Marked reduction in obstructive sleep apnea severity in slow wave sleep
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Introduction Obstructive sleep apnea (OSA) is widely accepted to improve during slow wave sleep (SWS) compared to lighter stages of NREM sleep. However, supporting data to establish the magnitude and prevalence of this effect is lacking. Consequently, we examined this phenomenon, controlling for posture, in a large group of patients investigated for OSA at an academic clinical sleep service.Methods A detailed retrospective analysis was conducted on data obtained from each 30-sec epoch of sleep in 253 consecutive full-night diagnostic polysomnography studies performed over a 3-month period. Respiratory and arousal event rates were calculated within each stage of sleep, in the supine and lateral postures, and across the whole night, with OSA patients classified on the basis of an overall apnea-hypopnea index (AHI) > or =15 events/h. Central sleep apnea (CSA) patients were defined by a central apnea index > 5/h. Sleep latency and time, and respiratory and arousal event rates in OSA, CSA, and non-OSA patients were compared between sleep stages and postures using linear mixed model analysis. The numbers of patients achieving reduced event rates in SWS and in the lateral posture were also examined.Results There were 171 patients with OSA, 14 with CSA, and 68 non-OSA patients. OSA patients took significantly longer to achieve slow wave and REM sleep (p < 0.001) than non-OSA patients and had less stage 4 sleep (p = 0.037). There were striking improvements in AHI and arousal index (Al) from stage 1 to 4 NREM sleep (p <0.001), with intermediate levels in REM sleep. AHI and Al were also markedly reduced in lateral versus supine sleep in all sleep stages (p < 0.001), with an effect size comparable to that of the slow wave sleep effect. The majority of OSA patients achieved low respiratory event rates in SWS. Eighty-two percent of patients achieved an AHI <15 and 57% < 5 events/hour during stage 4 sleep.Conclusion Although OSA patients demonstrate both a delayed and reduced proportion of SWS compared to non-OSA subjects, once they achieved SWS, AHI, and Al markedly improved in most patients.
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A greater frequency of post-apneic arousals and sleep onset events may increase time in transitional light sleep and delay progression into deep sleep, which is associated with a reduced AHI.
“A greater frequency of post-apneic arousals and sleep onset events may increase time in ‘transitional’ light sleep and delay a patient’s progression into deep sleep which is associated with a reduced AHI [107].”
From Co-morbid insomnia and sleep apnea (COMISA): Prevalence, consequences, methodological considerations, and recent randomized controlled trials (2019) · cites this paper as [107]
The Results report that OSA patients spent more time in stage 1 sleep and took longer to reach slow-wave sleep; they also show lower AHI and arousal rates in deeper NREM stages. The Discussion proposes a role for arousals but does not establish that post-apneic arousals or sleep-onset events cause patients to remain in transitional light sleep or delay their progression to deep sleep. (LLM, conf=0.84)
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- Authors
- Ratnavadivel, R., Chau, N., Stadler, D., Yeo, A., McEvoy, R. D., & Catcheside, P. G.
- Affiliations
- Flinders University (AU)
- Repatriation General Hospital (AU)
- Corresponding author
- Ratnavadivel, Rajeev
- Venue
- Journal of Clinical Sleep Medicine
- Published
- 2009-12-15
- Volume
- 5
- Issue
- 6
- Pages
- 519-524
- ISSN
- 1550-9389 (ISSN-L)
- 1550-9397
- PMC
- PMC2792966
- OpenAlex
- W1522441564
- Cited by
- 207
- References
- 38
- Citations by year
- 2026: 12 · 2025: 22 · 2024: 19 · 2023: 11 · 2022: 22 · 2021: 22 · 2020: 16 · 2019: 7 · 2018: 23 · 2017: 8 · 2016: 13 · 2015: 9 · 2014: 9 · 2013: 6 · 2012: 4
- FWCI
- 1.55
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Clinical Sleep Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
- Keywords
- obstructive sleep apnea, slow-wave sleep, sleep stages, central sleep apnea, apnea-hypopnea index, arousal index, sleep position, REM sleep, NREM sleep stages, sleep latency
- MeSH terms
- Arousal, Australia, Female, Humans, Male, Middle Aged, Posture, Respiration, Retrospective Studies, Severity of Illness Index, Sleep Stages, Sleep, REM, Cohort Studies, Polysomnography, Sleep Apnea, Obstructive, Sleep Apnea, Central
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