Positional Obstructive Sleep Apnea Research Articles

Positional obstructive sleep apnea and periodic limb movement during sleep: A large multi-center study.

The relationships among positional obstructive sleep apnea (POSA), obstructive sleep apnea (OSA), and periodic limb movement during sleep (PLMS) are unclear. We analyzed these relationships according to OSA severity and explored the underlying mechanisms. We retrospectively reviewed 6,140 eligible participants who underwent full-night diagnostic polysomnography in four clinical centers over a period of 5 years with eventsynchronized analysis. The PLMS index (PLMI) and periodic limb movements with arousal index (PLMAI) were evaluated. The effects of POSA on the PLMI, PLMAI, and PLMS were analyzed according to OSA severity. The mean PLMI and PLMAI, as well as PLMS prevalence, were significantly lower in those with severe OSA than in those with mild and moderate OSA. The mean PLMI was higher in mild OSA group than in control group. The mean PLMI (4.80 ± 12.71 vs. 2.59 ± 9.82 events/h, p < 0.001) and PLMAI (0.89 ± 3.66 vs. 0.53 ± 3.33 events/h, p < 0.001), and the prevalence of PLMS (11% vs. 5.3%, p < 0.001) were higher in patients with POSA than patients with non-POSA. This trend was particularly marked in severe OSA group (OR 1.55, 95%CI [1.07-2.27]) and less so in mild (OR 0.56, 95%CI [0.30-1.03]) and moderate (OR 1.82, 95%CI [0.99-3.34]) OSA groups. The POSA group tended to have a higher prevalence of PLMS, particularly in those with severe OSA. If PLMS is prominent, diagnosis and treatment of POSA and OSA may be considered.

0479 The Association of Positional Obstructive Sleep Apnea with Blood Pressure

0479 The Association of Positional Obstructive Sleep Apnea with Blood Pressure

Effectiveness of Mandibular Advancement Devices in Positional OSA Patients: A Retrospective Analysis of Predictive Variables in a Sample of Adult Patients.

Objectives To evaluate the efficacy of mandibular advancement devices (MADs) in improving apnea-hypopnea index (AHI) in positional obstructive sleep apnea (POSA), compared with a control group of nonpositional OSA (NPOSA) patients, from mild to very severe degree, in order to to find the main variables characterizing the examined group as potential predictors of treatment success. Materials and Methods In the present observational study, we retrospectively collected polysomnographic records of 39 positional adult patients, divided into 30 supine isolated OSA (siOSA) and 9 supine predominant OSA (spOSA) undergoing MADs from 2003 to 2019, and compared with those of a control group of 47 NPOSA patients. Demographics and anthropometrical data, home sleep apnea test (HSAT) records, drug-induced sleep endoscopy (DISE) results, and dental casts evaluation were analyzed pre- and post-treatment with MADs. Results A prevalence of the male sex (86%), mean age of 49,4 ± 14.98 years, and mean body mass index (BMI) of 26.74 ± 4.29 kg/m 2 were found among the OSA patients with significant differences between the three groups for sex and BMI. After MADs, the HSAT revealed significant reduction of AHI in all of the groups, with greater reduction of the supine AHI in POSA and significant reduction of the snore index for NPOSA. The hypopharynx section (H) of the NOHL Index, a fourth degree of hypopharyngeal collapse and an anteroposterior pattern was the most frequent to occur (19.9%) from DISE exam. No significant correlation between the initial total AHI and the dental variables was found, except for a reduced maxillary intermolar distance. Conclusion MADs are effective in reducing AHI in POSA and NPOSA patients from mild to very severe degree. Supine AHI decreased after treatment with MADs mainly in siOSA and spOSA patients compared with the NPOSA group. The snore index decreased significantly after treatment with MADs in all groups, showing the greater reduction in the NPOSA group. The tongue base (H) represented the most frequent anatomic area of collapse and there was a high prevalence of upper maxillary constriction.

