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Peer-reviewedCC BYClocks & sleep

Muscular Response in Sleep-Disordered Breathing Patients: New Methods of Assessment and Measurement.

  • Ruggero Campisi1
  • Ilaria Falco1
  • Giannicola Iannella2
  • Antonio Maniaci3
  • Miriam Nava4
  • Gianluca Bronzetti4
  • Davide Bianchi4
  • Alice Cescutti4
  • Manuele Casale5
  • Antonio Moffa5
  • Chiara Bianchini6
  • Stefano Pelucchi6
4 more authors
  • Pietro Bonzagni6
  • Kenny Peter Pang7
  • Mario Pierri8
  • Claudio Vicini1
8 affiliations
  1. 1GVM Care & Research, San Pier Damiano Hospital, Via Portisano 1, 48018 Faenza, Italy.
  2. 2Department of Sense Organs, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy.
  3. 3Department of Otolaryngology, Kore University of Enna, 94100 Enna, Italy.
  4. 4MedicAir Healthcare, Via Monte Rosa 61, 20149 Milan, Italy.
  5. 5Integrated Therapies in Otolaryngology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy.
  6. 6Department of Otolaryngology, University of Ferrara, 44121 Ferrara, Italy.
  7. 7Asia Sleep Centre, Paragon Medical Centre, 290 Orchard Road, #18-04, Singapore 238859, Singapore.
  8. 8Professional Master's Programme in Dental Sleep Medicine, Alma Mater Studiorum University of Bologna, Via Zamboni 33, 40126 Bologna, Italy.
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Abstract

Background

Obstructive sleep apnea (OSA) is a heterogeneous disorder influenced by both anatomical collapsibility and non-anatomical factors, such as neuromuscular response. Identifying these traits through simplified clinical surrogates is crucial for personalized precision medicine.Methods

This exploratory retrospective study evaluated 207 home polygraphy recordings of Italian patients to assess sleep-stage-specific Apnea-Hypopnea Index (REM vs. NREM AHI) as a clinical surrogate indicator of the balance between anatomical collapsibility and neuromuscular compensation. Patients were stratified by severity into simple snorers (AHI < 5 events/h), mild OSA (AHI 5-15 events/h), and severe OSA (AHI > 30 events/h). REM and NREM AHI values were compared and correlated with Apnea Index (AI), Hypopnea Index (HI), body mass index (BMI), and cumulative nocturnal desaturation indices (CT < 90% and T < 90 min).Results

In non-severe patients (simple snorers and mild OSA), REM AHI was significantly higher than NREM AHI (REM/NREM ratio > 1), suggesting relative neuromuscular protection during NREM sleep. Conversely, in severe OSA patients, the REM/NREM ratio progressively decreased and approached unity, with NREM AHI prevailing. Furthermore, NREM predominance was significantly associated with a higher AI and a worse cumulative desaturation indicating a globally more severe disease.Conclusions

A predominance of REM AHI characterizes milder OSA presentations with effective NREM muscular compensation, whereas NREM predominance aligns with an anatomically dominant, severe phenotype. Decomposing AHI into REM and NREM components provides a practical, readily available clinical surrogate to estimate the anatomy-neuromuscular balance and guide PALM-oriented personalized treatments.

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Cite

BibTeXRIS
BibTeX
@article{campisi2026muscular,
  title = {{Muscular Response in Sleep-Disordered Breathing Patients: New Methods of Assessment and Measurement.}},
  author = {Ruggero Campisi and Ilaria Falco and Giannicola Iannella and Antonio Maniaci and Miriam Nava and Gianluca Bronzetti and Davide Bianchi and Alice Cescutti and Manuele Casale and Antonio Moffa and Chiara Bianchini and Stefano Pelucchi and Pietro Bonzagni and Kenny Peter Pang and Mario Pierri and Claudio Vicini},
  journal = {Clocks \& sleep},
  year = {2026},
  month = oct,
  doi = {10.3390/clockssleep8040065},
  url = {https://europepmc.org/article/MED/42924741},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Muscular Response in Sleep-Disordered Breathing Patients: New Methods of Assessment and Measurement.
AU  - Ruggero Campisi
AU  - Ilaria Falco
AU  - Giannicola Iannella
AU  - Antonio Maniaci
AU  - Miriam Nava
AU  - Gianluca Bronzetti
AU  - Davide Bianchi
AU  - Alice Cescutti
AU  - Manuele Casale
AU  - Antonio Moffa
AU  - Chiara Bianchini
AU  - Stefano Pelucchi
AU  - Pietro Bonzagni
AU  - Kenny Peter Pang
AU  - Mario Pierri
AU  - Claudio Vicini
PY  - 2026
DA  - 2026/10/07
JO  - Clocks & sleep
DO  - 10.3390/clockssleep8040065
UR  - https://europepmc.org/article/MED/42924741
AB  - Background  Obstructive sleep apnea (OSA) is a heterogeneous disorder influenced by both anatomical collapsibility and non-anatomical factors, such as neuromuscular response. Identifying these traits through simplified clinical surrogates is crucial for personalized precision medicine.Methods  This exploratory retrospective study evaluated 207 home polygraphy recordings of Italian patients to assess sleep-stage-specific Apnea-Hypopnea Index (REM vs. NREM AHI) as a clinical surrogate indicator of the balance between anatomical collapsibility and neuromuscular compensation. Patients were stratified by severity into simple snorers (AHI < 5 events/h), mild OSA (AHI 5-15 events/h), and severe OSA (AHI > 30 events/h). REM and NREM AHI values were compared and correlated with Apnea Index (AI), Hypopnea Index (HI), body mass index (BMI), and cumulative nocturnal desaturation indices (CT < 90% and T < 90 min).Results  In non-severe patients (simple snorers and mild OSA), REM AHI was significantly higher than NREM AHI (REM/NREM ratio > 1), suggesting relative neuromuscular protection during NREM sleep. Conversely, in severe OSA patients, the REM/NREM ratio progressively decreased and approached unity, with NREM AHI prevailing. Furthermore, NREM predominance was significantly associated with a higher AI and a worse cumulative desaturation indicating a globally more severe disease.Conclusions  A predominance of REM AHI characterizes milder OSA presentations with effective NREM muscular compensation, whereas NREM predominance aligns with an anatomically dominant, severe phenotype. Decomposing AHI into REM and NREM components provides a practical, readily available clinical surrogate to estimate the anatomy-neuromuscular balance and guide PALM-oriented personalized treatments.
SN  - 2624-5175
ER  -