Sleep & breathing = Schlaf & Atmung
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Sleep disordered breathing occurring predominantly in rapid eye movement REM sleep (rapid-eye-movement-related sleep-disordered breathing, REM SDB) is present in 10 to 36% of patients undergoing polysomnography (PSG) for suspected obstructive sleep apnea (O'Connor et al. in Am J Respir Crit Care Med 161:1465-1472, 2000; Resta et al. in J Respir Medicine 99:91-96, 2005; Haba-Rubio et al. in Chest 128:3350-3357, 2005; Juvelekian and Golish, American Academy of Sleep Medicine, abstract, 2004). We hypothesize that REM SDB is an age-related condition in women and, additionally, more prevalent in women than in men. Subjects with REM SDB were identified retrospectively among 1,540 obstructive sleep apnea (OSA) patients with an apnea-hypopnea index (AHI) >or= 5. ⋯ REM SDB is more prevalent in women than in men and more prevalent in men and women younger than 55 than those older than 55. In this population, women are more obese and older than men, while younger women were more obese than older women. These descriptive distinctions suggest differences in mechanism which may depend on gender and age.
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Compliance with continuous positive airway pressure (CPAP) therapy is one of the most difficult management problems for patients with obstructive sleep apnea (OSA). We postulated that autotitration positive airway pressure (APAP) may be effective in some patients who have an intolerance of fixed CPAP. The study was done to estimate how often patients who cannot tolerate fixed CPAP can tolerate APAP. ⋯ The mean number of hours of use in these responders was 6.2; the mean percentage of nights of use among responders was 89%. Determinants of successful APAP use were an apnea-hypopnea index (AHI) less than 18, male sex, OSA related to rapid eye movement, and a high body mass index. APAP therapy may be an effective option in patients who do not tolerate fixed-CPAP therapy.