Natural History of REM-OSA in Children and Its Associations with Adverse Blood Pressure Outcomes: A Longitudinal Follow-Up Study

Figures & data

Table 1 Baseline Characteristics of Subjects with Different Baseline OSA Status and Subtypes (N = 610)

Characteristics	Normal (OAHI<1/h) N = 245	PS N= 103	OSA (OAHI ≥1/h) N = 262			P value^e
			REM-OSA N = 169	Non REM-OSA N = 93	P value^d
Male sex, n (%)	134 (54.7)	66 (64.1)	127 (75.1)	64 (68.8)	0.270	<0.001
Age, years	10.0 ± 1.8^a	9.4 ± 1.8^b	10.2 ± 1.8^a	9.9 ± 1.8^a,b	0.195	0.006
BMI z score, median (IQR)	0.37 (−0.38–1.09)^a	0.61 (−0.13–1.19)^b	0.87 (0.16–1.59)^c	0.81 (−0.17–1.70)^c	0.568	<0.001
Overweight/obese, n (%)	67 (27.3)	34 (33.0)	74 (43.8)	43 (46.2)	0.703	0.001
Tonsils ≥ grade 2, n (%)	101 (41.2)	58 (56.3)	89 (52.7)	59 (63.4)	0.092	0.001
Adenoid ≥ grade 2, n (%)	81 (33.1)	32 (31.1)	67 (39.6)	46 (49.5)	0.157	0.034
Allergic rhinitis, n (%)	168 (68.6)	86 (83.5)	122 (72.2)	71 (76.3)	0.465	0.080
Habitual snoring^&, n (%)	0 (0)	103 (100)	61 (36.1)	28 (30.1)	0.328	<0.001
Mouth breathing^&, n (%)	60 (24.5)	41 (39.8)	53 (31.4)	27 (29.0)	0.695	0.037
ESS score	6.4 ± 4.2	7.0 ± 4.3	6.8 ± 4.3	6.8 ± 4.2	0.936	0.613
REM sleep duration, minutes	102.5 ± 26.7^a	100.3 ± 24.9^a	101.9 ± 25.3^a	93.3 ± 27.5^b	0.012	0.031
NREM sleep duration, minutes	373.3 ± 37.4	374.3 ± 38.7	370.3 ± 41.4	369.7 ± 43.5	0.903	0.743
OAHI, events/h, median (IQR)	0.12 (0.00–0.49)^a	0.14 (0.00–0.48)^a	2.47 (1.42–4.50)^b	2.53 (1.54–6.37)^b	0.365	<0.001
OAHIREM, events/h, median (IQR)	0.00 (0.00–1.01)^a	0.00 (0.00–0.63)^a	8.18 (5.17–14.42)^b	1.83 (0.54–3.65)^c	<0.001	<0.001
OAHINREM, events/h, median (IQR)	0.00 (0.00–0.30)^a	0.00 (0.00–0.30)^a	0.77 (0.33–1.69)^b	2.64 (1.65–6.92)^c	<0.001	<0.001
ODI, events/h, median (IQR)	0.12 (0.00–0.37)^a	0.21 (0.00–0.46)^a	0.60 (0.24–1.38)^b	0.88 (0.41–1.55)^c	0.017	<0.001
ArI, events/h, median (IQR)	5.87 (4.47–7.50)^a	5.81 (4.37–7.84)^a	7.05 (5.38–8.70)^b	8.61 (6.87–11.56)^c	<0.001	<0.001
SpO2 nadir, %	92.8 ± 2.3^a	92.5 ± 3.9^a	90.9 ± 3.5^b	90.6 ± 3.1^b	0.555	<0.001
SpO2 nadir in REM, %	93.7 ± 2.1^a	93.3 ± 3.5^a	91.5 ± 2.9^b	92.3 ± 2.6^c	0.030	<0.001
SpO2 nadir in NREM, %	93.5 ± 2.0^a	93.5 ± 3.4^a	92.5 ± 3.1^b	91.2 ± 2.9^c	0.001	<0.001
Daytime SBP, mmHg*	111.8 ± 8.7	112.7 ± 8.4	112.8 ± 7.7	114.5 ± 8.2	0.159	0.167
Daytime SBP z-score*	−0.86 (−1.64–0.04)	−0.71 (−1.51–0.01)	−0.71 (−1.46 - −0.22)	−0.74 (−1.25–0.15)	0.214	0.455
Daytime DBP, mmHg*	71.5 ± 5.1	72.4 ± 5.9	71.8 ± 4.7	72.8 ± 5.4	0.200	0.289
Daytime DBP z-score*	−0.09 (−0.62 −0.44)	−0.19 (−0.56–0.61)	−0.14 (−0.55–0.30)	−0.01 (−0.57 −0.58)	0.225	0.684
Nighttime SBP, mmHg*	100.3 ± 9.7	99.1 ± 8.8	102.0 ± 8.5	102.5 ± 8.2	0.701	0.076
Nighttime SBP z-score*	0.14 (−0.60–1.12)	0.12 (−0.62–0.79)	0.36 (−0.22–1.06)	0.42 (0.04–1.03)	0.434	0.107
Nighttime DBP, mmHg*	59.2 ± 6.1	58.8 ± 6.1	59.9 ± 5.4	59.9 ± 5.1	0.994	0.547
Nighttime DBP z-score*	0.65 (−0.13–1.32)	0.40 (−0.06–1.15)	0.66 (−0.10–1.23)	0.59 (0.08–1.16)	0.866	0.643
Nocturnal SBP dipping,%*	10.3 ± 5.3^a,b	12.0 ± 5.7^a	9.6 ± 5.9^b	10.3 ± 5.3^a,b	0.400	0.039
Nocturnal DBP dipping,%*	17.2 ± 6.8	18.6 ± 7.8	16.5 ± 6.9	17.4 ± 6.1	0.397	0.295
Any hypertension (daytime or nocturnal), n (%)	34 (19.9)	11 (16.9)	24 (20.5)	15 (23.1)	0.686	0.853

