Study Objectives: To examine the feasibility of using digital oximetry biomarkers (OBMs) and body position to identify positional obstructive sleep apnea (POSA) phenotypes. Methods: A multiclass extreme gradient boost (XGBoost) was implemented to classify between three POSA phenotypes, i.e., positional patients (PP), including supine-predominant OSA (spOSA), and supine-isolated OSA (siOSA), and non-positional patients (NPP). A total of 861 individuals with OSA from the multi ethnic study of atherosclerosis (MESA) dataset were included in the study. Overall, 43 OBMs were computed for supine and non-supine positions and used as input features together with demographic and clinical information (META). Feature selection, using mRMR, was implemented, and nested cross validation was used for the model’s performance evaluation. Results: The best performance for the multiclass classification yielded a median weighted F1 of 0.79 with interquartile range (IQR) of 0.06. Binary classification between PP to NPP achieved weighted F1 of 0.87 (0.04). Conclusion: Using OBMs computed in PP and NPP with OSA, it is possible to distinguish between the different phenotypes of POSA. This data-driven algorithm may be embedded in portable home sleep tests.

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Study Objectives: To investigate the characteristics of Obstructive Sleep Apnea (OSA) positional patients (PP) phenotypes among different ethnic groups in the Multi-Ethnic Study of Atherosclerosis (MESA) dataset. Moreover, we hypothesized the existence of a new OSA PP phenotype we coined Lateral PP, for whom the lateral apneas hypopnea index (AHI) is at least double the supine AHI. Methods: From 2,273 adults with sleep information, we analyzed data of 1,323 subjects that slept more than 4 hours and had at least 30 minutes of sleep in both the supine and the non- supine positions. Demographics and clinical information were compared for the different PP, and ethnic groups. Results: 861 (65.1%) patients had OSA and 35 (4.1%) were Lateral PP. Lateral PP patients were mainly females (62.9%), obese (31.4 median body mass index), had mild to moderate OSA (94.3%), and mostly were non-Chinese American (97.1%). Among all OSA patients, 550 (63.9%) were Supine PP, and 17.7% were supine-isolated OSA (siOSA). Supine PP and Lateral PP were present in 73.1% and 1.0% of Chinese Americans, 61.0% and 3.4% of Hispanics, 68.3% and 4.7% of White-Caucasian, and 56.2% and 5.2% of Black-African American OSA patients. Conclusion: Chinese-American have the highest prevalence of Supine PP, whereas Black- African American patients lean towards less Supine PP and higher Lateral PP. Lateral PP appears as a novel OSA phenotype. However, it was found for a small group of OSA patients and thus, its presence should be further validated. Keywords: Positional obstructive sleep apnea (POSA), positional patients (PP), Positional Therapy, Lateral PP, OSA ethnicity and MESA.