AHI, apnea-hypopnea index; SPO2, oxygen saturation; SD, standard deviation; AASM, American Academy of Sleep Medicine; dB, decibel; FEV1, forced expiratory volume in one second; PEF, peak expiratory flow.

Data Sharing Statement

Data are available on request; however, an institutional approval is needed before sharing.

Ethics Approval and Informed Consent

The study was approved by the Institutional Review Board of the Health Sciences Colleges Research on Human Subjects at King Saud University (E-19-4169). All participants signed a written informed consent form. This study was conducted in accordance with the Declaration of Helsinki.

Acknowledgments

This study was funded by a grant from the Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia (08-MED511-02). The study sponsor played no role in the study design, the collection, analysis or interpretation of data, writing the manuscript, or the decision to submit the manuscript.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, have agreed on the journal (Nature and Science of Sleep) to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

All authors declare that they have no proprietary, financial, professional, or other personal interest of any nature in any product, service, and/or company that could be construed or considered to be a potential conflict of interest that might have influenced the views expressed in this manuscript.