Abstract
Abstract
Introduction
There is accumulating evidence that SDB present exclusively during REM sleep may be independently associated with adverse outcomes. However, it is not known whether REM-specific SDB will eventually progress to SDB during NREM sleep and whether there are gender-specific predictors of disease evolution. Thus, the current study characterized determinants of developing SDB during NREM sleep in those with REM-specific SDB.
Methods
Participants from the Sleep Heart Health study (SHHS) with REM-specific SDB at baseline and a follow-up sleep study were included in this analysis. Conventional cut-points were used to categorize SDB severity as follows: 5.0 - 14.9 events/hr (mild), 15.0 - 29.9 events/hr (moderate), and ≥ 30.0 events/hr (severe). Multivariable logistic regression was used to assess the odds of progression, defined as NREM-AHI ≥ 5 events/hr, on the follow-up sleep study. Covariates included age, race, body mass index (BMI) at baseline, and change in BMI. Weight gain was operationalized as an increase in BMI by > 1 kg/m2. All analyses were stratified by sex.
Results
The sample size was 830 participants (64% female). The distribution of REM-specific SDB at baseline was as follows: 59.4% mild, 27.8% moderate, and 12.8% severe. Forty-two percent of men and 23% of women developed SDB during NREM sleep. In women, baseline severity of REM-specific SDB and age were associated with the development of SDB during NREM sleep. The odds ratios (OR’s) for moderate and severe REM-specific SDB were 1.34 (CI 95%:0.83, 2.16) and1.83 (CI 95%: 1.00, 3.34), respectively. Moreover, the adjusted OR for development of SDB during NREM sleep was 1.02 (CI 95%: 1.00, 1.05) for a one year increase in age. In men, baseline BMI and weight gain were associated with progression, OR’s: 1.09 (CI 95%: 1.03, 1.17) and 1.36 (CI 95%:1.15, 1.60), respectively.
Conclusion
Severity of REM-specific SDB and age are associated with development of SDB during NREM sleep in women. In contrast, the major determinant of developing SDB during NREM sleep in men is body weight and an increase in body weight.
Support (If Any)
NIH Grants HL118414, HL075078.
