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‘REM-related OSA’: a forgotten diagnostic? Possible path to under-diagnosing sleep apnea

A. Benetó, S. Soler-Algarra, V. Salavert [REV NEUROL 2016;63:481-487] PMID: 27874164 DOI: https://doi.org/10.33588/rn.6311.2016190

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Volumen 63 | Number 11 | Nº of views of the article 11.729 | Nº of PDF downloads 625 | Article publication date 01/12/2016

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ABSTRACT

INTRODUCTION Restrictive criteria are proposed to define the disorder ‘REM-related OSA’ disorder, and questions remain about its nosological transcendence and clinical management.

AIM To evaluate the criteria proposed to define ‘REM-related OSA’, its relationship with cardio-metabolic comorbidity, and aspects related to it diagnostic.

PATIENTS AND METHODS Retrospective observational study of clinical and polysomnographic data from outpatients. 525 patients over 18 years old who had an Apnea Hypopnea Index (AHI) >= 5 (total, or partial, in REM and/or NREM) were included.

RESULTS ‘Phase-dependent’ subgroups were formed using a criterion based on the ‘ratio >= 2’ and another ‘strict’ criterion based on a partial AHI >= 5 compared to another partial AHI <5 (in REM or in NREM). In the ‘strict REM-related OSA’ subgroup, half of the patients showed an overall AHI < 5, with less severity in the respiratory parameters, but with lower comorbidity percentages. With the current diagnostic criteria, these patients would be excluded from the sleep apnea diagnosis.

CONCLUSIONS The application of the strict criterion to detect ‘REM-related OSA’ makes it possible to filter milder forms of sleep apnea associated with percentages of cardiovascular and/or metabolic comorbidity that are not significantly different from other more severe forms of sleep apnea. To avoid under-diagnosis, it would be advisable to review the sleep apnea diagnostic criteria and the indications of the reduced sleep apnea diagnostic techniques. KeywordsComorbidity Obstructive sleep apnea Phase-dependent OSA Polysomnography REM-related OSA Under-diagnosis CategoriesNeuropsiquiatría Sueño

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Original

‘REM-related OSA’: a forgotten diagnostic? Possible path to under-diagnosing sleep apnea