Apnea obstructiva del sueño en REM y su relevancia clínica
Obstructive sleep apnea in REM and its clinical relevance

Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
Ninguna publicación, nacional o extranjera, podrá reproducir ni traducir sus artículos ni sus resúmenes sin previa autorización escrita del editor; sin embargo los usuarios pueden descargar la información contenida en ella, pero deben darle atribución o reconocimiento de propiedad intelectual, deben usarlo tal como está, sin derivación alguna.
Mostrar biografía de los autores
Introducción. La apnea de sueño en REM es una entidad que se presenta en un subgrupo de pacientes con apnea obstructiva del sueño, que ha generado interés en los últimos años. Aunque es una condición que se ha descrito desde hace varios años, sólo hasta ahora se han comenzado a investigar sus diferencias con respecto a la apnea obstructiva de sueño de predomino en sueño NREM. Es así como se ha buscado establecer la función del sueño REM y determinar las asociaciones que tiene con escenarios clínicos relevantes en la práctica diaria como la somnolencia diurna y la enfermedad cardiovascular. Este artículo revisa la importancia del sueño REM y describe la evidencia disponible con respecto a la apnea de sueño en REM y su posible asociación con la somnolencia diurna, la hipertensión arterial sistémica y la enfermedad cardiovascular.
Materiales y métodos. Se realizó una revisión narrativa de la literatura para explorar la información disponible sobre la AOS en REM. La búsqueda de estudios se extendió hasta mayo de 2023 y se llevó a cabo en las bases de datos Medline y Embase.
Resultados. La revisión destaca la importancia y fisiología del sueño REM, epidemiología de la AOS en REM; apnea de sueño en REM y somnolencia diurna; apnea de sueño en REM e hipertensión arterial sistémica; apnea de sueño en REM y enfermedad cardiovascular y el impacto clínico de los pacientes con AOS leve, dado que generalmente no son considerados para tratamiento con CPAP.
Conclusiones. En Colombia no existen estudios que comparen la AOS en REM y NREM en términos de somnolencia diurna, hipertensión arterial, enfermedad isquémica del corazón o enfermedad cerebrovascular. Además, ninguno de los estudios previos se ha realizado en poblaciones a gran altitud. Esto presenta una oportunidad para avanzar en la investigación sobre esta condición y mejorar el manejo clínico de estos pacientes.
Visitas del artículo 268 | Visitas PDF 43
Descargas
- Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-14. doi: https://doi.org/10.1093/aje/kws342 DOI: https://doi.org/10.1093/aje/kws342
- Punjabi NM. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5(2):136-43. doi: https://doi.org/10.1513/pats.200709-155mg DOI: https://doi.org/10.1513/pats.200709-155MG
- Garvey JF, Pengo MF, Drakatos P, Kent BD. Epidemiological aspects of obstructive sleep apnea. J Thorac Dis. 2015;7(5):920-9. doi: https://doi.org/10.3978/j.issn.2072-1439.2015.04.52
- Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230-5. doi: https://doi.org/10.1056/nejm199304293281704 DOI: https://doi.org/10.1056/NEJM199304293281704
- Ruiz AJ, Sepulveda MA, Martinez PH, Munoz MC, Mendoza LO, Centanaro OP, et al. Prevalence of sleep complaints in Colombia at different altitudes. Sleep Sci. 2016;9(2):100-5. doi: https://doi.org/10.1016/j.slsci.2016.05.008 DOI: https://doi.org/10.1016/j.slsci.2016.05.008
- Menezes AM, Perez-Padilla R, Jardim JR, Muino A, Lopez MV, Valdivia G, et al. Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. Lancet. 2005;366(9500):1875-81. doi: https://doi.org/10.1016/s0140-6736(05)67632-5 DOI: https://doi.org/10.1016/S0140-6736(05)67632-5
