A Case of Sleepiness and Turbulent Dreams

This chapter outlines the growing evidence that obstructive sleep apnea during rapid-eye-movement sleep (REM-related OSA) is a prevalent disorder that is independently associated with adverse cardiovascular, metabolic, and neurocognitive outcomes. The authors also review the clinical implications of the duration of nightly continuous positive airway pressure (CPAP) use that is needed to effectively treat REM-related OSA. Current CPAP adherence guidelines of 4 hours/night potentially leave the majority of REM-related OSA untreated. Thus, the optimal duration of positive airway pressure therapy to effectively treat REM OSA requires clarification. Clinicians should encourage patients with REM-related OSA to increase CPAP usage to include the early morning hours, before awakening. Further research is needed to establish whether patients with significant REM-related OSA but an overall normal Apnea–Hypopnea Index would benefit from treatment.