Polysomnography And Clinical Features Of Patients With Rapid Eye Movement Sleep-related Obstructive Sleep Apnea Hypopnea

Aim:（1）To investigate rapid eye movement sleep-related obstructive sleep apnea hypopnea syndrome（rapid-eye-movement sleep-related obstructive sleep apnea-hypopnea syndrome,REM-OSAHS）and non-rapid eye movement sleep-related obstructive sleep apnea hypopnea Ventilation syndrome（Non-rapid-eye-movement sleep-related obstructive sleep apnea-hypopnea syndrome,NREM-OSAHS）patients with differences in demographics,anthropometry,polysomnography and clinical symptoms and gender differences.（2）To explore the prevalence and clinical characteristics among the various criteria that define REM-OSAHS.（3）To explore the influence factors and clinical significance of OSAHS severity in each group.Method:In this study,1416 patients were diagnosed with OSAHS by polysomnography（PSG）overnight,except for patients with other serious cardiopulmonary diseases,neuropsychiatric diseases and incomplete data.Divide the patients into REM group and NREM group according to the defined criteria,record the demographic and anthropometric parameters,Epworth Sleepiness Scale（ESS）score and polysomnography parameters of patients;ask the clinical manifestations and comorbidities.Compare the difference between the two groups of patients and the gender difference within the group.The study defined polysomnography results,prevalence,and clinical characteristics among various REM-OSAHS standards.Explore the influencing factors and clinical significance of OSAHS severity in each group.Results:REM-OSAHS were predominantly mild to moderate while NREM-OSAHS patients were predominantly severe.The proportion of women in REM-OSAHS was higher than that in NREM-OSAHS（36.2%vs 20.4%;P<0.001）.The age（40.5[24.0]vs 48.0[22.0]）,neck circumference（40.0[5.0]vs 42.0[5.0]）,waist circumference（100.0[16.8]vs 104.3[16.0]）,AHI（16.5[13.8]vs.52.2[43.5]）,ODI（10.0[7.7]vs46.1[46.8]）,AHI_REM（31.0[15.0]vs 46.1[45.2]）and AHI_NREM（8.5[6.6]vs 50.2[43.7]）of patients with REM-OSAHS were significantly lower than those of patients with NREM-OSAHS（all P<0.001）.BMI of patients with REM-OSAHS（27.6[6.2]vs 29.1[6.0]）was less than that of NREM-OSAHS（P=0.002）.Comparing the hypoxia-related indicators of the two groups,we found that ODI（10.0[7.7]vs 46.1[46.8]）,min Sp O2（86.0[7.0]vs 76.0[20.0]）,mean Sp O2（95.0[1.0]vs 94.0[3.0]）,T90（0.2[1.2]vs 7.0[25.6]）were statistically different.The prevalence of hypertension in REM-OSAHS was higher（44[32%]vs 604[51%];P<0.001）.The gender differences between the two groups were further compared.The female patients in REM-OSAHS and NREM-OSAHS groups were older and had smaller neck circumference（P<0.001）.The waist circumference of women with REM-OSAHS was larger than that of men（100.4?11.1vs 103.1?16.3;P=0.005）.There were significant differences in waist circumference（102.0[21.4]vs 105.0[14.0];P=0.005）,AHI（41.7[47.5]vs 53.4[42.5];P=0.003）,ODI（37.6[45.0]vs 48.1[47.5];P=0.001）.In REM-OSAHS patients,snoring（75[85]vs30[60];P=0.001）,witnessed apnea（60[68]vs21[42];P=0.003）were common in men,while nocturia（19[38]vs16[18];P=0.01）,insomnia（16[32]VS7[8];P<0.001）were common in women.The prevalence rates of the three kinds of REM-OSAHS were16.1%,9.7%and 4.1%respectively,which were significantly lower than the previous literature reports.AHI was positively correlated with neck circumference and BMI in male OSAHS patients（P<0.001）,while AHI was positively correlated with neck circumference and BMI in REM-OSAHS patients（P<0.05）.AHI was positively correlated with neck circumference and BMI in NREM-OSAHS and male NREM-OSAHS（P<0.001）.Conclusion:1.REM-OSAHS and NREM-OSAHS patients had different disease severity and demographic data distribution.2.The degree of obesity and fat distribution in REM-OSAHS patients were different from those in NREM-OSAHS patients.Prompt the impact of weight and neck circumference on the severity of the disease.When the weight of obesity changes,it was necessary to adjust treatment in time according to the change of AHI.3.There were differences in clinical manifestations of REM-OSAHS and NREM-OSAHS patients.Clinically,patients can be evaluated based on clinical manifestations to provide a reference for diagnosis.4.There were gender differences in the disease characteristics of REM-OSAHS patients.Male REM-OSAHS patients often show symptoms of snoring and apnea,while female patients mostly show nocturia and insomnia.Comprehensive clinical understanding of clinical manifestations for more accurate diagnosis and treatment.5.In the study of patients with REM-OSAH,multiple factors such as ethnic differences in the study population,different definition criteria for REM-OSAHS,different diagnostic guidelines,and definition of hypo-ventilation events should be considered.