Development of positional obstructive sleep apnea (POSA) after upper airway surgery in OSA patients

Apodaca, Paula Martínez Ruiz de; Carrasco-Llatas, Marina; Quiles, Silvia Matarredona; Galofre, José Dalmau

doi:10.1007/s11325-019-01910-7

Cited by 6 publications

(4 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A retrospective study on OSA patients with upper airway surgery found that the prevalence of positional OSA increased from 26 to 54% in those with persistent OSA at six months [ 46 ]. Among the non-responders to OSA surgery, almost 70% of patients were position dependent on preoperative PSG with no improvement at six months postoperatively [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of semi-upright position on severity of sleep disordered breathing in patients with obstructive sleep apnea: a two-arm, prospective, randomized controlled trial

et al. 2023

View full text Add to dashboard Cite

Background The severity of sleep-disordered breathing is known to worsen postoperatively and is associated with increased cardio-pulmonary complications and increased resource implications. In the general population, the semi-upright position has been used in the management of OSA. We hypothesized that the use of a semi-upright position versus a non-elevated position will reduce postoperative worsening of OSA in patients undergoing non-cardiac surgeries. Methods This study was conducted as a prospective randomized controlled trial of perioperative patients, undergoing elective non-cardiac inpatient surgeries. Patients underwent a preoperative sleep study using a portable polysomnography device. Patients with OSA (apnea hypopnea index (AHI) > 5 events/hr), underwent a sleep study on postoperative night 2 (N2) after being randomized into an intervention group (Group I): semi-upright position (30 to 45 degrees incline), or a control group (Group C) (zero degrees from horizontal). The primary outcome was postoperative AHI on N2. The secondary outcomes were obstructive apnea index (OAI), central apnea index (CAI), hypopnea index (HI), obstructive apnea hypopnea index (OAHI) and oxygenation parameters. Results Thirty-five patients were included. Twenty-one patients were assigned to the Group 1 (females-14 (67%); mean age 65 ± 12) while there were fourteen patients in the Group C (females-5 (36%); mean age 63 ± 10). The semi-upright position resulted in a significant reduction in OAI in the intervention arm (Group C vs Group I postop AHI: 16.6 ± 19.0 vs 8.6 ± 11.2 events/hr; overall p = 0.01), but there were no significant differences in the overall AHI or other parameters between the two groups. Subgroup analysis of patients with “supine related OSA” revealed a decreasing trend in postoperative AHI with semi-upright position, but the sample size was too small to evaluate statistical significance. Conclusion In patients with newly diagnosed OSA, the semi-upright position resulted in improvement in obstructive apneas, but not the overall AHI. Trial registration This trial was retrospectively registered in clinicaltrials.gov NCT02152202 on 02/06/2014.

show abstract

Section: Discussionmentioning

confidence: 99%

The impact of semi-upright position on severity of sleep disordered breathing in patients with obstructive sleep apnea: a two-arm, prospective, randomized controlled trial

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Also, after upper airway surgery for OSA patients become more positional dependent. Therefore an increased supine sleep during a post-op PSG is likely to significantly affect the study results [22,23].…”

Section: Discussionmentioning

confidence: 99%

Supine sleep patterns as a part of phenotyping patients with sleep apnea—a pilot study

et al. 2022

View full text Add to dashboard Cite

Purpose Polysomnography (PSG) is considered the best objective study to diagnose and quantify sleep disorders. However, PSG involves multiple electrodes and is usually performed in a sleep laboratory that in itself may change the physiology of sleep. One of the parameters that can change during PSG is the sleep position, leading to more supine sleep. The aim of this study was to quantify the amount of supine sleep during PSG and compare it to consecutive nights of a home sleep apnea test (HSAT) in the same patients. Methods This prospective study evaluated 22 consecutive patients undergoing PSG followed by HSAT. Sleep position was analyzed during PSG and subsequently on 2 to 6 nights (mean 3.7 nights) at home, and the amount of supine sleep was recorded during each night. Results Of 22 patients, there were 12 men (55%). The median age was 60.0 years for women and 45.5 years for men. Median proportion of supine sleep during PSG and HSAT was 61% and 26% (p < 0.001), respectively. Four “phenotypes” were identified according to their sleep position during PSG and HSAT, with 5 patients sleeping mainly supine during all nights, 7 patients sleeping mainly non-supine during all nights, 3 patients sleeping in different positions during each night, and 7 patients sleeping supine during PSG but non-supine at home, during HSAT. Conclusions There is a higher proportion of supine sleep during PSG compared to home sleep. We identified a subgroup of patients who slept mainly supine during PSG and mainly non-supine during HSAT. PSG may overestimate OSA severity in a specific phenotype of patients.

show abstract

“…During sleep, assuming a supine position can have deleterious effects on multiple aspects of the pathophysiology of OSA [12]. Anatomically, the supine position during sleep causes the base of the tongue to move backward, which leads to a reduction in the upper airway space [13].…”

Section: Pathophysiology Of Positional Obstructive Sleep Apneamentioning

confidence: 99%

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

Lee,

Choi

2023

Sleep Med Res

View full text Add to dashboard Cite

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.

show abstract

Development of positional obstructive sleep apnea (POSA) after upper airway surgery in OSA patients

Cited by 6 publications

References 30 publications

The impact of semi-upright position on severity of sleep disordered breathing in patients with obstructive sleep apnea: a two-arm, prospective, randomized controlled trial

The impact of semi-upright position on severity of sleep disordered breathing in patients with obstructive sleep apnea: a two-arm, prospective, randomized controlled trial

Supine sleep patterns as a part of phenotyping patients with sleep apnea—a pilot study

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

Contact Info

Product

Resources

About