Changes in site of obstruction in obstructive sleep apnea patients according to sleep position: A DISE study

Abstract

When sleep posture is changed from supine to lateral, obstruction due to structures such as tongue base and larynx improves dramatically. Obstruction in lateral position is mostly due to obstruction at the oropharyngeal LWs. Therefore, position dependency is mostly determined by LW collapsibility. Evaluating the changes of the upper airway according to sleep position can further characterize the upper airway collapsibility and can be used for tailored treatment planning.

Two subtypes of positional obstructive sleep apnea: Supine-predominant and supine-isolated

“…A number of recent studies on the pathogenesis of POSA have emphasized the gravity of respiratory events occurring in the supine position (Camacho et al, 2014;Joosten et al, 2014;Lee et al, 2015). In our study, siOSA presents with milder objective sleep parameters but poorer subjective sleep quality and mood; this result suggests the possibility that respiratory events occurring while in a supine position may be crucially detrimental to subjective sleep quality and mood, notwithstanding equivalent or milder obstructive features.…”

“…The POSA is a common form of the disease with milder clinical features compared with NPOSA (Oksenberg et al, 1997;Joosten et al, 2012). However, despite recent progress (Camacho et al, 2014;Lee et al, 2015), the mechanisms underlying POSA including its interaction with upper airway collapsibility, or reduced lung volume, are poorly understood (Joosten et al, 2014). Furthermore, despite recent studies suggestive of the effectiveness of positional therapy in POSA, its effectiveness depends on the severity of the disease (van Maanen et al, 2012Ravesloot et al, 2013).…”

Effect of Sleeping Position on Upper Airway Patency in Obstructive Sleep Apnea Is Determined by the Pharyngeal Structure Causing Collapse

“…5 Lee et al performed DISE in 85 patients and reported a decrease in the prevalence of tongue base obstruction when moving from supine (71.1%) to lateral sleep (7.1%). 3 However, there are some methodological differences between this paper and our study. First, as a condition for tongue base obstruction, Lee and colleagues used the criteria of a 50% displacement compared to wakefulness.…”

“…Some studies suggest that sleeping supine could affect the collapse of particular structures within the airway, such as the tongue base or epiglottis. [3][4][5] However, these studies lacked quantitative measurements of airway size and flow in the different sleeping positions, making it difficult to determine the effect size of positional changes.…”

Adult obstructive sleep apnoea and the larynx

“…A recent DISE study examining the effect of sleep position found that the incidence of laryngeal obstruction dropped dramatically from 21.2 to 1.2% when the study participant was moved from supine to lateral position. In addition, lateral pharyngeal wall obstruction was found to become the most prominent pattern in the lateral decubitus position, exhibiting no positional dependency [21 ]. These findings imply that laryngeal obstruction, as a component of sleep apnoea, is mainly relevant in the supine position, and raises the potential role of lateral sleep positioning devices in the treatment of OSA with laryngeal obstruction.…”