Nightmare Distress and Dream Recall in Patients With Obstructive Sleep Apnea

Abstract

Objectives: We aimed to examine dream recall and nightmare distress in patients with obstructive sleep apnea (OSA), and identify the associating factors.Methods: This cross-sectional study retrospectively enrolled adult participants (age ≥18 years) with newly diagnosed OSA that was confirmed by full-night polysomnography between 2016 and 2022. Dreaming components were assessed using a nine-item dreaming questionnaire (nightmare distress and dream recall). We compared the clinical and polysomnographic findings according to OSA severity and the presence of rapid eye movement (REM)-dependent OSA. Additionally, we assessed factors that related to nightmare distress and dream recall in patients with OSA.Results: Patients with mild OSA had significantly higher nightmare distress than those with moderate to severe OSA (p=0.044). Univariate linear regression analysis showed negative correlations between the apnea-hypopnea index (AHI) and nightmare distress (β=-0.105; p=0.040). Conversely, multivariate analyses indicated that the AHI and the presence of REM-dependent OSA were not significantly associated with nightmare distress and dream recall. Wakefulness after sleep onset (β=0.083; p=0.066), the Pittsburgh Sleep Quality Index (PSQI) (β=0.271; p<0.001), the Beck Depression Inventory (β=0.242; p<0.001), and the State-Trait Anxiety Inventory-State (STAI-S) (β=0.123; p=0.047) were related to nightmare distress. In contrast, younger age (β=-0.144; p=0.004), PSQI (β=0.098; p=0.058), STAI-S (β=0.156; p=0.003) were associated with dream recall.Conclusions: Depression, anxiety, and poor sleep quality were related to nightmare distress, while younger age and anxiety were associated with dream recall. OSA severity and the presence of REM-dependent OSA were not significantly associated with nightmare distress or dream recall.