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

Abstract

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.

Characteristics of patients with positional OSA according to ethnicity and the identification of a novel phenotype – Lateral Positional Patients (Lateral PP): A MESA study

“…for severe OSA. These results are in line with the results in the literature showing that Supine PP are mainly dominant in the less severe groups of patients with OSA 14 . Moreover, our findings on Supine PP and siOSA prevalence among OSA in MESA were also aligned with previous reports 6,14, Overall, up to 34.0% of all OSA individuals were siOSA, and by using positional therapy (PT) efficiently, they could resolve their OSA condition.…”

Criteria for oral appliance and/or supine avoidance therapy selection based on outcome optimization and cost-effectiveness

“…These results, however, were markedly similar to findings observed in other cohorts. For example, the percentage of positional-OSA patients with a non-supine AHI events/h in the normal range in our cohort was equivalent to a recent study of 6,437 patients 6 . Women had lower pre-treatment overall, supine, and non-supine AHI values compared to men, and by-sex differences remained post-OAT 23,[31][32][33] .…”

“…Positive airway pressure is the standard of care for moderate to severe OSA, while OAT is recommended for those with mild to moderate OSA or intolerant of positive airway pressure 5 . Patients with mild to moderate OSA tend to be less symptomatic and less tolerant of positive airway pressure 6 .…”

“…Over 65% of diagnosed patients have positional-OSA, i.e., the supine AHI and time sleeping in the supine position contribute to an elevated overall OSA severity 13 . Positional-OSA patients are more likely to have mild-moderate OSA and exhibit a positive treatment response to OAT 6,14,15 . Positional-OSA patients can also be efficaciously treated with supine avoidance therapy (SAT), whereby the overall OSA severity is typically reduced to the magnitude measured in the non-supine positions [16][17][18] .…”

Role of drug-induced sleep endoscopy in evaluation of positional vs non-positional OSA

“…Since higher BMI is associated with a higher degree of oropharyngeal lateral wall collapse [21], a decrease in BMI may lessen the severity of oropharyngeal lateral wall collapse, which in turn leads to a reduction in non-supine AHI. Second, a multicenter French cohort revealed that patients with positional OSA had a significantly lower likelihood of CPAP adherence and an increased risk of CPAP withdrawal as compared with non-positional OSA [22]. Previous studies utilized DISE to evaluate upper airway structural changes induced by CPAP titration [23,24].…”