CPAP-Associated REM Rebound is a Manifestation of Sleep Homeostasis in Patients with Severe OSA

Lei Wang, MD1, David E. McCarty, MD1, Paul Kim, PhD1, Clifton Frilot II, PhD2, Andrew L. Chesson, Jr., MD1, Andrew A. Marino, PhD1

1Division of Sleep Medicine, Department of Neurology, LSU Health Sciences Center, Shreveport, LA
2School of Allied Health Professions, LSU Health Sciences Center, Shreveport, LA

Presented at the 26th Annual Meeting of the Associated Professional Sleep Societies, Boston, MS, June, 2012


Sleep is homeostatically regulated, as evidenced by experimental sleep-deprivation studies. CPAP-induced REM rebound (CARR) is a phenomenon in which REM% sleep is dramatically increased in a sub-group of OSA patients when CPAP treatment is initiated. Presumably CARR results from a homeostatic process that produces deeper sleep when the hypoxemia stress is reduced by CPAP.

Recurrence analysis (RA) is a method of objectively measuring the extent of regulation on brain electrical manifested in the EEG. RA variables have been shown capable of continuously quantitating sleep depth in a manner that complements traditional sleep staging (1). We hypothesized that the extent of regulation of brain electrical activity manifested in the EEG in patients who exhibit CARR would be greater than that in patients undergoing CPAP titration who did not exhibit CARR (Non-CARR). We planned to interpret such observations as indicating that the extent of regulation of brain electrical activity in the EEG (brain activity governed by law rather than chance) was a regulated variable in sleep homeostasis, at least in patients who exhibited CARR.

Our specific objective was to find statistically reliable effects on EEG regulation in CARR patients.

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