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

Levendowski, Daniel J.; Oksenberg, Arie; Vicini, Claudio; Penzel, Thomas; Levi, Mark S.; Westbrook, Philip R.

doi:10.1016/j.sleep.2018.05.012

Cited by 24 publications

(19 citation statements)

References 25 publications

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“…The classification of POSA was applied to the AHI and ODI independently using two ratios, the overall event/h divided by the non-supine events/h (O/NS)≥1.4, and the supine divided by non-supine events/h (S/NS)≥2.0. 20 Thus, POSA was determined using 132 records, after exclusion of 52 records; 43 due to AHI<5 events/h, eight with insufficient non-supine time and one with insufficient supine time (Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…18 The ratio of overall/non-supine AHI (O/NS) is a more useful definition from a treatment perspective, because it provides a greater likelihood that patients identified with POSA will achieve ≥50% reduction in overall AHI if supine sleep is avoided. 19,20 The detection of POSA relies on the accurate assessment of head, neck, or body position, as well as adequate recording time (especially recorded sleep time) in both supine and non-supine positions, to enable reliable comparison of the best and worst sleeping positions. Measuring body position during attended PSG in the sleep laboratory is considered the gold standard to diagnose POSA.…”

Section: Introductionmentioning

confidence: 99%

“…19,[23][24][25] The characterization of POSA has also evolved, improving the likelihood that clinically important reductions in overall OSA severity will be achieved if supine sleep is avoided. 20 Unfortunately, if split night PSG or Type III studies without sleep position monitoring capability are used in the assessment of OSA, clinicians cannot routinely identify which patients might benefit from position therapy alone or in combination with oral appliance therapy. 26 Therefore, POSA patients may not be considered for important therapeutic options that may have lower cost and improved tolerability compared with nasal CPAP therapy.…”

Section: Introductionmentioning

confidence: 99%

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<p>A comparison between auto-scored apnea-hypopnea index and oxygen desaturation index in the characterization of positional obstructive sleep apnea</p>

Levendowski

Hamilton

Louis

et al. 2019

NSS

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Objective: Evaluate the concordance between overall and positional oxygen desaturation indices (ODI) and apnea-hypopnea indices (AHI) according to two different definitions for positional obstructive sleep apnea (POSA). Methods: A total of 184 in-home polysomnograms were edited to simulate Level III home sleep apnea tests (HSAT) with the auto-scored AHI and ODI based on recording time. POSA was determined using 132 records with an AHI≥5 and at least 20 mins of recording time in both supine and non-supine positions. POSA was defined independently for the AHI and ODI based on ratios of overall/non-supine event/h ≥1.4 (O/NS) and supine/non-supine event/h≥2.0 (S/NS). Results: Correlation between the AHI and ODI was 0.97 overall, 0.94 for supine, and 0.96 for non-supine recording times (all p<0.001). For most records, differences between the AHI and ODI were small, with only 14% of the records having a AHI-ODI difference exceeding >5/hr, and 6% exceeding >10 events/hr. The positive and negative percent agreements were uniformly good to excellent across varying clinical POSA cutoffs; percent agreements (positive, negative) were: AHI≥5=0.99, 0.78; AHI≥10=0.96, 0.89; and AHI≥15=0.96, 0.89. Cohen's Kappa scores also showed substantial agreement for overall as well as supine and non-supine positions across varying clinical cutoffs of the AHI. Frequency of POSA was reproducibly uniform between 59% and 61% for both POSA criteria. When the O/NS and S/NS definitions conflicted in POSA characterization, O/NS was superior for identifying patients who might exhibit a greater response to supine restriction positional therapy. Conclusions: Auto-scored positional oximetry is a clinically viable alternative to an autoscored Level III HSAT AHI in the characterization of POSA based on a 3% desaturation.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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<p>A comparison between auto-scored apnea-hypopnea index and oxygen desaturation index in the characterization of positional obstructive sleep apnea</p>

Levendowski

Hamilton

Louis

et al. 2019

NSS

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“…Finally, no definition of POSA is universally accepted in adults, much less children. 20 We chose to use the Cartright definition as it is the most widely published and was employed by Verhelst et al 31 in their recent study of pediatric patients. In a study on the impact of different POSA criteria on predicted response to positional therapy in adults, Levendowski et al 20 found that the Cartright criteria had 93% sensitivity and 83% specificity for predicting a 25% reduction in AHI with positional therapy, making it an overall reliable clinical definition of POSA.…”

Section: Discussionmentioning

confidence: 99%

Drug‐Induced Sleep Endoscopy in Children With Positional Obstructive Sleep Apnea

Kirkham

Melendez

Hoi

et al. 2020

Otolaryngol.--head neck surg.

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Objective Positional obstructive sleep apnea (POSA)—defined as obstructive sleep apnea twice as severe supine than nonsupine—may offer clues to the underlying pattern of upper airway collapse in children. We compared drug-induced sleep endoscopy (DISE) findings in children with and without POSA. We hypothesized that children with POSA would have significantly higher obstruction at the gravity-dependent palate and tongue base but not at the adenoid, lateral wall, or supraglottis. Study Design Retrospective case series. Setting Tertiary pediatric hospital. Subjects and Methods We included children aged 1 to 12 years with obstructive sleep apnea diagnosed by polysomnography who underwent DISE from July 2014 to February 2019. Scores were dichotomized as ≥50% obstruction (Chan-Parikh 2 or 3) vs <50% obstruction (Chan-Parikh 0 or 1). Results Of 99 children included, 32 (32%) had POSA and 67 (68%) did not. Children with POSA did not differ from children without POSA in age, overall apnea-hypopnea index, sex, race, syndromic diagnoses, obesity, or history of adenotonsillectomy. In logistic regression models, odds of ≥50% obstruction were significantly higher at the tongue base (odds ratio, 2.77; 95% CI, 1.04-7.39) after adjustment for age, sex, obesity, previous adenotonsillectomy, and syndrome. No difference was noted at the adenoid, velum, lateral wall, or supraglottis. Conclusion POSA was associated with higher odds of obstruction on DISE at the tongue base but not at other levels.

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“…Additionally, most of our participants were men (80.8%) and thus further studies including more women are needed. We used the most common criterion for defining positional dependency for OSA patients, but the use of other definitions could have provided different results 30 . The possible difference in positional dependency of apneas/hypopneas between REM and NREM sleep were not assessed in this study.…”

Section: Limitations Of the Present Studymentioning

confidence: 99%

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

et al. 2019

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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 > 4h and had ≥ 30 min sleep in both supine and lateral positions were assessed. PPs had a supine AHI / lateral AHI ratio ≥ 2 and Non-Positional Patients (NPP) had a supine AHI / lateral AHI ratio < 2.Results 35.3% of the severe OSA patients were PPs. They were less obese and had less severe OSA (p<0.001) compared to 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, 78 (75.7%) patients 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 been treated by CPAP.

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

Cited by 24 publications

References 25 publications

<p>A comparison between auto-scored apnea-hypopnea index and oxygen desaturation index in the characterization of positional obstructive sleep apnea</p>

<p>A comparison between auto-scored apnea-hypopnea index and oxygen desaturation index in the characterization of positional obstructive sleep apnea</p>

Drug‐Induced Sleep Endoscopy in Children With Positional Obstructive Sleep Apnea

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

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