Notes: Data presented as mean ± standard deviation unless otherwise specified. P value^d represents the comparisons between REM-OSA and non REM-OSA. P value^e represents the comparisons among all groups by one-way ANOVA, Kruskal–Wallis 1-way ANOVA and Chi-Square for parametric, non-parametric and categorical variables respectively. ^a,b,c Cells in each row with different superscripts represent statistically significant differences in group means or medians (p < 0.05). *Data were available from 171 normal, 65 PS, 117 REM-OSA and 65 non REM-OSA subjects. ^&Habitual snoring and mouth-breathing ≥ 3 nights per week.

Abbreviations: OSA, obstructive sleep apnea; PS, primary snoring; h, hour; OAHI, obstructive apnea–hypopnea index; REM, rapid-eye-movement; NREM, non-rapid-eye-movement; BMI, body mass index; ESS, Epworth Sleepiness Scale; ODI, oxygen desaturation index; ArI, arousal index; SpO2, oxygen saturation; OAHI_REM, OAHI in REM sleep; OAHI_NREM, OAHI in NREM sleep; DBP, diastolic blood pressure; SBP, systolic blood pressure.

Figure 1 Study flow chart.

Table 2 Baseline and Follow-Up Characteristics of Subjects with Different Baseline OSA Status and Subtypes (N = 234)

