Pay attention to treating a subgroup of positional obstructive sleep apnea patients

Chou, Yu Ting; Yang, Tien-Yu; Lin, Chin Kuo; Huang, Shiang-Yu; Tsai, Ying Huang; Chang, Ju Fang; Hou, Yu; Lin, Yu Ching

doi:10.1016/j.jfma.2016.06.007

Cited by 12 publications

(14 citation statements)

References 18 publications

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“…This may result in an increase in the occurrence of central and mixed apnoeas during supine sleep, as upper airway collapse is known to be aggravated by this body position; [13] (ii) subjects presenting with this triform of sleep apnoea evaluated in the current study, have been associated with altered, or increased respiratory control instability, that may have contributed to the atypical distribution of obstructive apnoeas; [4,14] (iii) obstructive apnoea indices vary in the lateral position whereas are more stable in the supine position. [15] The OAHI, which represents all obstructive-mediated apnoeas [8] was significantly lower in the lateral compared to the supine body position as expected. Therefore, it could be argued that mixed apnoeas contributed to the obstructive-mediated apnoea index severity in relation to body position.…”

Section: Discussionsupporting

confidence: 52%

The effects of body position on the distribution of obstructive, mixed and central sleep apnoea

Colff

Bartel

Becker

et al. 2019

Afr J Thorac Crit Care Med

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Background. Obstructive sleep apnoea is commonly aggravated by the supine body position. The impact of body position on the severity of mixed and central sleep apnoeas is understudied. Objectives. To evaluate the impact of body position on obstructive, mixed and central apnoea indices in subjects presenting with this triform of sleep apnoea during a single polysomnogram. Methods. We retrospectively analysed 26 polysomnograms where obstructive, mixed and central apnoeas each occurred at a rate >5/hr. Comparisons between lateral and supine body positions were made for obstructive apnoea index (OAI), mixed apnoea index (MAI), central apnoea index (CAI), apnoea-hypopnoea index (AHI) and obstructive apnoea-hypopnoea index (OAHI). Results. Mean (SD) apnoea indices were significantly lower in lateral v. supine positions, respectively:

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Section: Discussionsupporting

confidence: 52%

The effects of body position on the distribution of obstructive, mixed and central sleep apnoea

Colff

Bartel

Becker

et al. 2019

Afr J Thorac Crit Care Med

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“…There exists evidence in the literature for differences in POSA prevalence among differing ethnicities, most notably a potential increased prevalence among patients of Asian ethnicity compared to Caucasian, which may be related to differences in the craniofacial structure. [11][12][13][14][15][16]29 Further evidence from direct correlation studies however is lacking.…”

Section: Discussionmentioning

confidence: 99%

“…44 Our study, in line with the majority of previous literature reporting on prevalence of POSA and the severity of OSA, found the prevalence of POSA was higher in patients with milder OSA and reduced with increasing severity of the OSA. [12][13][14]16,28,29,37,45 It is likely that as the disease severity progresses the positional variability of the obstructive events is lost, and events start being observed in all body positions. 46,47 This may also be the reason that POSA is more commonly observed in patients with lower BMI, as BMI generally correlates with OSA severity.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Positional Sleep Apnea Among Regional and Remote Australian Population and Simulated Positional Treatment Effects</p>

