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Sleep Breath. 2019 Jul 20. doi: 10.1007/s11325-019-01897-1. [Epub ahead of print]

Prevalence and characteristics of positional obstructive sleep apnea (POSA) in patients with severe OSA.

Author information

1
Sleep Disorders Unit, Loewenstein Hospital-Rehabilitation Center, Raanana, Israel. arieo@clalit.org.il.
2
Sleep Disorders Unit, Loewenstein Hospital-Rehabilitation Center, Raanana, Israel.
3
Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
4
Department of Clinical Neurophysiology, Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
5
School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia.

Abstract

PURPOSE:

We assessed the prevalence of positional patients (PPs) and the main predictors of positional dependency in severe obstructive sleep apnea (OSA). A simulated effect of positional therapy (PT) vs. continuous positive airway pressure (CPAP) was also assessed.

METHODS:

Polysomnographic recordings of 292 consecutive patients with severe OSA (Apnea-Hypopnea Index (AHI) ≥ 30) who slept > 4 h and had ≥ 30 min sleep in both supine and lateral positions were assessed. PPs were defined to have a supine AHI/lateral AHI ratio ≥ two and non-positional patients (NPPs) a supine AHI/lateral AHI ratio < two.

RESULTS:

A total of 35.3% of the severe OSA patients were PPs. They were less obese and had less severe OSA (p < 0.001) compared with NPPs. The percentage of total apnea-hypopnea time from total sleep time (AHT%) was the most significant predictor for positional dependency. By sleeping in the lateral posture (i.e. after simulated PT), 78 (75.7%) PPs obtained significant improvement of their OSA severity and 9 (8.7%) of them became "non-OSA". Moreover, if CPAP was used only for 50% of total sleep time, 53 patients (18.2%) gained more benefit from avoiding the supine posture than from CPAP therapy.

CONCLUSIONS:

More than a third of the studied severe OSA patients were PPs. These patients could achieve a significant decrease in the number and severity of apneas and hypopneas by adopting the lateral posture, suggesting that PT may be a valuable therapy for a significant portion of these severe OSA patients who for whatever reason are not being treated by CPAP.

TRIAL REGISTRY:

ClinicalTrials.gov Identifier: NCT03232658.

KEYWORDS:

Lateral position; OSA treatment; Obstructive sleep apnea (OSA); Positional patients; Positional therapy; Severe OSA patients; Supine posture

PMID:
31325020
DOI:
10.1007/s11325-019-01897-1

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