Positional Sleep Apnea Research Articles

Positional sleep apnea in patients with ischemic stroke

Background: In non-stroke patients, the severity of sleep apnea (SA) is known to be frequently related to the sleeping position, a condition called positional SA. In the present study, we investigated whether in acute stroke the occurrence of apneas was related to the positioning of patients, and whether a similar finding could be observed after rehabilitation. With the purpose of identifying patients potentially being in need of a SA treatment beyond rehabilitation, we furthermore looked for epidemiologic and clinical parameters being related to persistent SA 6 months after stroke.Patients and methods: Fifty-five acute stroke patients underwent cardiorespiratory polygraphy within 72 hours after onset of neurological symptoms and after 6 months. Apart from the total AHI (AHITOT), the AHI with the patient in supine position and the AHI with the patient in other positions were determined. In all patients, demographic data, NIH-stroke scale score and cumulative vascular risk factors were assessed.Results: In the initial sleep study, 78% of patients had an AHI≥10/h, of whom 65% fulfilled the criteria of positional SA. On follow-up, the incidence of SA declined to 49% with positional SA being present in 33%. Multivariate logistic regression analysis identified AHITOT on admission [OR=1.07 (1.002–1.13)] and cumulative vascular risk factors [OR=3.48 (1.34–9.05)] as independent predictors of persistent SA 6 months after stroke.Conclusion: According to our results, positional SA is a predominant feature in acute stroke and its incidence decreases significantly during the following months. These findings may have implications for SA treatment in patients with acute stroke.

Craniofacial abnormalities in Chinese patients with obstructive and positional sleep apnea

Background Obstructive sleep apnea (OSA) is a common disorder characterized by recurrent episodes of a complete or partial collapse of the upper airway during sleep. Traditionally, the disease is diagnosed by overnight polysomnography. Studies have shown correlation between parameters of cephalometry and severity of sleep apnea. We wish to determine the variable of craniofacial dimensions in the upper airway that contribute to OSA, and to investigate the significance of craniofacial measurements in positional and non-positional sleep apnea patients. Methods From July 2002 to June 2006, we studied 84 males and 15 females who came to the sleep center because of daytime sleepiness. All the participants underwent overnight polysomnography and lateral cephalograms, performed by an experienced technician. Results Craniofacial measurements of gnathion–gonion, anterior superior hyoid to mandibular plane (MP–H), posterior nasal spine (PNS) to the velum tip (SPL), widest point of the soft palate (SPW), and the product of PNS to the velum tip and widest point of the soft palate (product of soft palate (SPP) = SPL × SPW) were positively related to the apnea/hypopnea index (AHI). The velum tip to the pharyngeal wall parallel to the Frankfurt horizontal (PAS) was negatively related to the AHI. We further divided the study subjects into 4 groups according to AHI value (group 1, AHI < 5; group 2, 5 ⩽ AHI < 15; group 3, 15 ⩽ AHI < 30; group 4, AHI ⩾ 30). Age, body mass index (BMI), neck circumference (NC), distances of PAS, SPL, SPW, SPP and angle of sella-nasion-infradentale (SNB) were significantly different depending on the degree of severity of sleep-disordered breathing (SDB). Patients who were older, with a high BMI and longer MP–H distance, had more daytime sleepiness (Epworth sleepiness scale, ESS). Furthermore, lower AHI values and longer PAS measurements were found in the positional sleep apnea group when compared to the non-positional sleep apnea group. After adjusting for confounding factors of age, BMI and NC, we found that BMI, MP–H distance and PAS measurement were correlated with severity of OSA. Conclusions Cephalometry could be a useful and inexpensive clinical tool to evaluate Chinese patients with OSA. MP–H and PAS should be measured in Chinese patients with OSA. MP–H was correlated with ESS. The PAS measurement was narrower in non-positional OSA patients compared to positional OSA patients.

