This was unexpected….
I have been running Reaper on my Mac mini (2018) with a pair of 1080p monitors and all has been mostly fine. Then I replaced one of those monitors with an Apple Studio Display. Suddenly, a mix I'd been working on started breaking up and distorting during playback, but only under specific conditions.
The distortion happened if I had the Ozone plugin visible and its window was displaying on the new monitor. (I use Ozone during mixing to get a detailed comparison to a reference mix.) Something as simple as moving the fx window onto the remaining 1080p monitor (HDMI) made the distortion stop. Which part of Ozone I was watching seemed to make no difference.
I haven't seen any other plugins that cause a similar problem...yet.
The Reaper performance monitor showed no change throughout this, but the system activity monitor showed an increase in Reaper's CPU usage by over a full core, 170% to 320%