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Sleep Med. 2018 Oct;50:145-151. doi: 10.1016/j.sleep.2018.05.012. Epub 2018 May 30.

A systematic comparison of factors that could impact treatment recommendations for patients with Positional Obstructive Sleep Apnea (POSA).

Author information

1
Advanced Brain Monitoring, Carlsbad, CA, USA. Electronic address: dan@b-alert.com.
2
Sleep Disorders Unit, Loewenstein Hospital - Rehabilitation Center, Raanana, Israel.
3
Ear-Nose-Throat Unit, Head and Neck Department, Morgagni-Pierantoni Hospital, Forlì, Italy.
4
Sleep Medicine Center, Charité Universitätsmedizin Berlin, Berlin, Germany.
5
Levi's Sleep Clinic, West Gosford, Australia.
6
Advanced Brain Monitoring, Carlsbad, CA, USA.

Abstract

OBJECTIVE/BACKGROUND:

Systematically compare four criteria for Positional Obstructive Sleep Apnea (POSA) based on AASM 2007 and 2012 hypopnea scoring definitions.

PATIENTS/METHODS:

142 records acquired by in-home polysomnography (Sleep Profiler PSG2™) were retrospectively analyzed using AHI based on the American Academy Sleep Medicine 2007 and 2012 criteria (AHI2007 and AHI2012). Positional obstructive sleep apnea (POSA) was characterized using four criteria: Amsterdam Positional OSA Classification (APOC), supine AHI twice the non-supine AHI (Cartwright), Cartwright plus the non-supine AHI < 5 (Mador), and the overall AHI severity at least 1.4 times the non-supine severity (Overall/NS-AHI).

RESULTS:

Correlations between the Cartwright and Overall/NS-AHI criteria increased with the inclusion of a more relaxed definition of hypopneas (AHI2007 = 0.79 and AHI2012 = 0.86, P < 0.00001). The prevalence of POSA based on the Cartwright and Overall/NS-AHI criteria was approximately 60% in those with at least mild OSA by AHI2007and AHI2012. A 16% reduction in POSA prevalence for AHI2012 vs. AHI2007 was attributed to the increased incident of mild OSA. For identification of those expected to have 25% or 35% reductions in SDB severity with positional therapy, Cartwright and Overall/NS-AHI exhibited the strongest sensitivity and Overall/NS-AHI and Mador the best specificity.

CONCLUSIONS:

The four criteria used to identify POSA have similarities and differences. While there were similarities between the Cartwright and Overall/NS-AHI criteria in the detection of POSA prevalence across both scoring criteria, the Overall/NS-AHI provided the most consistent detection of those most likely to demonstrate important reductions in sleep disordered breathing severity if supine sleep is avoided.

KEYWORDS:

Obstructive sleep apnea; Positional therapy; Prevalence; Sleep disordered breathing; Sleep position; Supine

PMID:
30055481
DOI:
10.1016/j.sleep.2018.05.012
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