Positioner–a method for preventing sleep apnea

Conclusions. A ‘Positioner’ preventing sleeping on the back can effectively reduce obstructive sleep apnea (OSA), but not always snoring for patients with long-term OSA. By preference, the device should be used for younger snorers without OSA as a training tool to avoid sleeping on the back. Instructions and support by a nurse are necessary for compliance. Objectives. Snoring is a progressive condition with a prevalence of 25–30% among the adult male population. Long-term snoring seems to be the basis for apneas caused by vibration damage to the pharyngeal tissue. Patients with OSA often have more apneas in the supine position than in the lateral position. Preventing sleeping on the back is a way to treat OSA. The aim of this study was to evaluate the efficacy and comfort of a recently developed Positioner. Subjects and methods. A total of 23 patients diagnosed with positional sleep apnea (AHI>15 in supine position and AHI<5 in lateral position), were included. The Positioner – a soft vest, attached to a board placed under the pillow, makes it impossible for the patient to sleep on his back. It was fitted and tried out individually. Patients answered sleep questionnaires and kept sleep diaries before beginning use. After 3 months, a new sleep study was done while using the Positioner and new questionnaires were filled out. Results. Eighteen patients (5 women and 13 men) completed the study. The rest could not tolerate being strapped into the Positioner. Of those participating, 61% demonstrated a decrease of AHI to<10 using the Positioner. The Epworth Sleepiness Scale (ESS) decreased from a mean of 12.3 to 10.2. Half of the patients snored more frequently with the Positioner. The evaluation of comfort showed that minor adjustments are desirable.

Prevalence of Positional Sleep Apnea in Patients Undergoing Polysomnography

The primary aim of this study was to determine the prevalence of positional obstructive sleep apnea using a functional definition. Positional sleep apnea was defined as a total apnea-hypopnea index (AHI) > or = 5 with a > 50% reduction in the AHI between the supine and nonsupine postures, and an AHI that normalizes (AHI < 5) in the nonsupine posture. A secondary aim was to determine if positional sleep apnea can be diagnosed accurately during a split-night study. Retrospective chart review. Two sleep centers in Buffalo, NY, one a Veterans Affairs Western New York Healthcare System Sleep Center (VAWNY) and the other a freestanding ambulatory center (Associated Sleep Center [ASC]). Three hundred twenty-six patients from the VAWNY, including 57 patients who underwent a split-night study and 242 patients from the ASC who underwent polysomnography. None. Patient characteristics and sleep study results. Positional sleep apnea was seen in 49 of 99 patients (49.5%) with mild sleep apnea (AHI, 5 to 15/h), 14 of 72 patients (19.4%) with moderate sleep apnea (AHI, 15 to 30/h), and 5 of 77 patients (6.5%) with severe sleep apnea (AHI > 30/h). Sufficient sleep (> 15 min) in both postures was not seen in 104 of 269 patients (38.7%) and 80 of 242 overnight studies (33.1%) at the VAWNY and ASC, respectively, and was not seen in 47 of 57 split-night studies (82.5%). The percentage of studies with insufficient sleep in both postures was significantly greater for split-night studies (p < 0.0001). Positional sleep apnea is common particularly in patients with mild disease. Positional sleep apnea cannot usually be assessed during a split-night study.

Radiofrequency Surgery of Hypertrophic Tongue Base in Patients with Positional Sleep Apnea

Radiofrequency Surgery of Hypertrophic Tongue Base in Patients with Positional Sleep Apnea

Prevalence of Positional Sleep Apnea

The number of apneas and hypopneas per hour (the apnea/hypopnea index, or AHI) often decreases when patients with obstructive sleep apnea move from the supine position to their sides. More than half of sleep apnea cases are positional, when positional sleep apnea is defined as a …

Treatment of obstructive sleep apnea with a new vest preventing the supine position

Prevention of the supine position has for decades been a well known treatment option in positional obstructive sleep apnea. It was the aim of this study to test the efficacy of a recently patented commercially available supine position preventing vest. The vest is made of linen tissue with a half cylindrical piece of hard foam in its dorsal part. 12 male patients slightly overweight (body mass index 26.5 +/- 2.6 kg/m(2)) and 55.8 +/- 11.6 years old were investigated polysomnographically prospectively. The pretherapeutical respiratory-disturbance index (RDI) was 26.7+/-11.9/h increasing to 39.3+/-16.1/h in the supine position. When using the vest, patients no longer slept on their back and the RDI dropped to 7.6 +/- 5.1/h (p < 0.005). Total sleep time at an oxygen saturation below 90 % was reduced from 11.7 +/- 11.3 % to 1.5 +/- 2.1 %. 9 patients (75 %) were cured (RDI < 10/h and RDI reduction > 50 %), 2 patients (17 %) improved (RDI reduction > 50 %) and only the oldest patient (76 years old) remained unchanged. Even though snoring decreased from 180 +/- 125 minutes to 110 +/- 52 minutes, an increase was observed in 30 % of the patients. Sleep quality and structure did not change considerably. The supine position prevention vest is a safe and simple treatment alternative of high efficacy in positional sleep apnea. As a complete remission cannot be predicted, polygraphic or polysomnographic controls are necessary.

