Prevalence and characteristics of positional sleep apnea in the HypnoLaus population-based cohort

Heinzer, Raphaël; Petitpierre, Nicolas; Martí-Soler, Helena; Haba‐Rubio, José

doi:10.1016/j.sleep.2018.02.011

Cited by 62 publications

(70 citation statements)

References 33 publications

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“…However, there remained a fifth of patients with POSA who preferred PT in part due to its user friendliness. With an estimated global OSA prevalence as high as 38%1 and a prevalence of POSA up to 77% in patients with OSA,10 11 the absolute number of patients with POSA who prefer PT to CPAP is still potentially in the millions. Hence, it remains important for research and innovation to further refine current PT devices’ design to cater to the many patients with POSA who would otherwise reject or not tolerate CPAP.…”

Section: Discussionmentioning

confidence: 99%

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Comparing treatment effects of a convenient vibratory positional device to CPAP in positional OSA: a crossover randomised controlled trial

Mok

Tan

Hsu

et al. 2020

Thorax

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ObjectivesUp to 77% of patients with obstructive sleep apnoea (OSA) have positional OSA (POSA) but traditional positional therapy (PT) methods have failed as they were poorly tolerated. New convenient vibratory PT devices have been invented but while recent studies suggest high treatment efficacy and adherence, there are no published data comparing these devices directly with continuous positive airway pressure (CPAP). Our objective is to evaluate if a convenient vibratory PT device is non-inferior to CPAP in POSA treatment.MethodsIn this crossover randomised controlled trial, we enrolled patients with POSA with significant daytime sleepiness (Epworth Sleepiness Scale (ESS)≥10). POSA diagnosis was based on: (1) total Apnoea/Hypopnoea Index (AHI)>10/hour and non-supine AHI<10/hour (2) supine AHI≥2 × non-supine AHI. Patients used their initial allocated devices (PT or CPAP) for 8 weeks before crossing to the alternative intervention after a 1 week washout. The primary aim is to measure changes in ESS between the two treatments. Secondary outcomes include sleep study parameters and patient treatment preference (ClinicalTrials.gov: NCT03125512).Results40 patients completed the trial between April 2017 and December 2018. Difference in ESS after 8 weeks of device use (PT minus CPAP) was 2.0 (95% CI 0.68 to 3.32), exceeding our predetermined non-inferiority margin of 1.5. AHI on CPAP was lower than with PT (4.0±3.2 vs 13.0±13.8 events/hour, respectively, p=0.001), although both were lower than at baseline. Time spent supine was significantly lower with PT than CPAP (p<0.001). 60% of patients preferred CPAP, 20% preferred PT, while 20% preferred neither device.ConclusionsThe non-inferiority ESS endpoint for PT compared with CPAP was not met and the results were inconclusive. Future trials with larger sample sizes or in less symptomatic patients are warranted to provide further insight into the role of these new vibratory PT devices.

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Section: Discussionmentioning

confidence: 99%

“…Up to 77% of patients with OSA have ‘positional OSA’ (POSA) where obstructive respiratory events are reduced in a non-supine sleeping position 10–12. For these patients, positional therapy (PT) is an attractive strategy.…”

Section: Introductionmentioning

confidence: 99%

Comparing treatment effects of a convenient vibratory positional device to CPAP in positional OSA: a crossover randomised controlled trial

Mok

Tan

Hsu

et al. 2020

Thorax

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“…Different studies have estimated OSA incidence rates from 5.6% to 60% in people over 65 [10][11][12] and aging has been positively related with an increase in OSA incidence [13][14][15][16][17]. In a study comprising 5615 men and women between 40-98 years of age, sleep apnea was found to be most frequent in subjects aged 60 years or older (approximately 50% had an AHI of 5-14, and approximately 20% had an AHI ≥15) [18].…”

Section: Introductionmentioning

confidence: 99%

Positional Obstructive Sleep Apnea Syndrome in Elderly Patients

Iannella

Magliulo

Iacono

et al. 2020

IJERPH

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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.

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“…In accordance with the American Academy of Sleep Medicine (AASM) [18,19], diagnosis and classification of OSA was made on the basis of the apnea-hypopnea index (AHI) obtained from polysomnography study (PSG). Patients were classified as either mild OSA (AHI ≥ 5 and <15), moderate (AHI ≥ 15 and <30), or severe OSA (AHI ≥ 30) [18,19]. The simple snorers according to PSG results (AHI was <5/h) were excluded from the study.…”

Section: Patient's Characteristicsmentioning

confidence: 99%

Long-Term Subjective Outcomes of Barbed Reposition Pharyngoplasty for Obstructive Sleep Apnea Syndrome Treatment

Iannella

Vallicelli

Magliulo

et al. 2020

IJERPH

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Background: The purpose of this study was to evaluate long-term subjective outcomes of barbed reposition pharyngoplasty for obstructive sleep apnea syndrome (OSAS) treatment using a specific questionnaire, the Palate Postoperative Problem Score (PPOPS). Methods: 140 patients who underwent barbed reposition pharyngoplasty (BRP) surgery in the Morgagni Pierantoni Hospital of Forlì, Italy were enrolled in the study. Postoperative outcomes were evaluated in a short- and long-term follow-up using the PPOPS questionnaire. The average period of follow-up was 26 months. All patients received the PPOPS questionnaire by telephone in a period between April and August 2019. Results: 51% of patients complained of swallowing problems after surgery. In 91% of cases, the problem cleared up spontaneously. At the time of the interview, only 9% of patients had a residual swallowing difficult. At the time of PPOPS evaluation, rhinolalia was observed in 8% of patients, whereas nose regurgitation was present in 2% of patients. In 20% of patients, the foreign body sensation was present during follow-up. The value of apnea–hypopnea index (AHI) reduced from the preoperative value of 31.5 to the postoperative value of 11.4. Conclusions: BRP surgery proved to be an effective technique, appreciated by the majority of patients. Use of the PPOPS questionnaire has demonstrated that the BRP technique seems to ensure efficacy and lower morbidity, with few complications after surgery.

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Prevalence and characteristics of positional sleep apnea in the HypnoLaus population-based cohort

Cited by 62 publications

References 33 publications

Comparing treatment effects of a convenient vibratory positional device to CPAP in positional OSA: a crossover randomised controlled trial

Comparing treatment effects of a convenient vibratory positional device to CPAP in positional OSA: a crossover randomised controlled trial

Positional Obstructive Sleep Apnea Syndrome in Elderly Patients

Long-Term Subjective Outcomes of Barbed Reposition Pharyngoplasty for Obstructive Sleep Apnea Syndrome Treatment

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