Rem Sleep Disorder: Negative Impact On Osa Patients

REM sleep behaviour disorder (RBD) is a parasomnia characterised by loss of muscle atonia during REM sleep, resulting in dream enactment. Obstructive sleep apnea (OSA) is a sleep disorder characterised by repetitive episodes of upper airway obstruction while sleeping, which can result in hypoxemia and sleep fragmentation.

OSA can sometimes be accompanied by RBD symptoms. OSA behaviours can mimic RBD symptoms since patients carry a history of limb and body movements associated with dream mentation and dreams that appear to be acted out. However, it is difficult to distinguish between the two.

The coexistence of OSA and RBD may be attributed to shared risk factors, including older-age onset and male predominance. It is critical to distinguish between the two conditions, as their treatment options and prognoses are very different.

REM sleep behaviour disorder is a parasomnia characterised by loss of muscle atonia during rapid eye movement (REM) sleep, resulting in dream enactment

REM sleep behaviour disorder (RBD) is a parasomnia characterised by the loss of muscle atonia during REM sleep, resulting in dream enactment behaviours that may cause injuries to patients or their bed partners. During normal REM sleep, the body experiences temporary paralysis of most of the body's muscles while the brain is active and dreaming. This allows us to dream quietly and safely throughout the night. For individuals with REM sleep behaviour disorder, paralysis does not occur during the REM stage. Instead, their body and voice perform their dreams while they remain asleep.

RBD is a specific type of parasomnia, which describes abnormal behaviours during sleep. During normal REM sleep, the body experiences temporary muscle paralysis, known as atonia, while the brain shows activity similar to wakefulness. The temporary paralysis of REM sleep allows us to dream safely, lying still while the brain is active. This paralysis involves most skeletal muscles and excludes muscles that help us breathe, digest, and some muscles of the eyes. REM sleep accounts for about 25% of a total night's sleep, with most of it taking place during the second half of the night.

For individuals with RBD, normal muscle paralysis does not occur, enabling the person to physically act out their dreams. RBD can manifest as small muscle twitches and quiet sleep talking to loud shouting, punching, kicking, grabbing their bed partner, and jumping out of bed. Interestingly, the dreams associated with RBD are often intense and frightening. Individuals may dream about being chased or attacked, and they can unknowingly enact the dream in real life.

RBD is relatively rare, affecting between 0.5 to 1% of adults. It is more common in men and adults over 50. Although rare, this disorder can also occur in children in higher-risk groups. Less than one per cent of people are estimated to have RBD. It usually begins after age 50, and the disease is associated with other neurodegenerative disorders, including Parkinson's disease, Lewy body dementia, and multiple system atrophy. Symptoms often worsen with time. The condition usually requires treatment because it increases the risk of injury to oneself and their bed partner.

Obstructive sleep apnoea (OSA) is a common sleep disorder characterised by repetitive episodes of upper airway obstruction while sleeping, which can result in hypoxemia and sleep fragmentation

Obstructive sleep apnoea (OSA) is a common sleep disorder characterised by repetitive episodes of upper airway obstruction while sleeping. This can result in hypoxemia and sleep fragmentation.

OSA occurs when the upper airway becomes blocked, leading to brief pauses in breathing during sleep. This is caused by a natural relaxation of the muscles that surround the throat while a person sleeps. During the daytime, these muscles hold the airway open and facilitate breathing. As these muscles relax during sleep, the airway can narrow or close and reduce the space needed for airflow.

OSA affects around one billion adults worldwide, though experts believe that actual prevalence may be much higher because the majority of cases go undiagnosed. The chances of developing OSA increase as a person gets older until around 60 to 70 years old, when the risk levels out. The risk in women and people assigned female at birth is highest as they become peri- or postmenopausal.

The most common symptoms of OSA include:

• Tossing and turning during sleep
• Waking up feeling the urge to urinate
• Breathing through the mouth while sleeping
• Waking up feeling tired
• Headaches upon waking
• Excessive daytime sleepiness
• Trouble with memory or impaired intelligence
• Impotence or decreased sex drive

OSA is typically diagnosed through a physical exam, a sleep study, or a home sleep test. Treatment options often involve PAP therapy and lifestyle changes to reduce symptoms.

OSA can sometimes be accompanied by REM sleep behaviour disorder symptoms

Obstructive sleep apnea (OSA) is a sleep disorder characterised by repetitive episodes of upper airway obstruction during sleep, which can result in hypoxemia and sleep fragmentation. Rapid eye movement (REM) sleep behaviour disorder (RBD) is a parasomnia characterised by loss of muscle atonia during REM sleep, associated with complex motor enactment of dreams. Although the nature of the two disorders is different, OSA may sometimes be accompanied by RBD symptoms.

