title: Sleepiness, quality of life, and sleep maintenance in REM versus non-REM sleep-disordered breathing.
abstract: BACKGROUND
  The impact of REM-predominant sleep-disordered breathing (SDB) on sleepiness, quality of life (QOL), and sleep maintenance is uncertain.
  
  
  OBJECTIVE
  To evaluate the association of SDB during REM sleep with daytime sleepiness, health-related QOL, and difficulty maintaining sleep, in comparison to their association with SDB during non-REM sleep in a community-based cohort.
  
  
  METHODS
  Cross-sectional analysis of 5,649 Sleep Heart Health Study participants (mean age 62.5 [SD = 10.9], 52.6% women, 22.6% ethnic minorities). SDB during REM and non-REM sleep was quantified using polysomnographically derived apnea-hypopnea index in REM (AHI(REM)) and non-REM (AHI(NREM)) sleep. Sleepiness, sleep maintenance, and QOL were respectively quantified using the Epworth Sleepiness Scale (ESS), the Sleep Heart Health Study Sleep Habit Questionnaire, and the physical and mental composites scales of the Medical Outcomes Study Short Form (SF)-36.
  
  
  RESULTS
  AHI(REM) was not associated with the ESS scores or the physical and mental components scales scores of the SF-36 after adjusting for demographics, body mass index, and AHI(NREM) x AHI(REM) was not associated with frequent difficulty maintaining sleep or early awakening from sleep. AHI(NREM) was associated with the ESS score (beta = 0.25; 95% confidence interval [CI], 0.16 to 0.34) and the physical (beta = -0.12; 95% CI, -0.42 to -0.01) and mental (beta = -0.20; 95% CI, -0.20 to -0.01) components scores of the SF-36 adjusting for demographics, body mass index, and AHI(REM).
  
  
  CONCLUSIONS
  In a community-based sample of middle-aged and older adults, REM-predominant SDB is not independently associated with daytime sleepiness, impaired health-related QOL, or self-reported sleep disruption.
authors.affiliation: The Pulmonary Center, Boston University School of Medicine, 72 East Concord Street, R-304, Boston, MA 02118, USA. hchami@bu.edu
authors.forename: Hassan A
authors.initials: HA
authors.lastname: Chami
authors.forename: Carol M
authors.initials: CM
authors.lastname: Baldwin
authors.forename: Angela
authors.initials: A
authors.lastname: Silverman
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.forename: David
authors.initials: D
authors.lastname: Rapoport
authors.forename: Naresh M
authors.initials: NM
authors.lastname: Punjabi
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Gottlieb
mesh_terms: D000368:Aged; D006970:Disorders of Excessive Somnolence / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011788:Quality of Life; D012890:Sleep / Q000502:physiology*; D012891:Sleep Apnea Syndromes / Q000150:complications*; D012895:Sleep, REM / Q000502:physiology*