Lately, this has seemed to be something we have talked about in the sleep center I am working, and I wrote this up. Does anyone have any further thoughts on the matter? If not, I hope you found the information helpful or insightful.
Have a great day!
EDIT:
Quote:Article:
REM-Related Sleep Apnea?
The topic of rapid eye movement stage sleep with sleep apnea has been a subject that has come up often over the past month. Per usual, when something comes up frequently I begin to dwell on the topic and simply want to know more, and more, and more, and more - yeah, it can be exhausting. But, that means I typically grow to have a clearer understanding. However, what I found was something that I did not expect to encounter, and I thought it may be something of interest to some of you!
First off, let me get some terms out of the way. I will refer "rapid eye movement" as REM. So "REM" sleep - or - "REM" related sleep apnea. I am sure most anyone could put that together, but maybe it will save me a few confusing emails! I'll also use the common acronyms such as CPAP (continuous positive airway pressure) and OSA (obstructive sleep apnea).
REM-related OSA has been coined by healthcare community to signify when a person has a significant number of sleep apneic events that manifest primarily in REM stage sleep and decrease substantially, or entirely, when in any other stage of sleep. The trend of REM-related OSA is highly variable ranging from anywhere between 10% to as much as 36% in controlled studies (Mohklesi & Punjabi, 2012). To me, that seems to be a small number of patients when it comes to the overall amount of people newly approaching a possible diagnosis of sleep apnea. The prevalence of REM-related sleep apnea has led to the questioning of whether it has a clinical significance or not. Should REM-related sleep apnea be treated or is it a natural phenomenon or a clinical entity that deserves treatment?
Per several different articles and even consulting other professionals, it seems that the consensus throughout the sleep community is the factor of co-morbidities. If a person has REM-related OSA with no other causes for concerns such as any other conditions, then the significance of REM-related OSA may be something natural that does not need to be treated. However, if a patient has any other diagnosis such as anxiety, depression, pulmonary disorder, a cardiac, or neurological problem (along with many others), then treatment with CPAP should be considered to correct. The application of therapy also comes into account too if the apnea events found in REM are highly severe, moderate, or mild. Mind you, dear reader that is the data I have found looking over the internet and talking with others. You are allowed to have your own opinion. Don't shoot the messager!
My perspective:
I am sure the depending on who one chooses to speak with will certainly sway their opinion on this matter. Some physicians may adhere to attempting treatment whenever possible while others may prefer to not utilizing CPAP in most instances. Some sleep centers may not allow their staff to treat if apnea is found primarily in REM while others may choose to do so regardless. As most any professional in the sleep technology field would agree there are certain problems, such as this one, that is very debatable to if, and how, a person may be treated or not.
Overall, I try to keep my perspective according to the guidelines in place by the American Academy of Sleep Medicine (AASM) and otherwise adhere to a physician's order/recommendation. That is pretty typical to how most technologist/technicians would approach the matter. We have certain guidelines that we must adhere too and a referring doctor that likely has a particular manner into how the patient is to be treated. The interesting part of this, for me, is proper treatment. The few that I have spoken with have suggested auto-CPAP would be the best treatment utilized to treat a patient. While others have felt that bi-level positive airway pressure (BiPAP/VPAP) would likely be the optimum form of therapy. I cannot find any studies that help to indicate which treatment mode would be the best option. The only studies that are available suggest that a titration sleep study should be performed to decipher what treatment method would be the best available to assure patient comfort, adherence, and optimal control of apneic events.
I think that most anyone in the sleep industry would agree with the approach. However, as most sometimes understand even medical studies and a specialized physician do not get the option to make these decisions. Insurance agencies sometimes just won't approve for a patient to return to a sleep center and simply want them prescribed a home unit to assume treatment. With REM-related sleep apnea, this is where the topic can become dense. The only controlled study cannot accurately allocate to whether 1 in 10 or 3 in 10 patients have this possible problem and therefore cannot recognize it as a particular condition. Without a particular condition, it seems that there cannot be a recommended specific treatment. I do not feel that auto-CPAP would be the best option due to the algorithm placed in the home CPAP units would not be able to accurately increase/decrease pressure quickly enough in the amount of time for REM sleep apnea to properly treated. However, it is an option for any type of treatment of insurers just won't allow a patient to return for a full titration visit.
Overall, if you have "REM-related sleep apnea" it is worth thoroughly discussing with a physician to if it should be treated, and if so, a full titration sleep study would likely be the most viable option to assure proper CPAP/auto-CPAP/bi-level PAP settings. I hope that this information is helpful and I would love to hear thoughts from the sleep community!
Moklesi B, Pnjabi NM. “REM-related” Obstructive Sleep Apnea: An epiphenomenon or a Clinically Important Entity? Sleep. 2012;35 (1):5-7. Doi: 10.5665/sleep.1570
Berry, R. B., Brookes, R., Gamaldo, C.E., Harding, S.M., Lloyd, R. M., Marcus, C.L., & Vaughn, B.V. (2016). The AASM manual for the scoring of sleep and associated events: rules, terminology, and technical specifications: version 2.3. Darien, IL: American Academy of Sleep Medicine.