Garg¹,

Er²,

Howarth³

et al. 2020

NSS

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Purpose: To assess the prevalence of positional sleep apnea (POSA) and its predictors in patients diagnosed to have obstructive sleep apnea (OSA) in the regional and remote population of the Northern Territory of Australia over a two-year study period (2018 and 2019). Patients and Methods: Of the total 1463 adult patients who underwent a diagnostic polysomnography (PSG), 946 patients were eligible to be included in the study, of them, 810 consecutive patients with OSA (Apnea-Hypopnea Index (AHI) ≥ 5) who slept >4 h and had ≥30 min sleep in both supine and lateral positions were assessed. Patients were considered to have POSA if supine AHI to lateral AHI ratio ≥2. The likely comparative impact of use of continuous positive airway therapy (CPAP) or positional therapy (PT) on disease severity was evaluated using model simulation. Results: A total of 495/810 (61%) patients had POSA, the majority were males (68% vs 60%, p=0.013) and non-Indigenous Australians (93% vs 87%, p=0.004). POSA patients were younger (mean difference 2.23 years (95% CI 0.27, 4.19)), less obese (BMI mean difference 3.06 (95% CI 2.11, 4.01)), demonstrated less severe OSA (p < 0.001) and a greater proportion reported alcohol consumption (72% vs 62%, p=0.001) as compared to those with non-POSA. Using the simulation model, if patients with POSA use PT two-thirds (323/495, 65%) would obtain significant improvement of their OSA severity, with one in five (92/495, 19%) displaying complete resolution. Comparing this to simulated CPAP therapy, where the majority (444/495, 90%) will show significant improvement, and onethird (162/495, 33%) will display complete resolution. Conclusion: POSA needs to be routinely recognised and positional therapy integrated in practice especially in the remote regions and in the developing world when effective methods are in place to monitor positional therapy.

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“…2,4,5 This variability is a consequence of several factors, including the size of the studied cohorts, the monocentric design, the ethnicity of the patients, and the use of different POSA definitions. [4][5][6][7] Several definitions of POSA have been used in the literature, but it is most commonly defined according to Cartwright's definition as OSA with a ratio of respiratory events in the supine to nonsupine position greater than 2:1. 8 When OSA occurs exclusively in the supine position, it is referred to as exclusive POSA (e-POSA) and is defined by a ratio of respiratory events in the supine to nonsupine position greater than 2:1 and a nonsupine apnea-hypopnea index (AHI) < 5 events/hour.…”

Section: Introductionmentioning

confidence: 99%

Positional obstructive sleep apnea within a large multicenter French cohort: prevalence, characteristics, and treatment outcomes

Sabil

Blanchard

Trzépizur

et al. 2020

Journal of Clinical Sleep Medicine

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Study Objectives: To assess, in a large cohort of patients with obstructive sleep apnea, the factors that are independently associated with positional obstructive sleep apnea (POSA) and exclusive POSA (e-POSA) and determine their prevalence. The secondary objective was to evaluate the outcome of positive airway pressure (PAP) therapy for patients with POSA and e-POSA. Methods: This retrospective study included 6,437 patients with typical mild-to-severe OSA from the Pays de la Loire sleep cohort. Patients with POSA and e-POSA were compared to those with non-POSA for clinical and polysomnographic characteristics. In a subgroup of patients (n = 3,000) included in a PAP follow-up analysis, we determined whether POSA and e-POSA phenotypes were associated with treatment outcomes at 6 months. Results: POSA and e-POSA had a prevalence of 53.5% and 20.1%, respectively, and were independently associated with time in supine position, male sex, younger age, lower apnea-hypopnea index and lower body mass index. After adjustment for confounding factors, patients with POSA and e-POSA had a significantly lower likelihood of treatment adherence (PAP daily use ≥ 4 h) at 6 months and were at higher risk of PAP treatment withdrawal compared to those with non-POSA. Conclusions: The prevalence and independent predictors of POSA and e-POSA were determined in this large clinical population. Patients with POSA and e-POSA have lower PAP therapy adherence, and this choice of treatment may not be optimal. Thus, there is a need to offer these patients an alternative therapy.

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Pay attention to treating a subgroup of positional obstructive sleep apnea patients

Abstract: One-third of positional OSA patients who had a high apnea index in the lateral position tends to become nonpositional OSA patients in the follow-up PSG and must be closely monitored if receiving positional therapy only.

Cited by 12 publications

References 18 publications

The effects of body position on the distribution of obstructive, mixed and central sleep apnoea

The effects of body position on the distribution of obstructive, mixed and central sleep apnoea

<p>Positional Sleep Apnea Among Regional and Remote Australian Population and Simulated Positional Treatment Effects</p>

Positional obstructive sleep apnea within a large multicenter French cohort: prevalence, characteristics, and treatment outcomes

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