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REM-OSA vs NREM-OSA in Children: Separate Clinical Phenotypes or Markers of OSA Severity

Haneen Toma1, Amal Alnaimi1,2, Mutasim Abu-Hasan1

  • 1Department of Pediatric Medicine, Division of Pulmonary, Doha, Qatar.

Pediatric Pulmonology
|November 24, 2025
PubMed

Insights

Obstructive sleep apnea (OSA) predominantly occurs during REM sleep. This study found REM-OSA and NREM-OSA are markers of disease severity, not distinct phenotypes, with NREM-OSA indicating more severe obstructive sleep apnea.

Area of Science:

  • Pediatric Sleep Medicine
  • Respiratory Medicine
  • Clinical Phenotyping

Background:

  • Obstructive sleep apnea (OSA) disproportionately affects REM sleep (REM-OSA) versus NREM sleep (NREM-OSA) in children and adults.
  • The clinical distinction between REM-OSA and NREM-OSA remains unclear, with debate on whether they represent separate phenotypes or a severity spectrum.

Purpose of the Study:

  • To compare clinical and polysomnography (PSG) characteristics of REM-OSA versus NREM-OSA in pediatric patients.
  • To assess the influence of these characteristics on the REM-AHI/NREM-AHI ratio.

Main Methods:

  • Analysis of clinical and PSG data from 253 children with moderate to severe OSA (2019-2024).
  • REM-OSA defined by REM-OAHI/NREM-OAHI ratio ≥2; NREM-OSA defined by ratio <2.

Main Results:

  • REM-OSA identified in 68.7% of patients (n=174), NREM-OSA in 31.2% (n=79).
  • No significant differences in gender, BMI, symptoms, or oxygenation indices between groups.
  • REM-OSA group exhibited lower overall apnea-hypopnea index (OAHI) and less severe OSA compared to NREM-OSA.
  • Low OAHI was the sole significant predictor of REM-OSA and high REM-AHI/NREM-AHI ratio.

Conclusions:

  • REM-OSA and NREM-OSA are likely indicators of OSA severity rather than distinct clinical phenotypes.
  • NREM-OSA is associated with more severe obstructive sleep apnea.
Abstract

Keywords:
NREM‐OSANon‐ Rapid Eye Movement (NREM)REM‐OSARapid Eye Movement (REM)obstructive sleep apnea (OSA)polysomnography (PSG)

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