Characteristics	Normal (OAHI<1/h) N = 95	PS N= 47	OSA (OAHI ≥1/h) N = 92			P value^e
			REM-OSA N = 58	Non REM-OSA N = 34	P value^d
Male sex, n (%)	49 (51.6)	27 (57.4)	42 (72.4)	22 (64.7)	0.438	0.073
Follow-up length, years	10.4 ± 1.0	10.7 ± 0.9	10.3 ± 1.1	10.2 ± 1.2	0.580	0.123
Age, years
Baseline	9.9 ± 1.8	9.3 ± 1.8	10.0 ± 1.9	9.6 ± 1.7	0.241	0.139
Follow-up	20.3 ± 2.0	20.0 ± 1.9	20.4 ± 2.0	19.8 ± 1.9	0.167	0.419
BMI z score, median (IQR)
Baseline	0.30 (−0.30–1.04)	0.52 (−0.21–1.16)	0.71 (−0.11–1.55)	0.77 (0.12–1.57)	0.713	0.067
Follow-up	0.33 (−0.92–1.00)	0.20 (−0.31–0.88)	0.47 (−0.32–0.93)	0.27 (−0.01–1.17)	0.783	0.557
Overweight/obese, n (%)
Baseline	24 (25.3)	13 (27.7)	21 (36.2)	14 (41.2)	0.636	0.251
Follow-up	31 (32.6)	14 (29.8)	19 (32.8)	12 (35.3)	0.804	0.964
Tonsils ≥ grade 2, n (%)
Baseline	33 (34.7)	23 (48.9)	28 (48.3)	22 (64.7)	0.148	0.030
Follow-up	11 (11.6)	9 (19.1)	12 (20.7)	4 (11.8)	0.276	0.353
Adenoid ≥ grade 2, n (%)
Baseline	29 (30.5)	14 (29.8)	19 (32.8)	14 (41.2)	0.489	0.751
Follow-up	NA	NA	NA	NA
Allergic rhinitis, n (%)
Baseline	82 (86.3)	42 (89.4)	52 (89.7)	29 (85.3)	0.534	0.194
Follow-up	67 (70.5)	31 (66.0)	45 (77.6)	25 (73.5)	0.354	0.573
Habitual snoring^&, n (%)
Baseline	0 (0)	47 (100)	19 (32.8)	11 (32.4)	0.968	<0.001
Follow-up	12 (12.6)	16 (34.0)	16 (27.6)	7 (20.6)	0.454	0.019
Mouth breathing^&, n (%)
Baseline	26 (27.4)	20 (42.6)	19 (32.8)	6 (17.6)	0.116	0.091
Follow-up	16 (16.8)	17 (36.2)	21 (36.2)	6 (17.6)	0.052	0.010
ESS score
Baseline	6.0 ± 4.1	7.1 ± 3.8	6.3 ± 4.3	7.0 ± 4.1	0.409	0.399
Follow-up	7.1 ± 4.1	7.7 ± 3.9	7.5 ± 4.3	6.7 ± 4.8	0.413	0.672
REM sleep duration, minutes
Baseline	105.8 ± 26.4	103.5 ± 24.2	106.1 ± 21.9	96.0 ± 24.8	0.045	0.214
Follow-up	120.2 ± 32.7	114.5 ± 33.9	111.5 ± 35.4	104.6 ± 38.7	0.389	0.126
NREM sleep duration, minutes
Baseline	377.9 ± 38.1	374.3 ± 37.5	387.8 ± 29.5	378.4 ± 42.3	0.211	0.251
Follow-up	380.2 ± 50.1	383.8 ± 59.9	377.9 ± 35.4	377.8 ± 65.4	0.989	0.953
OAHI, events/h, median (IQR)
Baseline	0.12 (0.00–0.39)^a	0.22 (0.00–0.50)^a	2.41 (1.38–4.57)^b	2.01 (1.14–3.82)^b	0.261	<0.001
Follow-up	0.60 (0.00–3.80)^a	1.40 (0.47–5.30)^b	2.05 (0.33–7.42)^b	1.80 (0.48–5.85)^b	0.624	0.013
OAHIREM, events/h, median (IQR)
Baseline	0.00 (0.00–0.69)^a	0.00 (0.00–1.09)^a	7.85 (5.38–14.15)^b	1.07 (0.35–2.90)^c	<0.001	<0.001
