Positional Obstructive Sleep Apnea Syndrome in Elderly Patients

Abstract

Background The purpose of this study was to evaluate the prevalence of position-dependent obstructive sleep apnea (POSA) in elderly patients (≥65 years old). Adult (range 19-65 years old) and elderly patients were also compared in order to show differences in the incidence of POSA between these two groups of patients. Methods A prospective bi-center study was performed between January 2018 and May 2019. A total of 434 participants underwent polysomnography (PSG) study at home (Embletta MPR). Body position during the PSG recordings was determined. Patients were subdivided in two groups: those aged between 19 and 65 years old (adult patients) and ≥65 years old (elderly patients). POSA patients were defined using Cartwright's system, Bignold classification, and the new Amsterdam Positional OSA Classification (APOC). Results The prevalence of POSA in elderly patients differed according to the classification system used: 49.3% using Cartwright's classification system, 20.5% with the Bignold classification, and 22.6%, 38.9%, and 5.4% of APOC 1, APOC 2, and APOC3 sub-classes were respectively identified for the APOC classification system. No difference between adult and elderly patients regarding the prevalence of POSA was observed. No statistical differences emerged between the two groups of patients in terms of supine (p = 0.9) and non-supine AHI (p = 0.4). Conclusions A significant number of elderly patients could be considered treatable with positional therapy according to the APOC classification. However, the efficacy and applicability of positional therapy in elderly patients must be confirmed by further research.

<p>Positional Sleep Apnea Among Regional and Remote Australian Population and Simulated Positional Treatment Effects</p>

“…Hence, we believe our study may be of value in understanding the demographic, clinical and PSG profile of POSA in this population. In this study, POSA was noted in 61%, in line with previous reports [11][12][13][14] and was predominantly noted among males (62%) and in non-Indigenous Australians (92%). This translates to three in every five patients with OSA have POSA and thus may merit greater focus and interventions.…”

“…There exists evidence in the literature for differences in POSA prevalence among differing ethnicities, most notably a potential increased prevalence among patients of Asian ethnicity compared to Caucasian, which may be related to differences in the craniofacial structure. [11][12][13][14][15][16]29 Further evidence from direct correlation studies however is lacking.…”

“…10 A distinct clinical type of OSA, "positional sleep apnea" (POSA) is considered when respiratory events occur predominantly in certain body position during sleep. 9,11 There are currently multiple clinical definitions of POSA; however, regardless of which definition is used, prevalence of POSA typically exceeds 50% among patients undergoing a PSG and diagnosed to have OSA. [12][13][14][15] It is also observed that in supine sleep, apneas and arousals are longer, desaturations are deeper, snoring is louder, and occurrence of tachy-bradycardia following an apnoeic episode are more severe compared to lateral sleep position.…”

Various Factors Affecting Short-Term Compliance Rates of CPAP in OSA Patients: in the Age of Insurance Coverage in Korea

“…In a previous study, it varied from 21% to 49.3% according to the classification method but showed similar results to ours. 10) Based on the results of this study, the group without posture dependence showed no significant difference in the 'good compliance group' ratio compared to the position-dependent group, but the average CPAP usage time was significantly longer. There is a result of a previous study that stated that if patients who use CPAP devices change their position during sleep or their oxygen saturation decreased, they usually took off their CPAP devices.…”

“…When AHI differed by more than 50% between REM sleep and NREM sleep, we defined REM-related OSA. 10) Automatic positive airway pressure (APAP) devices were adjusted between a range of 4 to 13 cm H2O according to individual patient conditions. All patients using fixed CPAP underwent an all-night titration test or split-night PSG under the supervision of an experienced expert for determining optimal pressure according to the AASM guidelines.…”