- Bottia S, Barrios-Bermúdez H, Rosselli D. Prevalencia de apnea de sueño en Colombia: un análisis de las bases de datos del Ministerio de Salud. Revista Médica Iatreia. 2024;37(1). doi: https://doi.org/10.17533/udea.iatreia.222 DOI: https://doi.org/10.17533/udea.iatreia.222
- Rishi AR, Rishi MA. Rapid eye movement related obstructive sleep apnea: Where do we stand? Respir Investig. 2021;59(5):589-95. doi: https://doi.org/10.1016/j.resinv.2021.06.006 DOI: https://doi.org/10.1016/j.resinv.2021.06.006
- Mokhlesi B, Punjabi NM. "REM-related" obstructive sleep apnea: an epiphenomenon or a clinically important entity? Sleep. 2012;35(1):5-7. doi: https://doi.org/10.5665/sleep.1570 DOI: https://doi.org/10.5665/sleep.1570
- Peever J, Fuller PM. Neuroscience: A Distributed Neural Network Controls REM Sleep. Curr Biol. 2016;26(1):R34-5. doi: https://doi.org/10.1016/j.cub.2015.11.011 DOI: https://doi.org/10.1016/j.cub.2015.11.011
- Simor P, van der Wijk G, Nobili L, Peigneux P. The microstructure of REM sleep: Why phasic and tonic? Sleep Med Rev. 2020;52:101305. doi: https://doi.org/10.1016/j.smrv.2020.101305 DOI: https://doi.org/10.1016/j.smrv.2020.101305
- Boyce R, Glasgow SD, Williams S, Adamantidis A. Causal evidence for the role of REM sleep theta rhythm in contextual memory consolidation. Science. 2016;352(6287):812-6. doi: https://doi.org/10.1126/science.aad5252 DOI: https://doi.org/10.1126/science.aad5252
- Li W, Ma L, Yang G, Gan WB. REM sleep selectively prunes and maintains new synapses in development and learning. Nat Neurosci. 2017;20(3):427-37. doi: https://doi.org/10.1038/nn.4479 DOI: https://doi.org/10.1038/nn.4479
- Murali NS, Svatikova A, Somers VK. Cardiovascular physiology and sleep. Front Biosci. 2003;8:s636-52. doi: https://doi.org/10.2741/1105 DOI: https://doi.org/10.2741/1105
- Morgan D, Tsai SC. Sleep and the endocrine system. Crit Care Clin. 2015;31(3):403-26 doi: https://doi.org/10.1016/j.jsmc.2015.10.002 DOI: https://doi.org/10.1016/j.ccc.2015.03.004
- Krimsky WR, Leiter JC. Physiology of breathing and respiratory control during sleep. Semin Respir Crit Care Med. 2005;26(1):5-12. doi: https://doi.org/10.1055/s-2005-864197 DOI: https://doi.org/10.1055/s-2005-864197
- Varga AW, Mokhlesi B. REM obstructive sleep apnea: risk for adverse health outcomes and novel treatments. Sleep Breath. 2019;23(2):413-23. doi: https://doi.org/10.1007/s11325-018-1727-2 DOI: https://doi.org/10.1007/s11325-018-1727-2
- Pirzada AR, BaHammam AS. Rapid eye movement predominant obstructive sleep apnoea: prognostic relevance and clinical approach. Curr Opin Pulm Med. 2021;27(6):514-522 doi: https://doi.org/10.1097/mcp.0000000000000817 DOI: https://doi.org/10.1097/MCP.0000000000000817
- O'Connor C, Thornley KS, Hanly PJ. Gender differences in the polysomnographic features of obstructive sleep apnea. Am J Respir Crit Care Med. 2000;161(5):1465-72. https://doi.org/10.1164/ajrccm.161.5.9904121 DOI: https://doi.org/10.1164/ajrccm.161.5.9904121
- Haba-Rubio J, Janssens JP, Rochat T, Sforza E. Rapid eye movement-related disordered breathing: clinical and polysomnographic features. Chest. 2005;128(5):3350-7. doi: https://doi.org/10.1378/chest.128.5.3350 DOI: https://doi.org/10.1378/chest.128.5.3350
- Koo BB, Patel SR, Strohl K, Hoffstein V. Rapid eye movement-related sleep-disordered breathing: influence of age and gender. Chest. 2008;134(6):1156-61. doi: https://doi.org/10.1378/chest.08-1311 DOI: https://doi.org/10.1378/chest.08-1311
