REM SLEEP-RELATED sleep apnoea may amplify the vascular processes that contribute to Alzheimer’s disease, according to a new framework linking sleep-disordered breathing during REM sleep to cerebrovascular damage and memory decline, particularly in older adults.
Obstructive sleep apnoea has been recognised as a common though underdiagnosed disorder in older adults, and has been identified as a potential upstream vascular stressor linked to increased Alzheimer’s disease risk. Although the cardiometabolic and vascular consequences of sleep apnoea have been increasingly studied, the specific contribution of rapid eye movement, or REM, sleep-related respiratory events to this relationship has remained underexplored.
The authors proposed a stage-informed framework synthesising four linked lines of existing evidence: that REM sleep physiology magnifies the hypoxic and haemodynamic burden of obstructive sleep apnea; that the cardiometabolic consequences of sleep apnea are heightened during REM sleep; that REM-related hypoxaemia is associated with markers of cerebrovascular pathology; and that vascular effects associated with REM-related hypoxaemia are associated with medial temporal lobe vulnerability and memory dysfunction, both core features of Alzheimer’s disease.
REM-predominant obstructive sleep apnoea was linked to elevated cardiometabolic risk, and markers of cerebrovascular pathology were linked to REM-related hypoxaemia even after accounting for standard cardiovascular risk factors. Vascular pathways associated with REM-related hypoxaemia were also linked to medial temporal lobe vulnerability, a brain region central to memory function and Alzheimer’s disease pathology. The authors noted that direct evidence linking REM-specific obstructive sleep apnea to Alzheimer’s disease biomarkers remained lacking, representing an evidence gap rather than a confirmed causal pathway.
These findings have suggested that reframing REM sleep as a window of cerebrovascular vulnerability could help refine risk stratification and personalise treatment for obstructive sleep apnoea, particularly in older adults and those at elevated Alzheimer’s disease risk. As this was a perspective article synthesising existing evidence rather than presenting new primary data, its conclusions represent a proposed framework rather than established causal findings. The authors have suggested that routine sleep study reporting should incorporate REM-specific indices to enable more precise phenotyping, even in patients whose overall apnoea severity falls in the mild range.
Reference
Berisha DE et al. Sleep apnea in REM sleep as an amplifier of vascular contributions to Alzheimer’s disease. Alzheimer’s Dement. 2026; 22:e71735.
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