Effect of positional therapy on the sleep apnea-specific hypoxic burden and pulse rate response in children with positional Obstructive Sleep Apnea

Effect of positional therapy on the sleep apnea-specific hypoxic burden and pulse rate response in children with positional Obstructive Sleep Apnea

Positional Obstructive Sleep Apnoea in children

Positional Obstructive Sleep Apnoea in children

Differences in Physiological Endotypes Between Nonpositional and Positional OSA: Results From the Shanghai Sleep Health Study Cohort

BACKGROUNDPositional obstructive sleep apnea (POSA) is a recognized subtype of obstructive sleep apnea (OSA) that exhibits distinct endotypic characteristics when compared to non-positional OSA (NPOSA). The basis for the disparity in endotypes between these subtypes remains poorly understood. RESEARCH QUESTIONS(1) Do individuals with NPOSA and POSA have different underlying OSA endotypes? (2) Which endotypic characteristics are critical in determining NPOSA and POSA severity? STUDY DESIGN AND METHODSWithin the Shanghai Sleep Health Study cohort, individuals with OSA were recruited and classified as POSA or NPOSA. Endotypes were calculated using polysomnography. RESULTSEndotype analysis was conducted in 1,036 individuals with OSA. Compared to individuals with NPOSA, those with POSA had lower LGAll (0.55 [0.46–0.66] VS 0.68 [0.52–0.90], p<0.001), lower ArTHAll (138.67 [118.94–180.87] %Veupnea VS 189.00 [129.71–257.76] %Veupnea, p<0.001), higher VpassiveAll (91.85 [83.13–95.15] %Veupnea VS 76.38 [23.77–92.08] %Veupnea, p<0.001) and higher VcompAll (6.50 [−6.77–16.39] %Veupnea VS 3.65 [−10.47–12.14] %Veupnea, p=0.003). Logistic regression analyses indicated that higher VpassiveAll was associated with increased odds of POSA versus NPOSA. In NPOSA, fully adjusted linear regression analyses indicated that VpassiveAll (β [95% confidence interval, 95% CI], −0.55[−0.68–[−0.42]], p<0.001) and LGAll (β [95% CI], 0.19[0.08–0.30], p<0.001) were significant independent predictors of AHI, with VpassiveAll being the most critical factor. In contrast, in POSA, collapsibility appeared to be less influential (β [95% CI], −0.09[−0.21–0.03], p=0.138). Non-anatomical endotypic characteristics (LGAll, β [95% CI], 0.29 [0.18–0.41], p<0.001; ArTHAll, β [95% CI], 0.15 [0.01–0.28], p=0.031; VcompAll, β [95% CI], −0.21[−0.29–[−0.12]], p<0.001) were significant in determining the severity of POSA, with LG being the most crucial factor. INTERPRETATIONThis study highlights the differences in endotypes between NPOSA and POSA. In Chinese individuals, anatomical factors were more significant in determining the severity of NPOSA, while non-anatomical traits were more likely to determine the severity of POSA. Future research should focus on developing personalized management strategies for individuals with NPOSA and POSA based on their endotypes. Clinical Trial Registration NumberThe study was approved by the Ethics Committee of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Approval No: 2019-KY-050[K]) and registered at the Chinese Clinical Trial Registry (No. ChiCTR1900025714).

Analysing the impact of body position shift on sleep architecture and stage transition: A comprehensive multidimensional study using event‐synchronised polysomnography data

SummaryAlthough understanding the physiological mechanisms of obstructive sleep apnea (OSA) is important for treating OSA, limited studies have examined OSA patients’ sleep architecture at the epoch‐by‐epoch level and analysed the impact of sleep position and stage on OSA pathogenesis. The epoch‐labelled polysomnogram was analysed multidimensionally to investigate the effect of sleep position on the sleep architecture and risk factors of apnea in patients with OSA. This retrospective multicentric case–control study reviewed full‐night diagnostic polysomnography of 6983 participants. The difference in the proportion of time spent supine during non‐rapid eye movement (NREM) and REM stages, and the mean duration of respiratory events per body position were evaluated. The frequency of sleep stage transition per body position shift type was computed. Further subgroup analysis was performed based on OSA severity and positional dependency. Supine time in patients with OSA varied across sleep stages, with lower proportions in N3 and REM, and shorter durations with severity. Patients with OSA spent less time in supine positions during N3 and REM, and experienced longer apnea events in both positions compared to the control group. The frequency of all sleep stage transitions increased with OSA severity and was higher among non‐positional OSA than positional OSA and the control group, regardless of body position shift type. The sleep stage transition from N3 and REM to wakefulness was notably heightened during position shift. Understanding the sleep architecture of patients with OSA requires analysing various sleep characteristics including sleep position simultaneously, with future studies focusing on position detection to predict sleep stages and respiratory events.

