Supine position and REM dependence in obstructive sleep apnea

Steffen, Armin; Maibücher, L; König, Inke R.

doi:10.1007/s00106-016-0265-0

Cited by 7 publications

(4 citation statements)

References 21 publications

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“…The point was that the aim of determining PD is to identify patients suitable for positional therapy (24). In another study, the "modified Cartwright index" was proposed as a measure for PD based on the wide variation in the proportion of each sleep position among patients (6). Specifically, the modified index was calculated by multiplying the proportion of time spent in the supine position (time in supine position/total sleep time) by a ratio of supine AHI to total AHI (supine AHI/total AHI).…”

Section: Discussionmentioning

confidence: 99%

“…The severity of OSA is influenced by factors such as sleep position, sleep stage, body weight, alcohol, and drug use (4). In particular, it is well known that in the supine sleep position, the gravitational effect makes the upper airway collapse more likely, exacerbating the severity of OSA (5,6). Patients who experience a significant increase in OSA severity in the supine sleep position are called to have a positional dependency (PD).…”

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confidence: 99%

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Influence of sleep stages on determining positional dependency in patients with obstructive sleep apnea

Ryu,

Kim,

Kim

et al. 2024

Clin Exp Otorhinolaryngol

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Objectives. The supine sleep position and the rapid eye movement (REM) stage are widely recognized to exacerbate the severity of obstructive sleep apnea (OSA). Position-dependent OSA is generally characterized by an apnea-hypopnea index (AHI) that is at least twice as high in the supine position compared to other sleep positions. However, this condition can be misdiagnosed if a particular sleep stage—REM or non-REM (NREM)—predominates in a specific position. We explored the impact of the sleep stage on positional dependency in OSA. Methods. Polysomnographic data were retrospectively analyzed from 111 patients with OSA aged 18 years or older, all of whom had an AHI exceeding five events per hour and slept in both supine and non-supine positions for at least 5% of the total sleep time. The overall ratio of non-supine AHI to supine AHI (NS/S-AHI ratio) was compared between total, REM, and NREM sleep. Additionally, a weighted NS/S-AHI ratio, reflecting the proportion of time spent in each sleep stage, was calculated and compared to the original ratio. Results. The mean NS/S-AHI ratio was consistent between the entire sleep period and the specific sleep stages. However, the NS/S-AHI ratios for individual patients displayed poor agreement between total sleep and the specific stages. Additionally, the weighted NS/S-AHI ratio displayed poor agreement with the original NS/S-AHI ratio, primarily due to discrepancies in patients with mild to moderate OSA. Conclusion. The weighted NS/S-AHI ratio may help precisely assess positional dependency.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Influence of sleep stages on determining positional dependency in patients with obstructive sleep apnea

Ryu,

Kim,

Kim

et al. 2024

Clin Exp Otorhinolaryngol

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“…Particularly in non-(severe) obese cohorts a dependence of the respiratory disorders on the supine position or REM sleep may exist. Such a dependence can be calculated with the Cartwright index modified by Steffen et al [17]. This index was therefore calculated for each PSG.…”

Section: Statisticsmentioning

confidence: 99%

“…Outcome data for sleep apnea parametersThe table shows the results of the polysomnographies (PSGs), each for all nights (for all 18 subjects) and separately for the individual nights (italic: data of the 8 subjects with several PSGs). In addition, the Cartwright index, modified by Steffen et al, is given, which shows whether supine or REM-associated sleep apnea is present[17]. Mean value ± standard deviation, minimum-maximum.…”

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confidence: 99%

Snoring: is a reliable assessment possible?

Fischer

Kuehnel

Vielsmeier

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose It is not easy to assess how severe and annoying a patient's snoring is. Solid parameters are lacking; snorers cannot deliver a reliable self-assessment and it is uncertain whether bed partners' statements can be relied upon. The purpose of the present study was therefore to investigate whether and how well snoring assessment based on acoustic parameters and bed partners' reporting agree. Methods In a double-blind, placebo-controlled study on snoring treatment, several acoustic parameters [snoring index (SI), percentage snoring time (ST), sound pressure level, sound energy, loudness, psychoacoustic annoyance and psychoacoustic snore score (PSS)] were measured in 18 subjects during 24 polysomnographies. Bed partners also assessed snoring annoyance and loudness as well as treatment outcome. Results No correlation was found between the subjective annoyance caused by snoring and the acoustic parameters. Regarding perceived loudness, there was a moderate, significant correlation with loudness (N 5) and PSS over the hour with the highest SI. SI, ST, LAeq and maximum sound pressure level dB(A) max showed no significant correlation. After the intervention only mean sound energy LAeq over the entire night showed a significant correlation (r s = 0.782; p = 0.022) with bed partners' assessments. However, this result was not confirmed in the second control night. Conclusions The non-existent or only weak correlation between bed partners' ratings and objective parameters indicate that snoring severity should be evaluated with caution. Neither acoustic parameters, at least for one measurement over just one night, nor bed partners' ratings should be used as the sole basis for snoring assessment.

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