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

Oksenberg, Arie; Gadoth, Natan; Töyräs, Juha; Leppänen, Timo

doi:10.1007/s11325-019-01897-1

Cited by 30 publications

(20 citation statements)

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…44 Our study, in line with the majority of previous literature reporting on prevalence of POSA and the severity of OSA, found the prevalence of POSA was higher in patients with milder OSA and reduced with increasing severity of the OSA. [12][13][14]16,28,29,37,45 It is likely that as the disease severity progresses the positional variability of the obstructive events is lost, and events start being observed in all body positions. 46,47 This may also be the reason that POSA is more commonly observed in patients with lower BMI, as BMI generally correlates with OSA severity.…”

Section: Discussionmentioning

confidence: 99%

“…[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. 16 Continuous positive airway pressure (CPAP) therapy is a well-established treatment modality for OSA and has been shown to improve quality of life in these patients. 17,18 However, acceptance and long-term adherence to CPAP therapy can be variable.…”

Section: Introductionmentioning

confidence: 99%

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

Garg¹,

Er²,

Howarth³

et al. 2020

NSS

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Purpose: To assess the prevalence of positional sleep apnea (POSA) and its predictors in patients diagnosed to have obstructive sleep apnea (OSA) in the regional and remote population of the Northern Territory of Australia over a two-year study period (2018 and 2019). Patients and Methods: Of the total 1463 adult patients who underwent a diagnostic polysomnography (PSG), 946 patients were eligible to be included in the study, of them, 810 consecutive patients with OSA (Apnea-Hypopnea Index (AHI) ≥ 5) who slept >4 h and had ≥30 min sleep in both supine and lateral positions were assessed. Patients were considered to have POSA if supine AHI to lateral AHI ratio ≥2. The likely comparative impact of use of continuous positive airway therapy (CPAP) or positional therapy (PT) on disease severity was evaluated using model simulation. Results: A total of 495/810 (61%) patients had POSA, the majority were males (68% vs 60%, p=0.013) and non-Indigenous Australians (93% vs 87%, p=0.004). POSA patients were younger (mean difference 2.23 years (95% CI 0.27, 4.19)), less obese (BMI mean difference 3.06 (95% CI 2.11, 4.01)), demonstrated less severe OSA (p < 0.001) and a greater proportion reported alcohol consumption (72% vs 62%, p=0.001) as compared to those with non-POSA. Using the simulation model, if patients with POSA use PT two-thirds (323/495, 65%) would obtain significant improvement of their OSA severity, with one in five (92/495, 19%) displaying complete resolution. Comparing this to simulated CPAP therapy, where the majority (444/495, 90%) will show significant improvement, and onethird (162/495, 33%) will display complete resolution. Conclusion: POSA needs to be routinely recognised and positional therapy integrated in practice especially in the remote regions and in the developing world when effective methods are in place to monitor positional therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Garg¹,

Er²,

Howarth³

et al. 2020

NSS

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“…However, it has been shown that in severe OSA some patients could gain even greater benefits from positional therapy compared with using CPAP with suboptimal adherence (Oksenberg, Gadoth, Töyräs, & Leppänen, 2019). In the weight-gain group, simulated positional therapy was able to compensate for a weight-related increase in the AHI.…”

Section: Ta B L Ementioning

confidence: 95%

Comparison of the effect of weight change, simulated computational continuous positive airway pressure treatment and positional therapy on severity of sleep apnea

Kulkas

Duce

Töyräs

et al. 2020

Journal of Sleep Research

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“…Several potential factors, including anthropometric measurement, clinical characteristics, and polysomnographic parameters, have been identified to help in differentiating between positional and non-positional OSA. Although there were some discrepancies regarding the difference between positional and non-positional OSA, most of the studies found that positional OSA tends to be younger, non-obese and are associated with mildmoderate OSA rather than severe OSA [3,7,8].…”

Section: Introductionmentioning

confidence: 99%

Role of drug-induced sleep endoscopy in evaluation of positional vs non-positional OSA

Lan

Liu

Lan

et al. 2020

J of Otolaryngol - Head & Neck Surg

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Background The study aimed to evaluate the anatomical differences between positional and non-positional OSA, and to identify the potential predictors for distinguishing between these two types of OSA. Methods A cross-sectional study of 230 consecutive patients with OSA undergoing DISE (Drug-induced Sleep Endoscopy) was carried out at a tertiary academic medical center. The factors correlating with positional and non-positional OSA were analyzed, including clinical characteristics, polysomnography data, and DISE findings. Results Univariate analysis revealed that non-positional dependency was correlated with a higher BMI (p < 0.001), neck circumference (p < 0.001), modified Mallampati score (p = 0.003), AHI (p < 0.001), degree of velum concentric collapse (p = 0.004), degree of oropharyngeal lateral wall collapse (p < 0.001), and degree of tongue base anteroposterior collapse (p = 0.004). Multivariate analysis revealed that oropharyngeal lateral wall collapse (OR = 1.90, p = 0.027) was the only anatomical factor significantly predicted non-positional dependency in OSA patients. AHI (OR = 1.04, p < 0.001), although significant, made only a marginal contribution to the prediction of non-positional dependency. Conclusions Oropharyngeal lateral wall collapse was identified as the only anatomical predictor for non-positional dependency in OSA patients. Therefore, further treatment modalities should address the distinct anatomical trait between positional and non-positional OSA. Graphical abstract

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

Cited by 30 publications

References 31 publications

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

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

Comparison of the effect of weight change, simulated computational continuous positive airway pressure treatment and positional therapy on severity of sleep apnea

Role of drug-induced sleep endoscopy in evaluation of positional vs non-positional OSA

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