RBD can be categorised into idiopathic and symptomatic types. Idiopathic RBD refers to the disorder when it is not accompanied by any neurological conditions, whereas symptomatic RBD is related to identifiable underlying causes, such as medications, narcolepsy, and neurodegenerative diseases like Parkinsonism.

The prevalence of RBD is estimated to be up to 2% in the elderly population, and even higher in individuals with neuropathological disorders such as Parkinson's disease, dementia, and multiple system atrophy. RBD is most common in males over the age of 50.

RBD can lead to accidental injury to oneself or one's bed partner. OSA can also mimic RBD symptoms, a phenomenon known as "pseudo-RBD". In such cases, treatment of OSA can eliminate the behaviours.

The coexistence of OSA and RBD may be attributed to shared risk factors, including older-age onset and male predominance. However, it is critical to distinguish between the two disorders as they have different treatment options and prognoses.

The management of RBD includes safety measures, medications such as melatonin, clonazepam, and pramipexole, and continuous positive airway pressure (CPAP) therapy. CPAP is considered safe and effective in the context of RBD and sleep-disordered breathing.

OSA behaviours can mimic RBD symptoms since patients carry a history of limb and body movements associated with dream mentation and dreams that appear to be acted out

Obstructive sleep apnea (OSA) can sometimes mimic the symptoms of REM sleep behaviour disorder (RBD), and this is referred to as 'pseudo-RBD'. Patients with OSA may have a history of limb and body movements associated with dream mentation and dreams that appear to be acted out. However, OSA behaviours differ from RBD in that they are not accompanied by REM sleep without atonia (RWA).

OSA is a common sleep disorder, particularly in older people, and is characterised by repetitive episodes of upper airway obstruction during sleep, which can result in hypoxemia and sleep fragmentation. RBD, on the other hand, is a parasomnia characterised by a loss of muscle atonia during REM sleep, which is associated with complex motor enactment of dreams.

Although OSA and RBD share some similar sleep phenomena, they are distinct disorders with different clinical and pathophysiological substrates. OSA behaviours can be mistaken for RBD due to the type of abnormal sleep behaviours that occur, such as punching, gesturing, talking, and violent dreams. However, OSA behaviours are not accompanied by RWA, which is an essential element of RBD.

It is critical to distinguish between OSA and RBD as they have different treatment options and prognoses.

RBD and OSA share similar sleep phenomena, but their association is yet to be fully understood

REM sleep behavior disorder (RBD) is a parasomnia characterised by the loss of muscle atonia during rapid eye movement (REM) sleep, leading to the physical enactment of dreams. Obstructive sleep apnea (OSA) is a sleep disorder characterised by repetitive episodes of upper airway obstruction during sleep, resulting in hypoxemia and sleep fragmentation. Although RBD and OSA are distinct disorders with different clinical and pathophysiological substrates, they may occasionally co-occur and share similar sleep phenomena.

RBD and OSA share similar sleep phenomena, but their association is not yet fully understood. OSA can sometimes be accompanied by RBD symptoms, and comorbid OSA in patients with RBD is common, with 34-61% of RBD patients also experiencing sleep apnea. The coexistence of OSA and RBD may be attributed to shared risk factors, such as older age and male predominance. However, differentiating between the two disorders can be challenging, particularly when OSA is characterised by sudden arousals following hypoxic episodes similar to RBD.

Accurate diagnosis and distinction between RBD and OSA are critical as their treatment options and prognoses differ significantly. While RBD is often treated with medications such as clonazepam and melatonin, OSA is typically managed with continuous positive airway pressure (CPAP) therapy. Furthermore, RBD is strongly associated with neurodegenerative disorders, such as Parkinson's disease, Lewy body dementia, and multiple system atrophy. Therefore, the presence of RBD symptoms in patients with OSA or vice versa can have significant clinical implications.

Several studies have investigated the relationship between RBD and OSA. Some research suggests that RBD may have a protective effect on OSA by preventing upper airway collapse during apneic periods. However, other studies have found no evidence of this protective effect. The influence of RBD on OSA severity and its potential impact on cardiovascular and metabolic complications remain subjects of ongoing research.

In summary, while RBD and OSA share some similarities in sleep phenomena, their association is complex and not yet fully elucidated. Further research is needed to understand the underlying mechanisms connecting these two sleep disorders and to optimise their management and treatment.

Frequently asked questions