Comparing the characteristics of positional and nonpositional sleep apnea patients among the Jordanian population

Abstract

BACKGROUND: Obstructive sleep apnea (OSA) is a common cause of sleep-disordered breathing with a large proportion of the patients exhibiting positional OSA (POSA). In this study, we aimed to evaluate the differences in the demographics, comorbidities, and polysomnographic features between POSA and non-POSA (NPOSA) in a Jordanian sample to further discern the propulsive elements for each group. METHODS: In this study, we evaluated 1037 adult patients with OSA. POSA was defined as an overall apnea and hypopnea index (AHI) >5, an overall AHI severity at least 1.4 times the nonsupine severity (overall/NS-AHI), and a minimum amount of time (i.e., 20 min) in the supine and nonsupine positions. To compare the clinical characteristics between POSA and NPOSA patients, statistical analyses were performed. RESULTS: The prevalence of POSA was 41.7%. In comparison to NPOSA patients, POSA patients had higher female sex prevalence, milder OSA, lower body mass index, lower hypertension prevalence, and lower hemoglobin A1C levels compared to NPOSA patients. Moreover, sleep efficiency, total sleep time, and supine sleep time were significantly higher in POSA patients. Nonsupine sleep time, total AHI, rapid eye movement (REM) AHI, non-REM (NREM) AHI, supine AHI, nonsupine AHI, left and right AHI, mean oxyhemoglobin saturation (SpO 2 ) awake, mean REM and NREM SpO 2 , SpO 2 nadir, and time SpO 2 below 90% were significantly lower among POSA patients. The multivariate regression analysis showed that only female gender and hypertension were significantly associated with POSA. CONCLUSION: POSA is common among OSA patients and demonstrates different clinical characteristics in comparison to NPOSA. Future prospective studies are needed to better characterize the POSA patients and investigate the benefit of positional therapy.

Exploring the Impact of Positional Sleep Apnea in a Turkish Population: Unveiling the Untold Story

“…Consistent with previous reports, the presence of POSA and e-POSA in our study was associated with milder OSA (lower AHI), lower neck circumference, lower BMI, and lower rate of obesity, as well as with male sex and younger age [ 2 , 7 – 9 , 12 , 16 , 21 – 24 ]. Hence, given its association with younger age, lower BMI, and milder OSA severity, POSA is suggested to represent an early stage of the OSA natural history that can develop in non-POSA with increasing age and weight, emphasizing the loss of the positional variability of the obstructive events as disease severity progresses [ 2 , 7 , 9 , 12 , 17 , 25 ]. Supporting the likelihood of POSA patients to become non-POSA with increasing BMI [ 7 ], reduction in weight after bariatric surgery was reported to be associated with an increase in the prevalence of POSA at the expense of non-POSA [ 25 ].…”

“…In our patients, both POSA and e-POSA were independently associated with lower AHI (total, supine, non-supine, REM, and non-REM). Higher AHI (total, supine, non-supine, REM, non-REM) in non-POSA than in POSA patients has also been reported in other studies, and is suggested to indicate a higher tendency of airway collapse and a more severe disease among non-POSA patients, regardless of the body position during sleep [ 7 , 24 , 26 ]. Moreover, our patients in the e-POSA group had significantly higher TST in the supine position and lower time in the lateral position, while an increase in TST in supine position was also independently associated with e-POSA.…”

“…Hence, given its association with younger age, lower BMI, and milder OSA severity, POSA is suggested to represent an early stage of the OSA natural history that can develop in non-POSA with increasing age and weight, emphasizing the loss of the positional variability of the obstructive events as disease severity progresses [ 2 , 7 , 9 , 12 , 17 , 25 ]. Supporting the likelihood of POSA patients to become non-POSA with increasing BMI [ 7 ], reduction in weight after bariatric surgery was reported to be associated with an increase in the prevalence of POSA at the expense of non-POSA [ 25 ].…”

“…The clinical type of OSA considerably alters the selected treatment. Patients with POSA significantly benefit from positional therapy (PT), which is based on the avoidance of sleeping in the supine position via new-generation PT devices, whereas CPAP is the mainstay therapy for those with non-POSA [ 6 , 7 , 16 , 17 ].…”

“…In this regard, given that PAP adherence remains a major problem in OSA patients, POSA patients treated with CPAP can also have low adherence, and thus may be confronting unwanted cardiometabolic consequences [ 13 , 18 , 19 ]. In contrast, although they represent young populations with mild OSA severity, e-POSA patients that are exposed to significant hypoxic burden may be underestimated and undertreated [ 2 , 7 , 9 , 12 , 13 ]. Despite the significant differences between positional and non-positional OSA types in terms of clinical manifestations and treatment options, few studies investigated the differences between clinical types of OSA and the risk factors that incite the emergence of POSA, e-POSA, or non-POSA, and findings were often contradictory [ 2 , 7 – 9 , 12 , 13 , 20 ].…”