- Conwell W, Patel B, Doeing D, Pamidi S, Knutson KL, Ghods F, et al. Prevalence, clinical features, and CPAP adherence in REM-related sleep-disordered breathing: a cross-sectional analysis of a large clinical population. Sleep Breath. 2012;16(2):519-26. doi: https://doi.org/10.1007/s11325-011-0537-6 DOI: https://doi.org/10.1007/s11325-011-0537-6
- Koo BB, Dostal J, Ioachimescu O, Budur K. The effects of gender and age on REM-related sleep-disordered breathing. Sleep Breath. 2008;12(3):259-64. doi: https://doi.org/10.1007/s11325-007-0161-7 DOI: https://doi.org/10.1007/s11325-007-0161-7
- Resta O, Carpanano GE, Lacedonia D, Di Gioia G, Giliberti T, Stefano A, et al. Gender difference in sleep profile of severely obese patients with obstructive sleep apnea (OSA). Respir Med. 2005;99(1):91-6. doi: https://doi.org/10.1016/j.rmed.2004.05.014 DOI: https://doi.org/10.1016/j.rmed.2004.05.014
- Won CHJ, Reid M, Sofer T, Azarbarzin A, Purcell S, White D, et al. Sex differences in obstructive sleep apnea phenotypes, the multi-ethnic study of atherosclerosis. Sleep. 2020;43(5):zsz274. doi: https://doi.org/10.1093/sleep/zsz274 DOI: https://doi.org/10.1093/sleep/zsz274
- Duce B, Kulkas A, Langton C, Toyras J, Hukins C. The prevalence of REM-related obstructive sleep apnoea is reduced by the AASM 2012 hypopnoea criteria. Sleep Breath. 2018;22(1):57-64. doi: https://doi.org/10.1007/s11325-017-1526-1 DOI: https://doi.org/10.1007/s11325-017-1526-1
- Mano M, Hoshino T, Sasanabe R, Murotani K, Nomura A, Hori R, et al. Impact of Gender and Age on Rapid Eye Movement-Related Obstructive Sleep Apnea: A Clinical Study of 3234 Japanese OSA Patients. Int J Environ Res Public Health. 2019;16(6):1068. doi: https://doi.org/10.3390/ijerph16061068 DOI: https://doi.org/10.3390/ijerph16061068
- Sakao S, Sakurai T, Yahaba M, Sakurai Y, Terada J, Tanabe N, et al. Features of REM-related Sleep Disordered Breathing in the Japanese Population. Intern Med. 2015;54(12):1481-7. doi: https://doi.org/10.2169/internalmedicine.54.4248 DOI: https://doi.org/10.2169/internalmedicine.54.4248
- Moraes W, Poyares D, Zalcman I, de Mello MT, Bittencourt LR, Santos-Silva R, et al. Association between body mass index and sleep duration assessed by objective methods in a representative sample of the adult population. Sleep Med. 2013;14(4):312-8. doi: https://doi.org/10.1016/j.sleep.2012.11.010 DOI: https://doi.org/10.1016/j.sleep.2012.11.010
- Ozdilekcan C, Ozdemir T, Turkkani MH, Sur HY, Katoue MG. The association of body mass index values with severity and phenotype of sleep-disordered breathing. Tuberk Toraks. 2019;67(4):265-71. doi: https://doi.org/10.5578/tt.69057 DOI: https://doi.org/10.5578/tt.69057
- Kass JE, Akers SM, Bartter TC, Pratter MR. Rapid-eye-movement-specific sleep-disordered breathing: a possible cause of excessive daytime sleepiness. Am J Respir Crit Care Med. 1996;154(1):167-9. doi: https://doi.org/10.1164/ajrccm.154.1.8680674 DOI: https://doi.org/10.1164/ajrccm.154.1.8680674
- Chami HA, Baldwin CM, Silverman A, Zhang Y, Rapoport D, Punjabi NM, et al. Sleepiness, quality of life, and sleep maintenance in REM versus non-REM sleep-disordered breathing. Am J Respir Crit Care Med. 2010;181(9):997-1002. doi: https://doi.org/10.1164/rccm.200908-1304OC DOI: https://doi.org/10.1164/rccm.200908-1304OC
- Chervin RD, Aldrich MS. The relation between multiple sleep latency test findings and the frequency of apneic events in REM and non-REM sleep. Chest. 1998;113(4):980-4. doi: https://doi.org/10.1378/chest.113.4.980 DOI: https://doi.org/10.1378/chest.113.4.980
