title: Effect of Sleep State and Position on Obstructive Respiratory Events Distribution in Adolescent Children.
abstract: OBJECTIVE
  This study aimed to examine the effect of sleep state (rapid eye movement [REM] versus non-rapid eye movement [NREM]) and position (supine versus non-supine position) on obstructive respiratory events distribution in adolescent population (ages 12 to 18 y).
  
  
  METHODS
  This was a retrospective study that included 150 subjects between the ages of 12 to 18 y with an apnea-hypopnea index (AHI) > 1/h. Subjects using REM sleep-suppressant medications and subjects with history of genetic anomalies or craniofacial syndromes were excluded.
  
  
  RESULTS
  The median age was 14 y with interquartile range (IQR) of 13 to 16 y, 56% of patients were males and the median body mass index (BMI) z-score was 2.35 (IQR: 1.71-2.59) with 77.3% of patients fulfilling obesity criteria. Respiratory obstructive events were more common in REM sleep. The median REM obstructive AHI (OAHI) was 8.9 events per hour (IQR: 2.74-22.8), whereas the median NREM OAHI was 3.2 events per hour (IQR: 1.44-8.29; p < 0.001). African American adolescents had more REM obstructive events with median REM OAHI of 13.2 events per hour (IQR: 4.88-30.6), which was significantly higher than median REM OAHI of 4.94 (IQR: 2.05-11.36; p = 0.004) in white adolescents. Obstructive events were more common in supine position with higher median supine OAHI of 6.55 (IQR: 4-17.73) when compared to median non-supine OAHI of 2.94 (IQR: 1-6.54; p < 0.001).
  
  
  CONCLUSIONS
  This study shows that sleep related obstructive respiratory events in the adolescents (12 to 18 y of age) occur predominantly in REM sleep and in supine position.
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care and Sleep Disorders Medicine, University of Louisville, Louisville, KY.
authors.forename: Karim
authors.initials: K
authors.lastname: El-Kersh
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care and Sleep Disorders Medicine, University of Louisville, Louisville, KY.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Cavallazzi
authors.affiliation: Department of Medicine, Division of Pulmonary, Critical Care and Sleep Disorders Medicine, University of Louisville, Louisville, KY.
authors.forename: Paras M
authors.initials: PM
authors.lastname: Patel
authors.affiliation: Department of Pediatrics, Division of Sleep Medicine, University of Louisville, Louisville, KY.
authors.forename: Egambaram
authors.initials: E
authors.lastname: Senthilvel
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography; D011187:Posture / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology*; D012894:Sleep Stages / Q000502:physiology*
keywords: NREM OSA; REM OSA; adolescent sleep apnea