J Sleep Med.  2023 Dec;20(3):169-174. 10.13078/jsm.230022.

Nightmare Distress and Dream Recall in Patients With Obstructive Sleep Apnea

• Kang YJ
• Han SH

• KMID: 2549705
• DOI: http://doi.org/10.13078/jsm.230022

Abstract

Objectives
We aimed to examine dream recall and nightmare distress in patients with obstructive sleep apnea (OSA), and identify the associating factors.
Methods
This cross-sectional study retrospectively enrolled adult participants (age ≥18 years) with newly diagnosed OSA that was confirmed by full-night polysomnography between 2016 and 2022. Dreaming components were assessed using a nine-item dreaming questionnaire (nightmare distress and dream recall). We compared the clinical and polysomnographic findings according to OSA severity and the presence of rapid eye movement (REM)-dependent OSA. Additionally, we assessed factors that related to nightmare distress and dream recall in patients with OSA.
Results
Patients with mild OSA had significantly higher nightmare distress than those with moderate to severe OSA (p=0.044). Univariate linear regression analysis showed negative correlations between the apnea-hypopnea index (AHI) and nightmare distress (β=-0.105; p=0.040). Conversely, multivariate analyses indicated that the AHI and the presence of REM-dependent OSA were not significantly associated with nightmare distress and dream recall. Wakefulness after sleep onset (β=0.083; p=0.066), the Pittsburgh Sleep Quality Index (PSQI) (β=0.271; p<0.001), the Beck Depression Inventory (β=0.242; p<0.001), and the State-Trait Anxiety Inventory-State (STAI-S) (β=0.123; p=0.047) were related to nightmare distress. In contrast, younger age (β=-0.144; p=0.004), PSQI (β=0.098; p=0.058), STAI-S (β=0.156; p=0.003) were associated with dream recall.
Conclusions
Depression, anxiety, and poor sleep quality were related to nightmare distress, while younger age and anxiety were associated with dream recall. OSA severity and the presence of REM-dependent OSA were not significantly associated with nightmare distress or dream recall.