- Punjabi NM, Bandeen-Roche K, Marx JJ, Neubauer DN, Smith PL, Schwartz AR. The association between daytime sleepiness and sleep-disordered breathing in NREM and REM sleep. Sleep. 2002;25(3):307-14. doi: https://doi.org/10.1093/sleep/25.3.307 DOI: https://doi.org/10.1093/sleep/25.3.307
- Geckil AA, Ermis H. The relationship between anxiety, depression, daytime sleepiness in the REM-related mild OSAS and the NREM-related mild OSAS. Sleep Breath. 2020;24(1):71-5. doi: https://doi.org/10.1007/s11325-019-01838-y DOI: https://doi.org/10.1007/s11325-019-01838-y
- Gabryelska A, Bialasiewicz P. Association between excessive daytime sleepiness, REM phenotype and severity of obstructive sleep apnea. Sci Rep. 2020;10(1):34. https://doi.org/10.1038/s41598-019-56478-9 DOI: https://doi.org/10.1038/s41598-019-56478-9
- Varga AW, Kishi A, Mantua J, Lim J, Koushyk V, Leibert DP, et al. Apnea-induced rapid eye movement sleep disruption impairs human spatial navigational memory. J Neurosci. 2014;34(44):14571-7. doi: https://doi.org/10.1523/jneurosci.3220-14.2014 DOI: https://doi.org/10.1523/JNEUROSCI.3220-14.2014
- Mokhlesi B, Finn LA, Hagen EW, Young T, Hla KM, Van Cauter E, et al. Obstructive sleep apnea during REM sleep and hypertension. Results of the Wisconsin Sleep Cohort. Am J Respir Crit Care Med. 2014;190(10):1158-67. doi: https://doi.org/10.1164/rccm.201406-1136oc DOI: https://doi.org/10.1164/rccm.201406-1136OC
- Mokhlesi B, Hagen EW, Finn LA, Hla KM, Carter JR, Peppard PE. Obstructive sleep apnoea during REM sleep and incident non-dipping of nocturnal blood pressure: a longitudinal analysis of the Wisconsin Sleep Cohort. Thorax. 2015;70(11):1062-9. doi: https://doi.org/10.1136/thoraxjnl-2015-207231 DOI: https://doi.org/10.1136/thoraxjnl-2015-207231
- Ren R, Zhang Y, Yang L, Shi Y, Covassin N, Tang X. Sleep fragmentation during rapid eye movement sleep and hypertension in obstructive sleep apnea. J Hypertens. 2023;41(2):310-5. doi: https://doi.org/10.1097/hjh.0000000000003332 DOI: https://doi.org/10.1097/HJH.0000000000003332
- Falla C, Young A, Pope A, O'Driscoll DM. Obstructive sleep apnea during REM sleep: effects on morning and evening blood pressure. Sleep. 2023;46(3). doi: https://doi.org/10.1093/sleep/zsac259 DOI: https://doi.org/10.1093/sleep/zsac259
- Suzuki M, Shimamoto K, Tatsumi F, Tsuji T, Satoya N, Inoue Y, et al. Long-term outcomes regarding arterial stiffness and carotid artery atherosclerosis in female patients with rapid eye movement obstructive sleep apnea. J Int Med Res. 2022;50(9):3000605221121941. doi: https://doi.org/10.1177/03000605221121941 DOI: https://doi.org/10.1177/03000605221121941
- Ljunggren M, Lindberg E, Franklin KA, Ohagen P, Larsson M, Theorell-Haglow J, et al. Obstructive sleep apnea during rapid eye movement sleep is associated with early signs of atherosclerosis in women. Sleep. 2018;41(7). doi: https://doi.org/10.1093/sleep/zsy099 DOI: https://doi.org/10.1093/sleep/zsy099
- Aung AT, Kristanto W, Tan MJ, Koo CY, Xu PQ, Chin CW, et al. Obstructive sleep apnea during rapid eye movement sleep in patients after percutaneous coronary intervention: a multicenter study. Sleep Breath. 2021;25(1):125-33. doi: https://doi.org/10.1007/s11325-020-02057-6 DOI: https://doi.org/10.1007/s11325-020-02057-6
- Somers VK, Dyken ME, Mark AL, Abboud FM. Sympathetic-nerve activity during sleep in normal subjects. N Engl J Med. 1993;328(5):303-7. doi: https://doi.org/10.1056/nejm199302043280502 DOI: https://doi.org/10.1056/NEJM199302043280502
- Findley LJ, Wilhoit SC, Suratt PM. Apnea duration and hypoxemia during REM sleep in patients with obstructive sleep apnea. Chest. 1985;87(4):432-6. doi: https://doi.org/10.1378/chest.87.4.432 DOI: https://doi.org/10.1378/chest.87.4.432
