REM-Dominant Sleep Apnea Significantly More Prominent Following COVID-19

Obstructive sleep apnea (OSA) occurring predominantly during rapid eye movement (REM) was significantly more prominent following COVID-19 infection, according to a study published in Sleep Medicine.¹ Researchers also found that the REM-predominant phenotype among patients with OSA was associated with fatigue and should be considered when managing patients’ long-COVID symptoms.

“The COVID-19 pandemic affects individuals with OSA at many levels,” wrote authors of a study published in the Journal of Clinical Sleep Medicine (JCSM).² “Social distancing, physical isolation, and suspension of many clinical services complicate the already prevalent underdiagnosis of OSA and potentially delay treatment for those who have been diagnosed.”

OSA is when a blockage in the windpipe causes breathing complications during sleep. It commonly leads to poor sleep quality, night sweats, fatigue, mood changes, headaches, and more.³ REM-predominant OSA, however, impacts a subset of patients with OSA (17-74%). This type of OSA mainly occurs during patients’ REM sleep stage.⁴

OSA alone is extremely prominent, affecting nearly 1 billion patients between the ages of 30 and 69.³ However, treatment options are scarce, as the FDA approved the very first pharmacological treatment (tirzepatide) for OSA just 1 year ago.⁵ And with limited options for patients with OSA, those with REM-predominant OSA have even fewer.

READ MORE: FDA Enforces Stricter Vaccine Development, Linking COVID Vaccine to Pediatric Deaths

Because REM-predominant OSA has been mostly associated with only mild OSA symptoms and no daytime sleepiness at the moment, those with this subtype of the OSA condition are often unincluded for treatment. And while the debates between REM-predominant OSA and general OSA treatment persist, other factors—like the COVID-19 pandemic—have also complicated the management of OSA.⁴

COVID-19’s Relationship with OSA

As JCSM authors previously mentioned, the COVID-19 pandemic’s sanctions led to increased daytime sleepiness, fatigue, compromised driving safety, decreased work productivity, and increased snoring. Furthermore, sleep medicine was also deemed nonessential during the pandemic, resulting in no positive airway pressure (PAP) treatment prescriptions for a period of time.²

Adding to the recent history of OSA and the factors that impact its treatment, COVID-19 infection, long-COVID, and the various respiratory-related complications from the virus all impact patients’ sleep. While it is known OSA and COVID-19 both impact sleep patterns in their own respective ways, researchers wanted to further elucidate the relationship between REM-predominant OSA and general OSA in the context of COVID-19.

“Although OSA has been reported more frequently after COVID-19 infection, the REM-predominant phenotype has not been specifically studied in this context,” wrote authors of the current study.¹ “The present study aims to characterize the prevalence and clinical relevance of REM-predominant OSA in individuals with a prior history of COVID-19.”

REM-Predominant OSA After COVID-19 Infection

Researchers conducted a case-control study featuring patients with a history of COVID-19 evaluated in a sleep laboratory. They separated participants equally, where patients with COVID-19 diagnoses were in the case group and those without a report of COVID-19 were the control group. All participants were at least 18 years old.

The final analysis consisted of 152 patients in the case group (mean age, 53.7 years; 75.7% men) and an equally matched cohort part of the control group.

“Despite a lower overall burden of respiratory events, patients in the post-COVID group demonstrated a significantly higher prevalence of REM-predominant OSA,” they wrote.¹ “This dissociation suggests that upper airway collapsibility may be selectively intensified during REM sleep in the post-viral state.”

Indeed, general OSA was most prominent among participants who did not report COVID-19 diagnoses. However, when exploring the REM-predominant phenotype, the case group reported 15 more cases than the control group (47.4% vs 17.8%). For the specific symptoms associated with REM OSA and long-COVID, fatigue was 17.1% more prominent among patients with REM-predominant OSA compared with patients without it.

While the REM-predominant phenotype in patients with OSA has been previously explored, it was COVID-19 that helped highlight its clinical significance. With REM OSA previously being overlooked compared with general OSA symptoms, findings from this study may inform future research to further bring REM OSA complications to light.

“In conclusion, this study demonstrates that REM-predominant OSA is significantly more prevalent among post-COVID individuals and is characterized by a distinct clinical profile marked by prominent fatigue rather than classical symptoms,” concluded authors of the study.¹ “These findings highlight the need to recognize REM-predominant OSA as a clinically meaningful phenotype that may require tailored diagnostic and management strategies.”

READ MORE: COVID-19 Resource Center

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REFERENCES

1. Calik I, Peker Y. REM – predominant obstructive sleep apnea in adults with a history of COVID-19 infection: a case-control study. Sleep Med. 2025;139:108729. https://doi.org/10.1016/j.sleep.2025.108729

2. Rizzo D, Libman E, Baltzan M, et al. Impact of the COVID-19 pandemic on obstructive sleep apnea: recommendations for symptom management. JCSM. 2021 Mar 1;17(3):429-434. doi: 10.5664/jcsm.8922.

3. Obstructive sleep apnea. Cleveland Clinic. December 4, 2024. Accessed December 18, 2025. https://my.clevelandclinic.org/health/diseases/24443-obstructive-sleep-apnea-osa

4. Ganguly G. REM-related obstructive sleep apnea: is it still an enigma or do we even care? JCSM. 2025;21(5):749-750. https://doi.org/10.5664/jcsm.11672

5. FDA approves first medication for obstructive sleep apnea. News Release. FDA. December 20, 2024. Accessed December 18, 2025. https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-obstructive-sleep-apnea