Evaluation of Minimum Recording Time and the Influence of Time in the Supine Position on Out-of-Center Sleep Tests

Abstract Introduction The prevalence of moderate to severe sleep-disordered breathing is of 17% among men aged between 50 and 70-years, and of 9% among women in the same age group. In Brazil, obstructive sleep apnea (OSA) is also highly prevalent, and it is associated with metabolic and cardiovascular impacts, excessive daytime sleepiness, and increasing risk of traffic accidents. Laboratory-based polysomnography is the gold standard test for OSA diagnosis. However, its complexity has led to the search for alternatives to simplify the diagnosis, such as the out-of-center sleep test (OCST). Objectives To discusses the minimum OCST recording time and the potential effects of the supine position on this parameter. Data Synthesis We conducted a search on the PubMed, Web of Science, Scopus, and Embase databases to identify relevant studies on OCST recording time and a possible association with body position. We used a combination of terms, including Obstructive Sleep Apnea and Home Monitoring OR Home Care Services OR Portable Monitoring AND Supine OR Position OR Recording Time OR Positional Obstructive Sleep Apnea. The references of the selected articles were also reviewed to find other relevant studies. Through our approach, eighteen articles were retrieved and included in the present study. Conclusion Since OCSTs are conducted in an unattended environment, with potential signal loss during the night, it is crucial to determine the minimum recording time to validate the test and assess how the time spent in the supine position affects this parameter. After reviewing the literature, this topic remains to be clarified, and additional studies should focus on that matter.

Abstract 12619: Positional Obstructive Sleep Apnea and Risk of Atrial Fibrillation

Introduction: Obstructive sleep apnea (OSA), a common sleep disorder, has been associated with the risk of atrial fibrillation (AF). OSA is a heterogenous condition but is heavily position-dependent. Positional OSA (POSA) is a common form of OSA in which OSA is predominantly manifested in a supine position. The implication of POSA in cardiovascular risks is unclear. This study aimed to examine whether the risk of AF is different between individuals with POSA and those with non-positional OSA (nPOSA). Methods: We identified individuals with OSA (AHI ≥ 5/h) from the Sleep Heart Health Study (SHHS) cohort. POSA was defined if overall AHI ≥ 5/h, supine AHI ≥ 5/h, and supine AHI greater than twice the non-supine AHI based on the SHHS visit 1 sleep study. Incident AF was deemed present if detected on a 12-lead ECG during the SHHS visit 2 or confirmed by the parent cohorts at any time between the baseline PSG and the final follow-up date for AF assessment. Multiple logistic regression analysis was conducted with covariates including age, race, gender, body mass index, smoking status, systolic blood pressure, use of hyperlipidemia medication, use of diabetes medication (oral or insulin), use of hypertension medication, cholesterol, triglyceride, and high-density-lipoprotein, and other sleep characteristics (total sleep duration, sleep efficiency, and sleep onset latency). Results: The study included a total of 1712 participants (females, 45%; mean age, 65 years old) with OSA. Compared with individuals with nPOSA, those with POSA were more likely to be white (p=.002), older (p&lt;.043), have lower AHI (p&lt;.001), lower BMI (p&lt;.001), lower systolic blood pressure (p&lt;.001), and lower triglyceride (p=.029), longer sleep duration (p=.002), and less likely to take hypertension medication (p&lt;.001). After accounting for these differences, the odds of incident AF were about 30% lower in the individuals with POSA compared with those with nPOSA (OR=0.7, p=.037). Conclusions: Individuals with OSA exhibit a lower risk of AF when they have POSA. While it is possible that residual confounding could account for this finding, we conclude that POSA might represent a unique phenotype with distinct cardiovascular implications.

