Dreams and Nightmares in Patients With Obstructive Sleep Apnea: A Review.

Obstructive sleep apnea (OSA) disrupts sleep and oxygen levels, which may affect dreaming. Some studies report that people with OSA have fewer dreams, while others find they have more emotionally intense dreams, often with violent or hostile themes. Respiratory-related dream content is rare. A clear link exists between post-traumatic stress disorder, co-occurring OSA, and nightmares. Continuous positive airway pressure (CPAP) treatment reduces nightmare frequency. Several studies show that more severe OSA, measured by the apnea-hypopnea index, is associated with lower dream recall. Future research should distinguish between patients with general OSA and those with rapid eye movement (REM)-predominant OSA.

Study at a glance

Abstract

Obstructive sleep apnea (OSA) can present with or provoke various psychological symptoms. In this article, we critically review studies that have examined dreams, dream recall, and dream content in patients with OSA. Obstructive events induce recurrent sleep fragmentation and intermittent desaturations in patients with OSA, which may trigger different parasomnias, including nightmares. Contradictory results have been reported concerning dreams in patients with OSA; while some investigators have reported less dreams in OSA patients, others have described that patients with OSA have increased dreams with emotional content, mainly violent and hostile content. Although there are reports of respiratory-related dream content in patients with OSA, most studies that have assessed the dream content of patients with OSA revealed that respiratory-related dream content was unusual. A clear association between post-traumatic stress disorders, comorbid OSA, and nightmares has been reported in several studies. Furthermore, an improvement in nightmare frequency with continuous positive airway pressure (CPAP) treatment has been shown. An inverse relationship between the severity of OSA reflected by the apnea-hypopnea index and dream recall has been demonstrated in several studies. Future studies should differentiate between patients with non-stage specific OSA and patients with rapid eye movement (REM) predominant OSA.