Prevalence and factors affecting REM and slow wave sleep rebound on CPAP titration styudy in patients with obstructive sleep apnea / Prevalencia de los factores que afectan el sueño REM y el brote de ondas lentas en los estudios con CPAP en apnea obstructiva del sueño

ABSTRACT

Background: In patients with obstructive sleep apnea syndrome (OSAS) treatment with CPAP results in an increase of REM sleep and slow wave sleep, but there is limited information about the prevalence of REM rebound in patients with OSAS and possible factors related to the rebound. Objective. REM rebound (RR) and slow wave sleep rebound (SWSR) has been described as a frequent phenomenon that occurs during CPAP titration, but the quantity that qualify for RR has not been mentioned in literature. The objective of our study was to determine the prevalence of REM rebound and slow wave sleep rebound in our sleep disorders center, to attempt to define RR and look for factors that may affect RR and SWSR on the first night of CPAP titration. Materials and methods. We included patients who had both baseline polysomnogram (bPSG) and CPAP polysomnogram (cPSG) studies done in the same laboratory. We included 179 patients>18 years with Apnea hypopnea index (AHI)>10/hr on the baseline study, with an adequate CPAP titration study. We compared the percentages of REM sleep and slow wave sleep during bPSG and cPSG. We analyzed the frequency of presentation and looked for the factors affecting RR and SWSR. Results. 179 patients were enrolled (M/F118/61), with a mean age of 48.6±4 for men, and 51.6±12.9 for women. The mean interval between the bPSG and cPSG was 45 days. The mean REM percentage during the bPSG was 15.55 percent and during cPSG study it was 21.57 percent. We took 6 percent as our differential point as the results became statistically significant at this point (p0001). We therefore present our data by dividing our patients population with RR<6 percent and RR>6 percent. The mean SWS percentage during the bPSG was 8.11±9.68 and during the cPSG was 13.17±10, with a p0.35 which is not statistically significant...

RESUMEN

Antecedentes En pacientes con síndrome de apnea obstructiva del sueño (SAOS) el tratamiento con CPAPproduce un incremento en el sueño REM y el sueño profundo, pero no hay suficiente información acerca de laprevalencia del rebote de sueño REM en pacientes con SAOS y los posibles factores relacionados con este fenómeno. Objetivo. El rebote de sueño REM (RR) y del sueño deondas lentas (RSOL) ha sido descrito como un fenómeno de frecuente presentación que ocurre durante la titulación de la presión del CPAP, pero la cantidad en el incrementodel estado de sueño que lo califique como rebote no ha sido mencionado en la literatura. El objetivo del estudiofue determinar la prevalencia de RR y RSOL en nuestro centro de sueño e intentar definir RR y buscar los factoresque puedan afectar el RR y el RSOL en la primera noche de titulación de CPAP.Material y métodos. Se incluyeron pacientes que tenían polisomnograma de base (bPSG) y PSG con CPAP (cPAG)realizados en un laboratorio del sueño. Se incluyeron 179 pacientes mayores de 18 años con índice de apneashipopneas (IAH) mayor de 10/hora en el estudio de base,con titulación de CPAP adecuada. Se comparó los porcentajes de sueño REM y sueño profundo durante el bPSSG y cPSG. Se analizó la frecuencia de presentación y los factores que afectan el RR y el RSOL. Resultados. Se incluyeron 179 pacientes (M/F 118/61), con edad promedio de 48.6 años ±12.9 para hombres y...