P032 Prospective Crossover Trial of Positional and Continuous Positive Airway Pressure Therapy (PaCT) for the Treatment of Mild-to-Moderate Positional Obstructive Sleep Apnoea

Abstract Introduction Positional obstructive sleep apnoea (pOSA), defined by a supine-to-non-supine AHI ratio ≥2, is a phenotype present in a significant subset of patients with sleep-disordered breathing. CPAP has been the gold standard for OSA treatment since its first description in clinical use, although various practical and patient factors may preclude its use. Positional therapy (PT) provides an alternative for pOSA – shown to be effective in restricting supine sleep, thereby reducing the frequency of events and improving outcomes. Methods Prospective, single-centre crossover trial of consecutive, treatment-naïve participants with symptomatic, mild-to-moderate pOSA on diagnostic polysomnogram. Eligible participants were randomised to undergo paired treatment CPAP and PT polysomnography to assess efficacy. Participants thereafter received a two-month trial of each, according to randomisation. Adherence, symptom, quality of life (QoL) measures, and patient preference were assessed. Results 53 participants completed treatment and follow-up. Mean age was 55.1±12.7 years. 30 participants were male (56.6%). Median BMI was 30.1kg/m2 (27–34). Median baseline AHI was 14.4 (9.9–20.2). Median baseline Epworth Sleepiness Scale (ESS) was 12 (10–14) and improved after treatment with positional [8 (6–11); p=0.001] and CPAP [8 (6-11); p&amp;lt;0.001] therapies. There was no difference in ESS reduction between treatment groups (p=0.691). There was no significant difference in usage between therapies (p=0.877). QoL measures were also assessed. Discussion In this cohort with symptomatic mild-to-moderate pOSA, treatment with both PT and CPAP resulted in comparable, clinically significant symptomatic improvement with similar usage. Our findings suggest either therapy can be considered effective in appropriately selected patients.

Cardiovascular diseases across OSA phenotypes: A retrospective cohort study

BackgroundDespite the considerable knowledge of Obstructive Sleep Apnea (OSA) implications for cardiac diseases, the evidence regarding cardiovascular complications across OSA phenotypes including Rapid Eye Movement OSA (REM-OSA) and Positional OSA (POSA) is limited. In this study, we aimed to evaluate the risk of cardiovascular diseases development and progression among patients with REM-OSA and POSA. MethodsBased on a retrospective cohort analysis, we included polysomnography studies done in the sleep lab at the Jordan University Hospital. Regarding cardiovascular diseases, primary outcomes were Heart Failure, and 1-years Major Adverse Cardiac Events while secondary outcomes were atrial fibrillation, pulmonary hypertension, other arrhythmia, metabolic profile, and echocardiographic measurements of the heart. ResultsThe total number of the included patients was 1,026 patients. POSA group had significantly lower percentage of patients with hypertension (P-value = 0.004). Additionally, systolic blood pressure and HbA1c were significantly lower among patients with POSA compared to the NPOSA group (P-value<0.050). Left ventricular end diastolic dimension was significantly higher among patients with POSA while ejection fraction was significantly lower (P-value<0.050). Patients with diabetes and mean HbA1c were significantly lower among patients with REM-OSA compared to patients with NREM-OSA (P-value = 0.015, P-value = 0.046). Multivariate regression analysis revealed that after adjusting for age, gender and preexisting comorbidities, POSA was significantly associated with lower ejection fraction and higher left ventricular diastolic diameter. ConclusionIn conclusion, our findings indicate that POSA might be associated with huge and clinically significant heart strain and poor cardiac functions, yet it might not have a clinically significant atherogenic effect. This study should guide clinicians to identify OSA phenotypes to imply the best treatment plan to reduce its detrimental impact on cardiac muscle.

