20th Annual Sleep and Health Benefit

Quantification of late REM sleep in patients with prolonged sleep duration

Margaret Blattner, MD, PhD

Beth Israel Deaconess Medical Center

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Clinical Implications
Research Narrative

Evaluation of hypersomnia includes polysomnography followed by multiple sleep latency testing (MSLT). To facilitate testing in the sleep lab, often the overnight portion of the study is terminated to begin sleep latency testing before patients would naturally wake up in the morning. REM sleep has strong circadian regulation and for patients with prolonged sleep duration, especially in combination with circadian phase delay, sleep onset REM periods may be reflective of the end of their “biologic night” rather than a true abnormality in REM propensity. Our goal was to describe the distribution of REM sleep documented on unrestricted PSG in a cohort of patients with prolonged sleep duration. We retrospectively reviewed consecutive extended sleep studies of patients with a total sleep time greater than 600 minutes. Of these studies, 38 patients have sleep onset before midnight and were included in the analysis. We found that there is a high prevalence of “late” REM sleep in patients with prolonged sleep duration. In this study, 95% of patients final REM period onset after 6 AM, 89% have final REM period onset after 8 AM, and 50% have final REM period onset REM sleep after 10 AM. This is long after the typical start time for the MSLT at most sleep centers. These results may shed light on why patients cross over fluidly between narcolepsy type 2 and idiopathic hypersomnia on repeat testing and has clinical implications for the evaluation of hypersomnia.

Research Category
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