Follow-up	1.28 (0.00–6.00)^a	3.08 (0.59–10.75)^a	8.12 (1.40–24.84)^b	3.36 (0.00–14.11)^a,b	0.089	0.003
OAHINREM, events/h, median (IQR)
Baseline	0.00 (0.00–0.29)^a	0.00 (0.00–0.30)^a	0.64 (0.40–1.65)^b	2.12 (1.34–3.55)^c	<0.001	<0.001
Follow-up	0.52 (0.13–2.10)^a	0.84 (0.25–3.14)^a	1.51 (0.48–4.21)^b	1.85 (0.57–3.94)^b	0.993	0.014
ODI, events/h, median (IQR)
Baseline	0.12 (0.00–0.29)^a	0.13 (0.00–0.45)^a	0.53 (0.20–1.50)^b	0.86 (0.48–1.42)^b	0.151	<0.001
Follow-up	1.26 (0.30–3.80)^a	0.86 (0.20–3.63)^a	2.16 (0.85–5.28)^b	2.70 (0.82–9.30)^b	0.411	0.022
ArI, events/h, median (IQR)
Baseline	5.63 (4.51–7.66)^a	6.08 (4.76–7.82)^a	7.08 (5.58–8.63)^b	8.24 (6.32–10.71)^b	0.054	<0.001
Follow-up	11.59 (8.99–15.64)	12.17 (9.25–15.99)	12.20 (9.58–16.53)	13.02 (10.06–16.45)	0.824	0.654
SpO2 nadir, %
Baseline	92.9 ± 2.6^a	93.1 ± 1.7^a	91.3 ± 2.8^b	90.4 ± 2.6^b	0.133	<0.001
Follow-up	92.6 ± 2.7	93.1 ± 3.4	91.6 ± 3.3	91.7 ± 2.5	0.845	0.051
SpO2 nadir in REM, %
Baseline	93.6 ± 2.6^a	93.8 ± 1.5^a	91.5 ± 2.8^b	91.9 ± 2.1^b	0.412	<0.001
Follow-up	93.4 ± 2.8	93.8 ± 3.6	92.4 ± 3.2	93.1 ± 2.6	0.276	0.080
SpO2 nadir in NREM, %
Baseline	93.8 ± 1.9^a	93.7 ± 1.9^a,b	92.8 ± 1.9^b	90.8 ± 2.7^c	<0.001	<0.001
Follow-up	93.3 ± 2.2^a	93.7 ± 1.9^a	92.8 ± 2.6^a,b	92.1 ± 2.3^b	0.198	0.011
Daytime SBP, mmHg
Baseline*	111.5 ± 9.6	112.0 ± 7.8	112.8 ± 8.8	114.1 ± 6.5	0.533	0.635
Follow-up	114.4 ± 9.5	115.0 ± 10.2	116.2 ± 9.6	117.4 ± 9.3	0.553	0.415
Daytime DBP, mmHg
Baseline*	71.1 ± 5.6	72.9 ± 5.7	71.7 ± 5.5	73.4 ± 5.1	0.245	0.259
Follow-up	72.4 ± 6.0	73.3 ± 6.6	72.6 ± 6.3	73.0 ± 6.3	0.780	0.876
Nighttime SBP, mmHg
Baseline*	99.4 ± 10.3	97.8 ± 6.3	103.1 ± 9.3	100.7 ± 7.3	0.293	0.089
Follow-up	102.7 ± 8.7	103.8 ± 8.9	105.2 ± 10.0	104.8 ± 8.3	0.865	0.366
Nighttime DBP, mmHg
Baseline*	59.1 ± 6.2	58.2 ± 4.8	59.9 ± 6.2	59.4 ± 5.3	0.760	0.698
Follow-up	61.9 ± 6.1	62.9 ± 6.7	62.1 ± 7.1	62.0 ± 5.0	0.914	0.815
Nocturnal SBP dipping,%
Baseline*	10.8 ± 5.0^a	12.5 ± 5.0^a	8.4 ± 6.5^b	11.7 ± 5.1^a	0.046	0.016
Follow-up	10.1 ± 4.9	9.6 ± 6.1	9.2 ± 6.1	10.6 ± 4.8	0.267	0.627
Nocturnal DBP dipping,%
Baseline*	16.8 ± 6.6	19.8 ± 7.4	16.4 ± 6.5	19.0 ± 5.1	0.114	0.087
Follow-up	14.5 ± 6.4	14.0 ± 7.1	14.4 ± 7.3	14.8 ± 6.1	0.799	0.954
Any hypertension
Baseline*	14 (20.9)	3 (10.3)	10 (26.3)	5 (21.7)	0.687	0.447
Follow-up	11 (11.6)	10 (21.3)	12 (20.7)	5 (14.7)	0.452	0.347