Positional Therapy for Obstructive Sleep Apnea: Therapeutic Modalities and Clinical Effects

Obstructive sleep apnea (OSA) is characterized by recurrent occurrences of partial or complete collapse of the upper airway during sleep, leading to shallow breathing or breathing pauses. These repeated breathing disruptions can result in intermittent hypoxia, hypercapnia, hyperactivity of the sympathetic nervous system, and fragmented sleep patterns. Left untreated, OSA can have significant health implications, including various symptoms and serious consequences. Positional OSA is a subtype of OSA where during sleep, the severity of apnea events is significantly higher in the supine position. This condition can worsen respiratory parameters, such as apnea/hypopnea events, oxygen desaturation and arousals, and cardiovascular burdens. Positional therapy is a treatment approach used for patients with positional OSA. Typically, positional therapy involves encouraging the patient to avoid sleeping on their back, and instead sleep in a lateral position. Various modalities for positional therapy exist, including positional training using a tennis ball, alarm, or vest, and sleep positioning pillows. Novel electric-operated postural devices have also been developed. Positional therapy has shown promise in improving apneic events and lowest oxygen saturation in patients with position-dependent sleep apnea. In comparison to positive airway pressure treatment, positional therapy has been reported to demonstrate non-inferior effects, while achieving better compliance. Consequently, positional therapy can be a cost-effective and non-invasive therapeutic alternative for managing positional OSA.

The effect of head of bed elevation on upper airway collapsibility during drug-induced sleep endoscopy.

Drug-induced sleep endoscopy with positive airway pressure evaluates the collapsibility of the upper airway. It is currently unknown whether body position affects this assessment. We sought to determine whether the collapsibility of the airway may change with head of bed elevation. A prospective, consecutive cohort study was performed by 2 sleep surgeons at a tertiary care center. Inclusion criteria included adults 18 years of age and older with obstructive sleep apnea who were intolerant to continuous positive airway pressure therapy. Patients underwent drug-induced sleep endoscopy with positive airway pressure to evaluate them for alternative treatment options. Patients were evaluated in supine position with the head of bed both level and elevated to 30°. The airway was evaluated using the standardized VOTE scoring system in both positions. The 61 patients included in the study were predominantly male (70.5%), middle-aged (51.2 years), and obese (body mass index, 30.2 kg/m2) with moderate-to-severe obstructive sleep apnea (apnea-hypopnea index, 34.1 events/h). The cohort consisted of predominantly positional obstructive sleep apnea (mean supine apnea-hypopnea index 48.7 events/h, nonsupine apnea-hypopnea index 20.8 events/h). All 4 sites of the upper airway demonstrated a significant decrease in airway opening pressures with the head of bed elevated compared to level (P < .01 for all sites). There was no significant difference in VOTE scoring between level and upright positions. Patients with the head of bed elevated to 30° have a significantly lower degree of airway collapsibility compared to patients in the level position but no significant change in VOTE scoring was observed. Owen GS, Talati VM, Zhang Y, LoSavio PS, Hutz MJ. The effect of head of bed elevation on upper airway collapsibility during drug-induced sleep endoscopy. J Clin Sleep Med. 2024;20(1):93-99.

Positional sleep apnea phenotyping using machine learning and digital oximetry biomarkers * *The work was performed at the Technion Institute of Technology, Haifa, Israel.

Study Objectives. To examine the feasibility of using digital oximetry biomarkers (OBMs) and body position to identify positional obstructive sleep apnea (POSA) phenotypes. Methods. A multiclass extreme gradient boost (XGBoost) was implemented to classify between three POSA phenotypes, i.e., positional patients (PP), including supine-predominant OSA (spOSA), and supine-isolated OSA (siOSA), and non-positional patients (NPP). A total of 861 individuals with OSA from the multi ethnic study of atherosclerosis (MESA) dataset were included in the study. Overall, 43 OBMs were computed for supine and non-supine positions and used as input features together with demographic and clinical information (META). Feature selection, using mRMR, was implemented, and nested cross validation was used for the model’s performance evaluation. Results. The best performance for the multiclass classification yielded a median weighted F1 of 0.79 with interquartile range (IQR) of 0.06. Binary classification between PP to NPP achieved weighted F1 of 0.87 (0.04). Conclusion. Using OBMs computed in PP and NPP with OSA, it is possible to distinguish between the different phenotypes of POSA. This data-driven algorithm may be embedded in portable home sleep tests.

