Clinical Research
The polysomnographic characteristics in idiopathic rapid eye movement sleep behavior disorder patients with different severity of obstructive sleep apnea
Wenbin Ma, Jihui Zhang, Junying Zhou, Yaping Liu, Jinbo Chen, KwokWing Yun
Published 2017-07-08
Cite as Chin J Neurol, 2017, 50(7): 520-525. DOI: 10.3760/cma.j.issn.1006-7876.2017.07.009
Abstract
ObjectiveTo determine the polysomnographic characteristics in idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) patients with different severity of obstructive sleep apnea (OSA).
MethodsA total of 206 consecutive iRBD patients (80.1% males, mean age was (66.2±10.0) years) were recruited based on international classification of sleep disorders Ⅱ diagnostic criteria and confirmed by video-polysomnography. Patients were divided into three groups according to the severity of OSA, namely no OSA group (apnea-hypopnea index (AHI)≤5/hour, n=48), mild to moderate OSA group (AHI 5-30/hour, n=100), and severe OSA group (AHI>30/hour, n=58).
ResultsWhen comparing the severe OSA patients with no and mild to moderate OSA patients, as expected, patients with severe OSA had higher percentage of stage Ⅰ sleep (22.9%±12.2% vs 13.2%±6.4%, 15.4%±6.0%, F=21.80, P<0.01), lower percentage of stage Ⅱ sleep (58.5%±10.4% vs 68.0%±20.5%, 61.8%±10.5%, F=6.62, P<0.01), less REM sleep (16.0%±8.2% vs 19.3%±9.8%, 20.0%±7.8%, F=4.24, P=0.02) as well as higher arousal index ((33.4±16.2)/h vs (8.9±4.3)/h, (14.9±6.5)/h, F=94.56, P<0.01). In addition, patients with severe OSA had a lower percentage of total electromyography (EMG) activity during REM sleep than other two groups (27.2%(25.9%)vs 30.3%(25.2%), 39.1%(28.0%), H=8.20, P=0.02). There were no statistically significant differences in total sleep time, sleep efficiency, sleep latency, slow wave sleep, periodic limb movement index and period limb movements during sleep.
ConclusionsPatients with iRBD comorbided with severe OSA have distinct polysomnographic characteristics when compared with those without OSA and those with mild-to-moderate OSA. Those patients have increased sleep time in stage Ⅰ sleep, decreased sleep time in stage Ⅱ sleep and REM sleep, and more easily awakened from total sleep. Patients with iRBD comorbided with severe OSA have a lower percentage of tonic EMG activity during REM sleep. Excessive tonic EMG activity of upper airway muscle during REM sleep in iRBD might protect patients against severe OSA.
Key words:
REM sleep behavior disorder; Sleep apnea, obstructive; Electromyography; Sleep architecture
Contributor Information
Wenbin Ma
Department of Psychiatry, the Chinese University of Hong Kong, Shatin, Hong Kong SAR 999077, China
Jihui Zhang
Junying Zhou
Yaping Liu
Jinbo Chen
KwokWing Yun
