Extreme Rapid Eye Movement Rebound Exceeding Three Hours During Continuous Positive Airway Pressure Titration Despite High-Dose Antidepressant Therapy: A Case Report

Rapid eye movement (REM) rebound following the initiation of continuous positive airway pressure (CPAP) is commonly observed, with episodes exceeding two hours being rare. We report a 38-year-old male with severe obstructive sleep apnea (OSA) (apnea-hypopnea index (AHI) = 74.2/hour) receiving fluoxetine 80 mg daily and trazodone 100 mg, who had a 206.5-minute continuous REM sleep episode during CPAP titration, followed by 66.5 minutes of stage N3 sleep. This duration exceeds previously reported continuous REM episodes during titration. This case demonstrates that severe OSA-related sleep fragmentation can overcome potent pharmacological REM suppression when effective treatment is initiated.