Notes: Data presented as mean ± standard deviation unless otherwise specified. P value^d represents the comparisons between REM-OSA and non REM-OSA. P value^e represents the comparisons among all groups by one-way ANOVA, Kruskal–Wallis 1-way ANOVA and Chi-Square for parametric, non-parametric and categorical variables respectively. ^a,b,c Cells in each row with different superscripts represent statistically significant differences in group means or medians (p<0.05). *Data were available from 67 normal, 29 PS, 38 REM-OSA and 23 non REM-OSA subjects. ^&Habitual snoring and mouth-breathing ≥ 3 nights per week.

Abbreviations: OSA, obstructive sleep apnea; PS, primary snoring; h, hour; OAHI, obstructive apnea–hypopnea index; REM, rapid-eye-movement; NREM, non-rapid-eye-movement; BMI, body mass index; ESS, Epworth Sleepiness Scale; ODI, oxygen desaturation index; ArI, arousal index; SpO2, oxygen saturation; OAHI_REM, OAHI in REM sleep; OAHI_NREM, OAHI in NREM sleep; DBP, diastolic blood pressure; SBP, systolic blood pressure.

Table 3 Characteristics at Follow-Up by SDB Status and Subtypes at 10-Year Follow-Up (N = 234)

	SDB Status and Subtypes at 10-Year Follow Up
Characteristics at Follow-Up	Normal (OAHI<5/h) N = 149	PS N= 27	OSA (OAHI ≥5/h) N = 58			P value^e
			REM-OSA N = 34	Non REM-OSA N = 24	P value^d
Age, years	20.1 ± 2.0	20.4 ± 2.0	20.7 ± 1.9	19.7 ± 1.6	0.051	0.250
Male sex, n (%)	83 (55.7)	14 (51.9)	25 (73.5)	18 (75)	0.900	0.081
BMI, m/kg^Citation2	21.2 ± 3.4^a	21.5 ± 3.0^a	23.8 ± 5.0^b	23.6 ± 4.5^b	0.856	<0.001
BMI z score, median (IQR)	0.23 (−0.60–0.58)^a	0.42 (−0.33–0.93)^a,b	0.63 (−0.01–1.56)^b	0.59 (−0.21–1.48)^b	0.862	0.017
Height, cm	167.0 ± 9.2^a,b	163.9 ± 8.7^a	168.8 ± 7.9^a,b	170.7 ± 6.2^b	0.324	0.031
Overweight/obese, n (%)	39 (26.2)	11 (40.7)	15 (44.1)	11 (45.8)	0.897	0.055
Tonsils ≥ grade 2, n (%)	20 (13.4)	3 (11.1)	7 (20.6)	6 (25.0)	0.692	0.365
Allergic rhinitis, n (%)	99 (66.4)	26 (96.3)	27 (79.4)	16 (66.7)	0.311	0.020
Habitual snoring^&, n (%)	0 (0)	27 (100)	13 (38.2)	11 (45.8)	0.563	<0.001
Mouth breathing^&, n (%)	22 (14.8)	18 (66.7)	13 (38.2)	7 (29.2)	0.545	<0.001
ESS score	7.1 ± 4.0^a	9.9 ± 3.7^b	6.7 ± 4.8^a	6.1 ± 4.2^a	0.636	0.004
REM sleep duration, minutes	114.2 ± 33.5	125.7 ± 34.2	116.1 ± 37.7	103.4 ± 36.3	0.203	0.145
NREM sleep duration, minutes	380.0 ± 58.6	382.9 ± 42.9	384.1± 57.0	370.9 ± 60.4	0.398	0.834
OAHI, events/h, median (IQR)	0.60 (0.00–1.70)^a	0.90 (0.10–2.60)^a	8.48 (5.76–14.59)^b	15.22 (7.68–23.20)^c	0.026	<0.001
OAHIREM, events/h, median (IQR)	1.14 (0.00–5.03)^a	1.56 (0.37–7.74)^a	26.33 (15.05–37.22)^b	10.04 (5.79–25.08)^c	<0.001	<0.001
OAHINREM, events/h, median (IQR)	0.57 (0.12–1.37)^a	0.63 (0.15–2.09)^a	4.67 (2.12–8.42)^b	13.98 (7.23–24.41)^c	<0.001	<0.001
ODI, events/h, median (IQR)	0.95 (0.29–2.69)^a	1.40 (0.20–2.10)^a	6.83 (3.04–11.28)^b	8.20 (4.43–17.61)^b	0.117	<0.001
ArI, events/h, median (IQR)	11.24 (8.79–14.35)^a	10.36 (8.18–13.20)^a	16.45 (11.85–22.47)^b	23.68 (16.44–34.98)^c	0.005	<0.001
SpO2 nadir, %	93.2 ± 2.1^a	92.7 ± 2.0^a	89.6 ± 4.2^b	90.0 ± 3.4^b	0.723	<0.001
SpO2 nadir in REM, %	94.1 ± 2.1^a	93.4 ± 2.1^a,c	89.9 ± 4.3^b	91.7 ± 3.1^b,c	0.077	<0.001
SpO2 nadir in NREM, %	93.7 ± 1.9^a	93.5 ± 1.7^a	91.9 ± 2.0^b	90.7 ± 3.4^b	0.097	<0.001
Daytime SBP, mmHg	114.4 ± 8.9^a	112.2 ± 11.2^a	119.9 ± 8.2^b	119.1 ± 11.0^b	0.759	0.001
Daytime DBP, mmHg	72.4 ± 5.9	72.0 ± 7.5	74.5 ± 5.9	73.8 ± 6.6	0.668	0.186
Nighttime SBP, mmHg	102.9 ± 8.0^a	100.9 ± 10.2^a	108.8 ± 10.6^b	105.6 ± 9.0^a,b	0.237	0.001
Nighttime DBP, mmHg	61.8 ± 5.9	60.6 ± 7.0	64.3 ± 6.7	63.2 ± 6.8	0.558	0.086
Nocturnal SBP dipping,%	9.8 ± 5.1	9.9 ± 5.9	9.3 ± 6.3	11.0 ± 5.9	0.290	0.685
Nocturnal DBP dipping,%	14.4 ± 6.8	15.7 ± 6.1	13.6 ± 7.5	14.5 ± 5.8	0.620	0.691
Any hypertension, n (%)	18 (12.1)	4 (14.8)	10 (29.4)	6 (25)	0.784	0.051