Comparing the Characteristics of REM and Positional Obstructive Sleep Apnea Phenotypes Among Jordanian Population

Comparing the Characteristics of REM and Positional Obstructive Sleep Apnea Phenotypes Among Jordanian Population

Upper airway morphology in adults with positional obstructive sleep apnea

PurposeTo compare the anatomical balance and shape of the upper airway in the supine position between adults with positional obstructive sleep apnea (POSA) and adults with non-positional OSA (NPOSA).MethodsAdults diagnosed with OSA (apnea-hypopnea index (AHI) > 10 events/h) were assessed for eligibility. POSA was defined as the supine AHI more than twice the AHI in non-supine positions; otherwise, patients were classified as NPOSA. Cone beam computed tomography (CBCT) imaging was performed for every participant while awake in the supine position. The anatomical balance was calculated as the ratio of the tongue size to the maxillomandibular enclosure size. The upper airway shape was calculated as the ratio of the anteroposterior dimension to the lateral dimension at the location of the minimal cross-sectional area of the upper airway (CSAmin-shape).ResultsOf 47 participants (28 males, median age [interquartile range] 56 [46 to 63] years, median AHI 27.8 [15.0 to 33.8]), 34 participants were classified as having POSA (72%). The POSA group tended to have a higher proportion of males and a lower AHI than the NPOSA group (P = 0.07 and 0.07, respectively). After controlling for both sex and AHI, the anatomical balance and CSAmin-shape were not significantly different between both groups (P = 0.18 and 0.73, respectively).ConclusionAdults with POSA and adults with NPOSA have similar anatomical balance and shape of their upper airway in the supine position.Trial registrationThis study was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR Trial ACTRN12611000409976).

Efficacy of vibrotactile positional therapy devices on patients with positional obstructive sleep apnoea: a systematic review and meta-analysis

IntroductionVibrotactile positional therapy (PT) devices are a new treatment modality for positional obstructive sleep apnoea (POSA). This review aimed to determine the effect of vibrotactile PT on the Apnoea Hypopnoea...

Positional obstructive sleep apnea (POSA)

Positional obstructive sleep apnea (POSA)

Patient compliance and satisfaction with a new forehead device for positional obstructive sleep apnoea treatment: a post hoc analysis of a randomised controlled trial

BackgroundThe influence of body position in obstructive sleep apnoea patients is well known. A positional therapy device placed at the forehead has proven to be effective in reducing the severity...

0793 Effect of Sleeping Position on Obstructive sleep apnea in Children Undergoing Polysomnography

Abstract Introduction Obstructive sleep apnea (OSA) in children is characterized by partial or complete upper airway obstruction during sleep, associated with gas exchange abnormalities and disrupted sleep with well-recognized neurobehavioral, neurocognitive, cardiovascular consequences. Positional obstructive sleep apnea (POSA) is defined as a lower AHI (by 50%) in the non-supine position than in the supine position. POSA has been well described in adults, affecting about 55% of adults with OSA. This occurs because airway collapse is maximal in the supine position compared to lateral or prone positions in this subset of patients with significant reduction in airway dimension occurring antero-posteriorly compared to circumferential reduction in airway dimension. However, POSA has not been well studied in children. Methods In this single center retrospective study, data was collected from one hundred consecutive polysomnographic studies from children (6-18 years) with moderate and severe OSA. Mean age was 10.7 years with 50% males in our cohort. Regression analysis was performed to study the relationship of sleeping position with the following variables: Age, sex, BMI, neck circumference, AHI, and desaturation index (DI) in supine and non-supine positions. Results 60% of the patients in our study had significantly lower (by 50%) AHI and DI in non-supine position. This effect was seen in both moderate and severe OSA, though the effect was higher with increasing AHI and BMI. The effect of sleeping position persisted even when corrected for time spent in each position. Conclusion Most of the children in our cohort showed significant reduction in OSA in non-supine sleeping position. Positional therapy (PT), being a low-cost and non-invasive intervention is a reasonable approach in patients who demonstrate differences in AHI, oxygenation, and ventilation. Identifying the OSA phenotype and the subset of OSA patients likely to benefit from non-supine position increases the success of PT. PT may be helpful in situations where adenotonsillectomy may not be indicated and CPAP may not be well tolerated, not desired by the patient, and/or not sufficient to improve OSA. We intend to perform further analysis to study the effect of position on gas exchange and identify the phenotype who may benefit from PT in a larger cohort. Support (if any)