POSITIONAL VS. NONPOSITIONAL SLEEP APNEA.

The severity of obstructive sleep apnea may worsen when patients lie on their backs rather than on their sides. In fact, some patients are said to have positional sleep apnea (an apnea/hypopnea frequency at least twice as high in …

Management of sleep apnoea syndrome.

Obstructive sleep apnoea is a chronic condition characterized by repetitive episodes of upper airway collapse during sleep, leading to sleep fragmentation. The management of sleep apnoea consists of general and specific measures. General measures should include weight loss in overweight patients; avoidance of alcohol during the evening hours; avoidance of any hypnotic drug. Specific measures may range from simple position training in patients with positional sleep apnoea (sleep apnoea appearing only when lying on the back) of slight severity; to oral appliances with the aim of creating a prognathism during sleep, to the introduction of a nasopharyngeal tube during sleep every night. When position training, oral appliances or a nasopharyngeal tube are used, their effect should be monitored by full night polysomnography. The best specific treatment for sleep apnoea is nasal continuous positive airway pressure. The main problem with nasal continuous positive airway pressure is the long-term compliance which should be assessed regularly over the years. In cases where nasal continuous positive airway pressure is not tolerated or compliance is bad, a surgical treatment can be proposed. Uvulopalatopharyngoplasty seems to give disappointing results. By contrast, maxillomandibular surgery is credited with the best results available as far as surgery is concerned, comparable to nasal continuous positive airway pressure.

A Comparative Study of Treatments for Positional Sleep Apnea

Sixty male patients all with apnea plus hypopnea indices (A + HI) above 12.5, who met a criterion of positionality by having two or more times the rate of these events during supine sleep in comparison to their lateral sleep rate, were randomly assigned to one of four treatments for 8 weeks. All were restudied for two nights, one with and one without treatment devices. On treatment more than half the patients in each group reduced their A + HI to within normal limits and a third remained WNL without the use of devices. Half of those trained to sleep in the lateral position with the help of an alarm maintained this learning without the alarm as did half of those who were encouraged to learn this sleep posture on their own. There is an additive effect for the positional patient from wearing a tongue retaining device (TRD) if they continue to sleep in the supine position. Factors associated with successful treatment include overall severity, severity in the lateral position, weight, weight change, nasal patency and motivation to help their condition.

Pregnancy Test

A positional device based on vibration and placed at the forehead Somnibel) has proven to be effective in reducing the apnea-hypopnea index(AHI) in patients with positional sleep apnea (POSA)(Thorax 202, in press).The aim was to analyze daily and weekly differences in terms of percentage of time in the supine position and device use between patients using an active device(AD) and inactive device ID).This is a post-hoc analysis of a multicenter, prospective, parallel RCT.The study included 87 patients, diagnosed as POSA and divided in two groups (AD and ID).Daily usage data and recordings were downloaded from the device in each follow-up visit (4, 8 and 12 weeks).The median (IQR) percentage of time in supine was significantly different from de first night (2.3(3.3)% in the AD group and 8.1(16.0)% in the ID group; p&lt;0.001) and throughout the following 13 nights (range 2.1(3.3)% to 3.6(3.4)% for the AD group and 7.8(14.3)% to 13.3(12.5)% for the ID group; p&lt;0.005).These differences persisted during the following weeks(p&lt;0.02).The median use during the first 14 days in AD group (range 6.68 (2.50) to 7.53(2.77)h) not significantly different from the ID group (range 6.85(3.00) to 7.62(2.10)h). The median daily use of the device at week 12 was similar (6.7h(1.8) for AD group and 6.8h(2.6) for ID group;p&gt;0.05), being above 6.4h throughout the follow-up period.The significant reduction in supine from the first night showed that the device has an immediate effect onto the patient’s sleep and do not require an adaptation period.The daily use of the device was high in both groups and did not decline over time suggesting&nbsp;that it could be a treatment option in patients with POSA.