Notes: Data presented as mean ± standard deviation unless otherwise specified. P value^d represents the comparisons between REM-OSA and non REM-OSA. P value^e represents the comparisons among all groups by one-way ANOVA, Kruskal–Wallis 1-way ANOVA and Chi-Square for parametric, non-parametric and categorical variables respectively. ^a,b,c Cells in each row with different superscripts represent statistically significant differences in group means or medians (p < 0.05).

Abbreviations: OSA, obstructive sleep apnea; PS, primary snoring; h, hour; OAHI, obstructive apnea–hypopnea index; REM, rapid-eye-movement; NREM, non-rapid-eye-movement; BMI, body mass index; ODI, oxygen desaturation index; ArI, arousal index; SpO2, oxygen saturation; OAHI_REM, OAHI in REM sleep; OAHI_NREM, OAHI in NREM sleep; DBP, diastolic blood pressure; SBP, systolic blood pressure.

Table 4 SDB Status and Subtypes at Baseline and Follow-Up (N = 234)

	Baseline SDB Subtypes	Follow-Up
		No SDB OAHI<5/h	Primary Snoring	OAHI ≥5/h REM-OSA	OAHI ≥5/h Non REM-OSA	Subtotal
Incidence/Progression	Normal	–	7/95	10/95	7/95	24/95 (25%)
	Primary snoring	–	–	5/47	7/47	12/47 (26%)
	Mild OSA – REM-OSA (OAHI 1-<5/h)	–	–	–	–	–
	Mild OSA – Non REM-OSA (OAHI 1-<5/h)	–	–	–	–	–
Persistence	Normal	71/95	–	–	–	71/95 (75%)
	Primary snoring	–	9/47	–	–	9/47 (19%)
	Mild OSA – REM-OSA (OAHI 1-<5/h)	–	–	7/45	4/45	11/45 (24%)
	Mild OSA – Non REM-OSA (OAHI 1-<5/h)	–	–	2/28	5/28	7/28 (25%)
	MS OSA – REM-OSA (OAHI ≥5/h)	–	–	6/13	1/13	7/13 (54%)
	MS OSA – Non REM-OSA (OAHI ≥5/h)	–	–	4/6	0/6	4/6 (67%)
Remission/Improvement	Primary snoring	26/47	–	–	–	26/47 (55%)
	Mild OSA – REM-OSA (OAHI 1-<5/h)	27/45	7/45	–	–	34/45 (76%)
	Mild OSA – Non REM-OSA (OAHI 1-<5/h)	20/28	1/28	–	–	21/28 (75%)
	MS OSA – REM-OSA (OAHI ≥5/h)	4/13	2/13	–	–	6/13 (46%)
	MS OSA – Non REM-OSA (OAHI ≥5/h)	1/6	1/6	–	–	2/6 (33%)

Abbreviations: OSA, obstructive sleep apnea; MS, moderate-to-severe; h, hour; OAHI, obstructive apnea–hypopnea index; REM, rapid-eye-movement.

