Prevalence and characteristics of rapid eye movement-related sleep apnea in a population-based cohort

This study aimed to estimate the prevalence and characteristics of rapid eye movement-related obstructive sleep apnea (REMrOSA) in the general Saudi Arabian population, contributing novel data to the field and providing insights into this specific OSA phenotype.

We analyzed data from a previously described Saudi population study targeting school employees aged 30-60 years. The study was conducted in two stages: an initial screening of 2682 participants using screening questionnaires and a confirmatory test of 346 participants using polysomnography (PSG). OSA was defined as an apnea-hypopnea index (AHI) ≥5. REMrOSA was identified on the basis of specific criteria, including a REM-AHI/non-REM (NREM)-AHI ratio ≥2, NREM-AHI <15, and REM duration ≥30 min. An extrapolation method was used to estimate the prevalence of REMrOSA in the general population.

Among the 346 subjects who underwent PSG, 235 had OSA. Approximately one-third (30.64%) of these patients had REMrOSA, with a higher prevalence noted in females (38.03%) than in males (27.44%). The estimated prevalence of REMrOSA in the general Saudi population was 2.68%, with males (3.5%) being more affected than females (1.93%). Patients with REMrOSA presented lower AHI, Epworth Sleep Scale score, and arousal index than did those with non-REMrOSA (NREMrOSA). Logistic regression analysis indicated that patients with exclusive positional OSA (e-POSA) were 2.7 times more likely to have REMrOSA.

REMrOSA is a common condition among patients with OSA, with an estimated prevalence of 2.68% in the general Saudi population. Patients with REMrOSA tend to have milder disease, are less symptomatic, and are seen more in e-POSA.