Positional therapy is a valuable treatment alternative for obstructive sleep apnea

Oksenberg, Arie; Gadoth, Natan

doi:10.2478/jtim-2019-0016

Cited by 4 publications

(2 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The prevalence of positional dependency varies according to different definitions and depends on age, BMI, and AHI [7,11,17,18]. Positional OSA was previously defined as an AHI ≥ 5/h with s-AHI/ns-AHI ratio ≥2.…”

Section: Discussionmentioning

confidence: 99%

The Worsening of Positional Mild Obstructive Sleep Apnea over Time Is Associated with an Increase in Body Weight: Impact on Blood Pressure and Autonomic Nervous System

Chang

Cui

et al. 2021

Respiration

View full text Add to dashboard Cite

Background: Most patients with mild obstructive sleep apnea (OSA) are positional dependent. Although mild OSA worsens over time, no study has assessed the natural course of positional mild OSA. Objectives: The aim of this study was to evaluate the natural course of positional mild OSA, its most valuable progression predictor, and its impact on blood pressure (BP) and the autonomic nervous system (ANS). Methods: This retrospective observational cohort study enrolled 86 patients with positional mild OSA and 26 patients with nonpositional mild OSA, with a follow-up duration of 32.0 ± 27.6 months and 37.6 ± 27.8 months, respectively. Polysomnographic variables, BP, and ANS functions were compared between groups at baseline and after follow-up. Results: In patients with positional mild OSA after follow-up, the apnea/hypopnea index (AHI) increased (9.1 ± 3.3/h vs. 22.0 ± 13.2/h, p = 0.000), as did the morning systolic BP (126.4 ± 13.3 mm Hg vs. 130.4 ± 15.9 mm Hg, p = 0.011), and the sympathetic activity (49.4 ± 12.3% vs. 55.3 ± 13.1%, p = 0.000), while the parasympathetic activity decreased (50.6 ± 12.3% vs. 44.7 ± 13.1%, p = 0.000). The body mass index changes were the most important factor associated with AHI changes among patients with positional mild OSA (Beta = 0.259, adjust R2 = 0.056, p = 0.016, 95% confidence interval 0.425 and 3.990). The positional dependency disappeared over time in 66.3% of patients with positional mild OSA while 69.2% of patients with nonpositional mild OSA retained nonpositional. Conclusions: In patients with positional mild OSA, disease severity, BP, and ANS regulation worse over time. Increased weight was the best predictor for its progression and the loss of positional dependency. Better treatments addressing weight control and consistent follow-up are needed for positional mild OSA.

show abstract

Section: Discussionmentioning

confidence: 99%

The Worsening of Positional Mild Obstructive Sleep Apnea over Time Is Associated with an Increase in Body Weight: Impact on Blood Pressure and Autonomic Nervous System

Chang

Cui

et al. 2021

Respiration

View full text Add to dashboard Cite

show abstract

“…Esto puede conducir a un aumento en el esfuerzo respiratorio necesario para reabrir las vías respiratorias superiores, posiblemente aumentando la activación simpática general y conduciendo a una mayor respuesta cardiovascular [229]. Esto también está respaldado por el hecho de que, en la posición supina, los niveles de CPAP necesarios son más elevados que en las posiciones no supinas [231]. Los cocientes de riesgo elevados observados en este estudio podrían deberse a apneas más prolongadas y los mayores cambios observados en las desaturaciones que se han relacionado con la AOS de componente supina predominante [229].…”

Section: Aos Posicional Y Mortalidadunclassified

Apnea obstructiva del sueño posicional. Implicaciones clínicas.

Arroyo Domingo

View full text Add to dashboard Cite

Background. Obstructive sleep apnea (OSA) is a highly prevalent disease with major negative implications both for the patient and the health system. Patients showing a higher rate of respiratory events while sleeping in the supine position suffers from the so called positional obstructive sleep apnea (POSA), which is one of the most frequent OSA phenotypes (56%-75%).There is not a consensus within the medical community concerning POSA diagnosis. Since the first definition of positional patients by Cartwright as those showing an apnea-hypopnea index (AHI) in the supine position at least twice the AHI in the non-supine position, numerous amendments have been performed.Recently, the Amsterdam Positional OSA Classification (APOC) criterion has been proposed, which attempts to identify those patients who could benefit the most from a positional therapy due to the removal of positional-related apneas leads to a nonpathologic condition despite residual events or, alternatively, because the absence of positional apneas leads to a significant reduction of the severity of the disease. Are there differences in the severity degree of POSA and Non-POSA patients? Published works are contradictory. Some researchers consider POSA as a milder phenotype of the disease. On the contrary, other authors link supinedependent apneas to more frequent, longer, and severe events, with deeper desaturations, and with a more severe bradycardia-tachycardia pattern. Thus, further research is needed to gain insight into the actual effects of positional apneas. Hypotheses and objectives.The main hypothesis in the present PhD Thesis is that the variability linked to the different existing POSA definitions could affect the viii prevalence, clinical characteristics, and management of patients, and thus, to their health and quality of life. Particularly, as a secondary question, it is hypothesized that positional patients could have higher cardiac autonomic disbalance than nonpositional subjects. Accordingly, the main aim of the PhD Thesis is to characterize patients diagnosed as POSA according to the new APOC criteria and thoroughly analyze their differences compared to a group of non-positional subjects. The following secondary objectives are also stated: to estimate the POSA prevalence according to the existing positional criteria; to analyze the differences among the POSA categories defined by the APOC criterion; to analyze the polysomnographic and pulseoximetric indexes of POSA and Non-POSA patients; to study the influence of POSA in sleep quality, quality of life, and CPAP treatment adherence; to analyze its effect on cardiac autonomic modulation. Materials and methods. A total of 409 patients consecutively referred to the sleep unit of the Pneumology Service of the Río Hortega University Hospital of Valladolid between July 2016 and April 2018 were included in the research. All patients underwent unsupervised nocturnal polysomnography (PSG) at home and simultaneous nocturnal pulse oximetry recording by means of a portable pulseoximeter. A triax...

show abstract

Effects of the combination of novel eye mask sleep position therapy device and oral appliance on positional OSA: A multi-arm, parallel-group randomized controlled trial

Huang

Zou

et al. 2023

Sleep Medicine

View full text Add to dashboard Cite

Positional therapy is a valuable treatment alternative for obstructive sleep apnea

Cited by 4 publications

References 5 publications

The Worsening of Positional Mild Obstructive Sleep Apnea over Time Is Associated with an Increase in Body Weight: Impact on Blood Pressure and Autonomic Nervous System

The Worsening of Positional Mild Obstructive Sleep Apnea over Time Is Associated with an Increase in Body Weight: Impact on Blood Pressure and Autonomic Nervous System

Apnea obstructiva del sueño posicional. Implicaciones clínicas.

Effects of the combination of novel eye mask sleep position therapy device and oral appliance on positional OSA: A multi-arm, parallel-group randomized controlled trial

Contact Info

Product

Resources

About