Table 5 Associations Between OSA Subtypes and Blood Pressure Among Participants from Both Visits (Pooled Data from Both Visits)

	Groups	Adjusted Mean	95% CI		Mean Difference	95% CI		p
			Lower Bound	Upper Bound		Lower Bound	Upper Bound
Daytime SBP (mmHg)	OAHI <1/h	114.16	112.88	115.43	0.18*	−1.82	2.19	0.857
	OAHI ≥1/h, REM-OSA	114.34	112.63	116.05	−1.08^	−3.87	1.70	0.443
	OAHI ≥1/h, Non REM-OSA	115.42	113.07	117.78
Daytime DBP (mmHg)	OAHI <1/h	72.23	71.27	73.18	0.45*	−0.93	1.84	0.520
	OAHI ≥1/h, REM-OSA	72.68	71.47	73.89	−1.22^	−3.09	0.65	0.201
	OAHI ≥1/h, Non REM-OSA	73.90	72.30	75.50
Nighttime SBP (mmHg)	OAHI <1/h	101.95	100.59	103.30	2.19*	0.12	4.26	0.039
	OAHI ≥1/h, REM-OSA	104.13	102.34	105.93	1.22^	−1.64	4.08	0.400
	OAHI ≥1/h, Non REM-OSA	102.91	100.48	105.34
Nighttime DBP (mmHg)	OAHI <1/h	60.35	59.35	61.35	1.58*	0.11	3.04	0.035
	OAHI ≥1/h, REM-OSA	61.93	60.64	63.21	0.70^	−1.29	2.69	0.489
	OAHI ≥1/h, Non REM-OSA	61.23	59.52	62.93
Nocturnal SBP dipping (%)	OAHI <1/h	10.43	9.58	11.29	−1.84*	−3.25	−0.43	0.011
	OAHI ≥1/h, REM-OSA	8.59	7.42	9.76	−1.90^	−3.88	0.09	0.061
	OAHI ≥1/h, Non REM-OSA	10.49	8.82	12.16
Nocturnal DBP dipping (%)	OAHI <1/h	16.16	15.06	17.26	−1.33*	−3.09	0.42	0.136
	OAHI ≥1/h, REM-OSA	14.83	13.35	16.31	−2.12^	−4.56	0.33	0.089
	OAHI ≥1/h, Non REM-OSA	16.94	14.88	19.01

Notes: *Mean difference between REM-OSA and OAHI<1/h (REM-OSA minus OAHI<1/h). ^Mean difference between REM-OSA and non REM-OSA (REM-OSA minus non REM-OSA). Covariates in the model: gender, age at baseline, BMI at baseline, body height, parental history of hypertension.

Abbreviations: OSA, obstructive sleep apnea; h, hour; OAHI, obstructive apnea–hypopnea index; REM, rapid-eye-movement; NREM, non-rapid-eye-movement; DBP, diastolic blood pressure; SBP, systolic blood pressure; CI, confidence interval.

Table 6 Subgroup Analysis on the Associations Between OSA Subtypes and Nocturnal Systolic Blood Pressure Dipping Among Participants

Visit Time Point		Groups	Adjusted Mean	95% CI		Mean Difference	95% CI		p
				Lower Bound	Upper Bound		Lower Bound	Upper Bound
Baseline	Nocturnal SBP dipping (%)	OAHI <1/h	9.87	7.70	12.03	−3.24*	−5.45	−1.03	0.004
		OAHI ≥1/h, REM-OSA	6.62	4.03	9.21	−3.26^	−6.72	0.19	0.064
		OAHI ≥1/h, Non REM-OSA	9.89	6.43	13.34
10-year follow-up	Nocturnal SBP dipping (%)	OAHI <1/h	11.00	9.38	12.61	−0.44*	−2.10	1.21	0.599
		OAHI ≥1/h, REM-OSA	10.56	8.75	12.36	−0.53^	−2.47	1.40	0.588
		OAHI ≥1/h, Non REM-OSA	11.09	9.17	13.01

