Rapid eye movement–related obstructive sleep apnea: a physiological phenotype predicting favorable outcomes following palatal surgery

Purpose Rapid eye movement-related obstructive sleep apnea (REM-OSA) is a physiological phenotype of OSA whose clinical significance and impact on surgical outcomes remain unclear. This study evaluated the prevalence, clinical characteristics, and predictive value of REM-OSA for palatal surgery outcomes.Methods Adult patients with OSA intolerant of continuous positive airway pressure who underwent palatal surgery were retrospectively reviewed. REM-OSA was defined as a REM apnea-hypopnea index (AHI) at least twice the non-REM AHI. Surgical success was defined as a > 50% reduction in AHI and a postoperative AHI Results Among 90 patients, 24 (26.7%) had REM-OSA. Compared with NREM-OSA, REM-OSA patients were younger (35.9 vs. 39.3 years, p = 0.043) and had lower baseline AHI (36.4 vs. 52.0 events/hour, p = 0.005). Although AHI reduction was similar between groups, REM-OSA showed a significantly higher surgical success rate (79.2% vs. 53.0%, p = 0.007). REM-OSA remained an independent predictor of surgical success after adjustment for age and baseline AHI (adjusted OR 5.44, 95% CI 1.41-21.00, p = 0.014).Conclusions REM-OSA was associated with younger age and lower baseline disease severity. Although the absolute reduction in AHI following palatal surgery was comparable between groups, patients with REM-OSA achieved a significantly higher surgical success rate. These findings suggest that REM-OSA may serve as a clinically useful predictor of favorable outcomes following palatal surgery.