- Chiu HY, Liu YY, Shiao TH, Su KC, Chou KT, Chen YM. Clinical Characteristics of Rapid Eye Movement-Related Obstructive Sleep Apnea: An Experience in a Tertiary Medical Center of Taiwan. Nat Sci Sleep. 2022;14:1521-32. doi: https://doi.org/10.2147/nss.s368659 DOI: https://doi.org/10.2147/NSS.S368659
- Daghlas I, Dashti HS, Lane J, Aragam KG, Rutter MK, Saxena R, et al. Sleep Duration and Myocardial Infarction. J Am Coll Cardiol. 2019;74(10):1304-14. doi: https://doi.org/10.1016/j.jacc.2019.07.022 DOI: https://doi.org/10.1016/j.jacc.2019.07.022
- Zhu Y, Chen X, Guo L, Wang L, Chen N, Xiao Y, et al. Acute sleep deprivation increases inflammation and aggravates heart failure after myocardial infarction. J Sleep Res. 2022;31(6):e13679. doi: https://doi.org/10.1111/jsr.13679 DOI: https://doi.org/10.1111/jsr.13679
- Real EB GJ, Navarro C, Bodí V, Bañuls MP, Racugno P, López-Lereu MP, Mommeneu JV, Heras C, Signes J. Structural cardiac changes during REM and non-REM sleep in patients with myocardial infarction. European Respiratory Journal. 2020;56(suppl 64):2546. doi: https://doi.org/10.1183/13993003.congress-2020.2546 DOI: https://doi.org/10.1183/13993003.congress-2020.2546
- Aurora RN, Crainiceanu C, Gottlieb DJ, Kim JS, Punjabi NM. Obstructive Sleep Apnea during REM Sleep and Cardiovascular Disease. Am J Respir Crit Care Med. 2018;197(5):653-60. doi: https://doi.org/10.1164/rccm.201706-1112oc DOI: https://doi.org/10.1164/rccm.201706-1112OC
- Nishimura A, Kasai T, Matsumura K, Kikuno S, Nagasawa K, Okubo M, et al. Obstructive sleep apnea during rapid eye movement sleep in patients with diabetic kidney disease. J Clin Sleep Med. 2021;17(3):453-60. doi: https://doi.org/10.5664/jcsm.8924 DOI: https://doi.org/10.5664/jcsm.8924
- Jankowski J, Floege J, Fliser D, Bohm M, Marx N. Cardiovascular Disease in Chronic Kidney Disease: Pathophysiological Insights and Therapeutic Options. Circulation. 2021;143(11):1157-72. doi: https://doi.org/10.1161/circulationaha.120.050686 DOI: https://doi.org/10.1161/CIRCULATIONAHA.120.050686
- Wimms AJ, Kelly JL, Turnbull CD, McMillan A, Craig SE, O'Reilly JF, et al. Continuous positive airway pressure versus standard care for the treatment of people with mild obstructive sleep apnoea (MERGE): a multicentre, randomised controlled trial. Lancet Respir Med. 2020;8(4):349-58. doi: https://doi.org/10.1016/s2213-2600(19)30402-3 DOI: https://doi.org/10.1016/S2213-2600(19)30402-3
- Linz D, Loffler KA, Sanders P, Catcheside P, Anderson CS, Zheng D, et al. Low Prognostic Value of Novel Nocturnal Metrics in Patients With OSA and High Cardiovascular Event Risk: Post Hoc Analyses of the SAVE Study. Chest. 2020;158(6):2621-31. doi: https://doi.org/10.1016/j.chest.2020.06.072 DOI: https://doi.org/10.1016/j.chest.2020.06.072
- Azarbarzin A, Sands SA, Stone KL, Taranto-Montemurro L, Messineo L, Terrill PI, et al. The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study. Eur Heart J. 2019;40(14):1149-57. doi: https://doi.org/10.1093/eurheartj/ehy624 DOI: https://doi.org/10.1093/eurheartj/ehy624
- Wang L, Ou Q, Shan G, Lao M, Pei G, Xu Y, et al. Independent Association Between Oxygen Desaturation Index and Cardiovascular Disease in Non-Sleepy Sleep-Disordered Breathing Subtype: A Chinese Community-Based Study. Nat Sci Sleep. 2022;14:1397-406. doi: https://doi.org/10.2147/NSS.S370471 DOI: https://doi.org/10.2147/NSS.S370471
- Kendzerska T, Gershon AS, Hawker G, Leung RS, Tomlinson G. Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study. PLoS Med. 2014;11(2):e1001599. doi: https://doi.org/10.1371/journal.pmed.1001599 DOI: https://doi.org/10.1371/journal.pmed.1001599