Despite markedly reduced REM sleep in neuromuscular diseases, OSA and particularly REM-related OSA are common, and REM-related OSA is independently associated with morning hypercapnia and FVC decline, suggesting that REM-stage characteristics may be predictive of subsequent chronic respiratory failure.
OSA was highly prevalent in patients with neuromuscular diseases who underwent polysomnography.
REM sleep duration was markedly reduced in patients with neuromuscular diseases.
REM-related OSA was present in more than half of NMD patients with OSA who had sufficient REM sleep for evaluation.
REM-related OSA was independently associated with morning hypercapnia in multivariable analysis.
REM-related OSA was independently associated with significant FVC impairment in multivariable analysis.
Mild overall OSA severity was independently associated with REM-related OSA.
Compared with NREM-related OSA, the REM-related OSA group had a higher frequency of female sex, hypertension, and depression.
The authors suggest that REM-stage characteristics in NMD patients may be predictive of subsequent chronic respiratory failure.
This research examined sleep patterns in 290 patients with neuromuscular diseases (conditions that affect muscles and the nerves controlling them) who had formal overnight sleep studies over a 10-year period. The study found that the vast majority of these patients (nearly 88%) had obstructive sleep apnea, where breathing repeatedly stops during sleep. Notably, the stage of sleep called REM sleep — the stage most associated with dreaming and known to be when breathing muscles are most relaxed — was dramatically reduced in these patients, averaging only about 12% of total sleep time compared to the typical 20–25% in healthy adults. Despite this reduced REM sleep, more than half of the patients who had enough REM sleep to be evaluated showed a pattern where their breathing problems were concentrated specifically in the REM stage. This 'REM-related' sleep apnea was linked to signs of more severe respiratory compromise: patients with this pattern were nearly five times more likely to have elevated carbon dioxide levels in their blood in the morning (a sign the body is struggling to breathe adequately), and were about four times more likely to have significantly reduced lung function or a marked drop in lung capacity when lying down compared to sitting up (a sign of diaphragm weakness). This research suggests that in people with neuromuscular diseases, focusing only on overall sleep apnea severity scores may miss important warning signs concentrated in REM sleep. The association between REM-related breathing problems and markers of respiratory failure implies that careful analysis of REM sleep during sleep studies could help identify which neuromuscular disease patients are at greatest risk of developing serious breathing problems over time, potentially informing earlier intervention with breathing support therapies.
Oguz M, Kiyan E, Pihtili A, Altan G, Cakar A, Durmus H. (2026). REM-related obstructive sleep apnoea in neuromuscular diseases: A 10-year retrospective cohort study.. Sleep & breathing = Schlaf & Atmung. https://doi.org/10.1007/s11325-026-03575-5