Association between REM sleep and obstructive sleep apnea in obese and overweight adolescents

  • Orna Sever
  • Eric J. Kezirian
  • Emily Gillett
  • Sally L Davidson Ward
  • Michael Khoo
  • Iris A. PerezEmail author
Pediatrics • Original Article



Overweight and obese children have demonstrated reduced rapid eye movement (REM) sleep, affecting energy balance regulation and predisposition to weight gain. Obstructive sleep apnea (OSA) is a known cause of decreased REM sleep. The purpose of this study is to examine the association between the percentage of REM sleep, BMI z-score, and OSA severity in overweight and obese adolescents.


We performed a cross-sectional study of 92 (43% female) overweight and obese adolescents (13–17 years old) who underwent overnight polysomnography (PSG) at Children’s Hospital Los Angeles between 2010 and 2017.


The average Body Mass Index (BMI) z-score was 2.27 ± 0.47, with 71% having BMI z-score ≥ 2. REM% during PSG was 15.6 ± 6.8, and obstructive apnea-hypopnea index was 17.1 ± 24.3. The distribution across categories of OSA severity was 27% none (≤ 1.5 events/h), 24% mild (> 1.5–5 events/h), 8% moderate (> 5–10 events/h), and 41% severe (> 10 events/h). REM% was not associated with BMI z-score, either on univariate or multivariate regression with adjustment for age, gender, and apnea-hypopnea index (AHI). When subdivided into OSA categories, a 1-unit increase in BMI z-score was associated with a 5.96 (p = 0.03) increase in REM% in mild OSA and an 8.86 (p = 0.02) decrease in REM% in severe OSA. There was no association between BMI z-score and REM% in none and moderate OSA.


Among overweight and obese adolescents, BMI z-score was associated with decreased REM% in severe OSA and unexpectedly increased REM% in mild OSA, but there was no association in none or moderate OSA.


Adolescents Obesity Obstructive sleep apnea Rapid eye movement 



American Academy of Sleep Medicine


body mass index


centers for disease control and prevention


non rapid eye movement


obstructive apnea-hypopnea index


obstructive sleep apnea




rapid eye movement



This work was supported in part by the National Institutes of Health (NIH) grants HL090451 and EB001978, University of Southern California Center for Transdisciplinary Research on Energetics and Cancer grant TREC U54 CA 116848, and grant M01 RR00047 and RO1-HL-105210 from Children’s Hospital Los Angeles General Clinical Research Center.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

This study was approved by the Children’s Hospital Los Angeles institutional review board.

Informed consent

Informed consent was waivered by the Children’s Hospital Los Angeles institutional review board for all individual participants included in the study.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Orna Sever
    • 1
    • 2
  • Eric J. Kezirian
    • 2
  • Emily Gillett
    • 1
    • 2
  • Sally L Davidson Ward
    • 1
    • 2
  • Michael Khoo
    • 3
  • Iris A. Perez
    • 1
    • 2
    Email author
  1. 1.Children’s Hospital Los AngelesLos AngelesUSA
  2. 2.Keck School of Medicine of USCLos AngelesUSA
  3. 3.Viterbi School of EngineeringUniversity of Southern CaliforniaLos AngelesUSA

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