Sleep Med Psychophysiol.  2004 Jun;11(1):10-16.

REM-related Sleep-Disordered Breathing

Affiliations
  • 1Pulmonary Sleep Disorder Center, Department of Pulmonary and Critical Medicine, Korea University Ansan Hospital, Seoul, Korea.
  • 2Brain Korea 21 Project for Biomedical Science, Korea University College of Medicine, Seoul, Korea.

Abstract

Sleep is associated with definite changes in respiratory function in normal human beings. During sleep, there is loss of voluntary control of breathing and a decrease in the usual ventilatory response to both low oxygen and high carbon dioxide levels. Especially, rapid eye movement (REM) sleep is a distinct neurophysiological state associated with significant changes in breathing pattern and ventilatory control as compared with both wakefulness and non-rapid eye movement (NREM) sleep. REM sleep is characterized by erratic, shallow breathing with irregularities both in amplitude and frequency owing to marked reduction in intercostal and upper airway muscle activity. These blunted ventilatory responses during sleep are clinically important. They permit the marked hypoxemia that occurs during REM sleep in patients with lung or chest wall disease. In addition, sleep-disordered breathing (SDB) is more frequent and longer and hypoventilation is more pronounced during REM sleep. Although apneic episodes are most frequent and severe during REM sleep, most adults spend less than 20% to 25% of total sleep time in REM. It is therefore possible for patients to have frequent apneas and hypopneas during REM sleep and still have a normal apnea-hypopnea index if the event-rich REM periods are diluted by event-poor periods of NREM sleep. In this review, we address respiratory physiology according to sleep stage, and the clinical implications of SDB and hypoventilation aggravated during REM sleep.

Keyword

Sleep; Sleep-disordered breathing; Apnea-hypophea index

MeSH Terms

Adult
Anoxia
Apnea
Carbon Dioxide
Eye Movements
Humans
Hypoventilation
Lung
Oxygen
Respiration
Respiratory Physiological Phenomena
Sleep Apnea Syndromes*
Sleep Stages
Sleep, REM
Thoracic Wall
Wakefulness
Carbon Dioxide
Oxygen
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