REM and NREM sleep-state distribution of respiratory events in habitually snoring school-aged community children

Abstract 

Background

Studies ascribe different functions to rapid eye movement (REM) and non-rapid eye movement (NREM) sleep, such that their disruption could result in discrepant clinical outcomes. Although sleep architecture is globally preserved in children with obstructive sleep apnoea (OSA), it is considered to be an REM sleep REMS disorder. Furthermore, body position during sleep affects the occurrence of respiratory events, while the presence of obesity has been claimed to affect sleep-state distribution of respiratory disturbance.

Methods

To explore the distribution of respiratory events during REMS and NREM sleep NREMS and its potential predictors, a cross-sectional analysis of 335 overnight sleep studies in snoring children from the community was conducted. The ratio of REMS to NREMS respiratory events was compared, and potential associations were assessed using general linear modelling (GLM).

Results

Children were 7.3±1.2years old and had a body mass index (BMI) z-score of 1.0±1.3. The obstructive apnoea–hypopnea index (OAHI) was 1.7±3 and 45.8% of children had an apnoea–hypopnea index (AHI) >1h⁻¹ total sleep time (TST). Obstructive respiratory events were 3.8times more likely in REMS (2.0h⁻¹) than NREMS (0.5h⁻¹), and the GLM revealed distinctive predictive associations for the apnoeic and hypopneic indices separately, and for body position, the latter indicating that the REMS/NREMS distribution of respiratory events depends on body position.

Conclusion

Obstructive respiratory events are predominantly, albeit not exclusively, present in REMS in school-aged children. NREMS respiratory events are more likely in the presence of lower oxyhaemoglobin saturations during event, side body position and in African–American children. However, REMS dominance is not affected by either BMI z-score or obesity. Our findings suggest that incorporating comprehensive respiratory event profiles of children may enhance our understanding of the pathophysiology and adverse outcomes in the context of paediatric OSA.

Abbreviations: REMS, rapid eye movement sleep, NREMS, non-rapid eye movement sleep, OAHI, obstructive apnea–hypopnea index, AI, apnea index, OAI, obstructive apnea index, MAI, mixed apnea index, CAI, central apnea index, HI, hypopnea index, OHI, obstructive hypopnea index, CHI, central hypopnea index, MHI, mixed hypopnea index

Keywords: Sleep apnea, Pediatric, Sleep states, REM sleep, NREM sleep, BMI