Influence of Body Position on Severity of Obstructive Sleep Apnea: A Systematic Review

Menon, Akshay; Kumar, Manoj

doi:10.1155/2013/670381

Cited by 56 publications

(47 citation statements)

References 43 publications

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“…Previous studies investigating body positioning and obesity-associated hypoventilation in patients undergoing NPPV showed that these factors may affect inspiratory and expiratory pressures to achieve a better minute ventilation (MV) [4][5][6]. Patient's comfort and adherence can be improved with the appropriate use of NPPV [7,8].…”

Section: Introductionmentioning

confidence: 99%

Effects of Modes, Obesity, and Body Position on Noninvasive Positive Pressure Ventilation Success in the Intensive Care Unit: A Randomized Controlled Study

Türk¹,

Aydoğdu²,

Gürsel³

2018

Turk Thorac J

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OBJECTIVES:Different outcomes and success rates of non-invasive positive pressure ventilation (NPPV) in patients with acute hypercapnic respiratory failure (AHRF) still pose a significant problem in intensive care units. Previous studies investigating different modes, body positioning, and obesity-associated hypoventilation in patients with chronic respiratory failure showed that these factors may affect ventilator mechanics to achieve a better minute ventilation. This study tried to compare pressure support (BiPAP-S) and average volume targeted pressure support (AVAPS-S) modes in patients with acute or acute-on-chronic hypercapnic respiratory failure. In addition, short-term effects of body position and obesity within both modes were analyzed. MATERIAL and METHODS:We conducted a randomized controlled study in a 7-bed intensive care unit. The course of blood gas analysis and differences in ventilation variables were compared between BiPAP-S (n=33) and AVAPS-S (n=29), and between semi-recumbent and lateral positions in both modes. RESULTS:No difference was found in the length of hospital stay and the course of PaCO2, pH, and HCO3 levels between the modes. There was a mean reduction of 5.7±4.1 mmHg in the PaCO2 levels in the AVAPS-S mode, and 2.7±2.3 mmHg in the BiPAP-S mode per session (p<0.05). Obesity didn't have any effect on the course of PaCO2 in both the modes. Body positioning had no notable effect in both modes. CONCLUSION:Although the decrease in the PaCO2 levels in the AVAPS-S mode per session was remarkably high, the course was similar in both modes. Furthermore, obesity and body positioning had no prominent effect on the PaCO2 response and ventilator mechanics. Post hoc power analysis showed that the sample size was not adequate to detect a significant difference between the modes.

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Section: Introductionmentioning

confidence: 99%

Effects of Modes, Obesity, and Body Position on Noninvasive Positive Pressure Ventilation Success in the Intensive Care Unit: A Randomized Controlled Study

Türk¹,

Aydoğdu²,

Gürsel³

2018

Turk Thorac J

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“…6 Although obstructive events in adults with OSA tend to be worse in the supine position, this finding is less consistent in pediatric literature. 7 Pereira et al 8 found that in children younger than 3 y with OSA, the respiratory disturbance index increased with the increase in time spent in supine sleep but in a later study assessing infants with the age range between 8 to 12 months, the authors found no significant difference between mean supine AHI and non-supine AHI. 8,9 Another study that included children aged 1 to 10 y with OSA suggested that there were less obstructive events in the supine position.…”

Section: Discussionmentioning

confidence: 95%

“…[4][5][6] Also, the effect of position on the distribution of obstructive respiratory events in the pediatric population is not consistent among different studies. [7][8][9][10][11][12] Furthermore, previous studies assessing the effect of sleep stage and position on the distribution of obstructive respiratory events did not explore such effects in a pediatric adolescent population. …”

Section: Introductionmentioning

confidence: 99%

Effect of Sleep State and Position on Obstructive Respiratory Events Distribution in Adolescent Children