Notes: *Mean difference between REM-OSA and OAHI<1/h (REM-OSA minus OAHI<1/h). ^Mean difference between REM-OSA and non REM-OSA (REM-OSA minus non REM-OSA). Covariates in the model: gender, age at baseline, BMI at baseline, body height, parental history of hypertension.

Abbreviations: OSA, obstructive sleep apnea; h, hour; OAHI, obstructive apnea–hypopnea index; REM, rapid-eye-movement; NREM, non-rapid-eye-movement; DBP, diastolic blood pressure; SBP, systolic blood pressure; CI, confidence interval.

Table 7 Associations Between OSA Subtypes and Blood Pressure Among Participants from Both Visits Using OAHI ≥5/h to define OSA(Pooled Data from Both Visits)

	Groups	Adjusted Mean	95% CI		Mean Difference Between REM-OSA and Non REM-OSA	95% CI		p
			Lower Bound	Upper Bound		Lower Bound	Upper Bound
Daytime SBP (mmHg)	OAHI <5/h	114.10	113.06	115.14	0.47*	−2.38	3.32	0.746
	OAHI ≥5/h, REM-OSA	114.57	111.82	117.33	−2.49^	−7.19	2.22	0.298
	OAHI ≥5/h, Non REM-OSA	117.06	113.08	121.03
Daytime DBP (mmHg)	OAHI <5/h	72.44	71.65	73.23	0.18*	−1.761	2.128	0.853
	OAHI ≥5/h, REM-OSA	72.62	70.72	74.52	−2.62^	−5.728	0.481	0.097
	OAHI ≥5/h, Non REM-OSA	75.25	72.62	77.88
Nighttime SBP (mmHg)	OAHI <5/h	102.33	101.22	103.45	2.25*	−0.71	5.22	0.136
	OAHI ≥5/h, REM-OSA	104.59	101.71	107.46	0.52^	−4.34	5.37	0.834
	OAHI ≥5/h, Non REM-OSA	104.07	99.96	108.18
Nighttime DBP (mmHg)	OAHI <5/h	60.63	59.81	61.46	1.80*	−0.27	3.87	0.088
	OAHI ≥5/h, REM-OSA	62.43	60.41	64.45	0.17^	−3.17	3.50	0.921
	OAHI ≥5/h, Non REM-OSA	62.27	59.44	65.09
Nocturnal SBP dipping (%)	OAHI <5/h	10.17	9.49	10.86	−2.15*	−4.19	−0.12	0.038
	OAHI ≥5/h, REM-OSA	8.02	6.07	9.97	−2.53^	−5.97	0.91	0.149
	OAHI ≥5/h, Non REM-OSA	10.55	7.65	13.45
Nocturnal DBP dipping (%)	OAHI <5/h	16.15	15.26	17.03	−2.27*	−4.76	0.23	0.075
	OAHI ≥5/h, REM-OSA	13.88	11.48	16.28	−3.33^	−7.48	0.82	0.115
	OAHI ≥5/h, Non REM-OSA	17.21	13.71	20.71

Notes: *Mean difference between REM-OSA and OAHI<5/h (REM-OSA minus OAHI<5/h). ^Mean difference between REM-OSA and non REM-OSA (REM-OSA minus non REM-OSA). Covariate in the model: gender, age at baseline, BMI at baseline, body height, parental history of hypertension.

Abbreviations: OSA, obstructive sleep apnea; h, hour; OAHI, obstructive apnea–hypopnea index; REM, rapid-eye-movement; NREM, non-rapid-eye-movement; DBP, diastolic blood pressure; SBP, systolic blood pressure; CI, confidence interval.

Dehlink E, Tan HL. Update on paediatric obstructive sleep apnoea. J Thorac Dis. 2016;8(2):224–235. doi:10.3978/j.issn.2072-1439.2015.12.04

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