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Objective: We aimed to investigate if different childhood obstructive sleep apnea (OSA) subtypes, namely rapid eye movement (REM)-related, nonrapid eye movement (NREM)-related and stage-independent OSA would exert different effects on ambulatory blood pressure (ABP). Methods: Data from our previous school-based cross-sectional study were reanalyzed. Subjects who had an obstructive apnea–hypopnea index (OAHI) between 1 and 10 events per hour and a total REM sleep duration of >30min were included in our analysis. REM-related and NREM-related OSA were defined as a ratio of OAHI in REM sleep (OAHIREM) to OAHI in NREM sleep (OAHINREM) of >2 and <0.5, respectively. The others were classified as stage-independent OSA. Results: A total of 162 subjects were included in the analysis. In the mild OSA (OAHI, 1–5events/h) subgroup, no significant differences in any ABP parameters were found between OSA subtypes. On the other hand, in subjects with moderate OSA (OAHI, 5–10events/h), the REM-related OSA subtype had a significantly lower daytime systolic blood pressure (SBP) z score (−0.13±0.90 cf 1.15±0.67; P =.012) and nighttime SBP z score (0.29±1.06 cf 1.48±0.88, P =.039) than the stage-independent OSA subtype. Linear regression analyses revealed that OAHINREM but not OAHIREM was significantly associated with both daytime (P =.008) and nighttime SBP (P =.042) after controlling for age, gender, and body size. Conclusion: Children with obstructive events mainly in REM sleep may have less cardiovascular complications than those with stage-independent OSA. [ABSTRACT FROM AUTHOR]

A letter to the editor related to a study revealing that the rapid eye movement sleep behavior disorder (RBD) is an early precursor of the Parkinson's disease, is presented.

Background: Rapid eye movement sleep behavior disorder (RBD) is characterized by prominent dream-enacting behaviors, often resulting in sleep-related injuries.Objectives: This study aimed to prospectively examine the treatment response of people with RBD treated with clonazepam, by quantitatively delineating the characteristic changes in the clinical and polysomnographic features, and to explore the factors associated with this response.Methods: Patients diagnosed with idiopathic RBD (iRBD) were consecutively recruited and invited to complete clinical and polysomnographic (PSG) assessments and self-administered questionnaires (including the modified REM Sleep Behavior Questionnaire, RBDQ-3M) before and after the initiation of treatment with clonazepam.Results: Thirty-nine iRBD patients (male: 74.4%, mean age at diagnosis: 68.3 ± 7.8 years) were recruited with a follow-up duration of 28.8 ± 13.3 months. Clonazepam was offered as the first-line treatment (starting dose: 0.43 ± 0.16 mg, range: 0.125-1.00; dose at follow-up: 0.98 ± 0.63 mg, range: 0.125-3). Treatment response, as defined by a complete elimination of sleep-related injuries and potentially injurious behaviors to self and/or to bed partner, at follow-up was reported in 66.7% of the overall study subjects. Frequency of disturbing dreams with violent and frightening content and vigorous behavioral RBD symptoms was significantly reduced, while residual nocturnal symptoms and an increase in REM-related EMG activities were observed at follow-up. Less optimal treatment outcomes were found to be associated with the presence of comorbid obstructive sleep apnea and earlier onset of RBD.Conclusions: Clonazepam differentially changes dream affect and content, as well as reduces vigorous verbal and motor behaviors. Residual RBD symptoms are common, despite treatment. Other more effective alternative or adjunctive interventions are needed for better clinical management of RBD. [ABSTRACT FROM AUTHOR]