El‐Kersh

Cavallazzi

Patel

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: This study aimed to examine the effect of sleep state (rapid eye movement [REM] versus non-rapid eye movement [NREM]) and position (supine versus non-supine position) on obstructive respiratory events distribution in adolescent population (ages 12 to 18 y). Methods: This was a retrospective study that included 150 subjects between the ages of 12 to 18 y with an apnea-hypopnea index (AHI) > 1/h. Subjects using REM sleep-suppressant medications and subjects with history of genetic anomalies or craniofacial syndromes were excluded. Results: The median age was 14 y with interquartile range (IQR) of 13 to 16 y, 56% of patients were males and the median body mass index (BMI) z-score was 2.35 (IQR: 1.71-2.59) with 77.3% of patients fulfilling obesity criteria. Respiratory obstructive events were more common in REM sleep. The median REM obstructive AHI (OAHI) was 8.9 events per hour (IQR: 2.74-22.8), whereas the median NREM OAHI was 3.2 events per hour (IQR: 1.44-8.29; p < 0.001). African American adolescents had more REM obstructive events with median REM OAHI of 13.2 events per hour (IQR: 4.88-30.6), which was significantly higher than median REM OAHI of 4.94 (IQR: 2.05-11.36; p = 0.004) in white adolescents. Obstructive events were more common in supine position with higher median supine OAHI of 6.55 (IQR: 4-17.73) when compared to median non-supine OAHI of 2.94 (IQR: 1-6.54; p < 0.001).Conclusions: This study shows that sleep related obstructive respiratory events in the adolescents (12 to 18 y of age) occur predominantly in REM sleep and in supine position. I NTRO DUCTI O NObstructive sleep apnea (OSA) is a sleep related breathing disorder that can affect up to 5% of children.1 It is characterized by partial or complete upper airway obstruction that can disrupt normal sleep ventilation and sleep pattern.2 This upper airway obstruction can occur in rapid eye movement (REM) and non-rapid eye movement (NREM) sleep. In REM sleep, the withdrawal of excitatory noradrenergic and serotonergic inputs to upper airway motor neurons further reduces pharyngeal muscle activity, which together with reduced arousal threshold and reduced ventilatory responses to hypoxia and hypercapnia increase the propensity for upper airway obstruction in REM sleep, with more prolonged obstructions accompanied by severe desaturations. Although obstructive respiratory events in children, unlike adults, is thought to be REM predominant, a subset of pediatric population may have NREM predominance of their obstructive respiratory events. [4][5][6] Also, the effect of position on the distribution of obstructive respiratory events in the pediatric population is not consistent among different studies. [7][8][9][10][11][12] Furthermore, previous studies assessing the effect of sleep stage and position on the distribution of obstructive respiratory events did not explore such effects in a pediatric adolescent population. ObjectiveThe objective of this study was to examine the distribution of obstructive respiratory events in REM versu...

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“…However, Menon and Kumar (2013) found a supine sleeping posture is more commonly associated with obstructive sleep apnea (OSA), a common condition in infants, particularly those born prematurely. Katz, Mitchell, and D'Ambrosia (2012) indicate infants have Bboth anatomical and physiological predispositions toward airway obstruction and gas exchange abnormalities including superiorly placed larynx, increased chest wall compliance, ventilation-perfusion mismatching, and ventilatory control instability.^In addition to prematurity, OSA is increasingly common in infants born with Down syndrome (Goffinski et al, 2015), craniofacial conditions, and various other genetic syndromes (Bacher et al, 2011).…”

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confidence: 99%

“…quality, it has been found that infants and children afflicted with OSA may benefit from sleeping in a lateral position as a systematic review revealed fewer obstructive events in this position (Menon & Kumar, 2013).…”

mentioning

confidence: 99%

Effects of Antecedent Manipulations and Social Reinforcement to Increase Lateral Positioning in a Premature Infant with Obstructive Sleep Apnea

Voulgarakis

Forte

Giacomelli

et al. 2016

Behav Analysis Practice

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Recent research suggests supine positioning for sleeping infants is the safest position to prevent breathing related difficulties; however doing so can significantly increase obstruction in apneic infants resulting in decreased sleep quality. We implemented a multi-component treatment package compromised of antecedent interventions and parentmediated social reinforcement to increase lateral positioning in a premature infant with obstructive sleep apnea. Results indicate that the intervention increased lateral positioning in the participant by over 80 % in the final phase of the study, indicating efficacy of the intervention. Limitations and suggestions for future research are discussed.

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Influence of Body Position on Severity of Obstructive Sleep Apnea: A Systematic Review

Cited by 56 publications

References 43 publications

Effects of Modes, Obesity, and Body Position on Noninvasive Positive Pressure Ventilation Success in the Intensive Care Unit: A Randomized Controlled Study

Effects of Modes, Obesity, and Body Position on Noninvasive Positive Pressure Ventilation Success in the Intensive Care Unit: A Randomized Controlled Study

Effect of Sleep State and Position on Obstructive Respiratory Events Distribution in Adolescent Children

Effects of Antecedent Manipulations and Social Reinforcement to Increase Lateral Positioning in a Premature Infant with Obstructive Sleep Apnea

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