The Prevalence of Positional Obstructive Sleep Apnoea in a Sample of the Saudi Population

Abstract

Purpose Positional obstructive sleep apnoea (POSA) is of important clinical significance, as positional treatment can augment or obviate continuous positive airway pressure. This study aimed to determine the prevalence of POSA and its characteristics using different definitions. Methods We retrospectively examined a cohort of patients who underwent polysomnography (PSG) between 2013 and 2019 at two sleep centres. Demographic data and PSG data were collected from 624 patients with an apnoea–hypopnea index (AHI) ≥ 5. POSA was defined using different criteria as follows: (1) AHI of at least twice as high in the supine position as in the lateral position (Cartwright’ s definition). (2) A supine AHI ≥ 10 and a lateral AHI < 10 (Marklun’s definition). (3) AHI of at least twice as high in the supine position than in the lateral position, with the lateral AHI not exceeding 5 (Mador’s definition or Exclusive POSA; e-POSA). (4) AHI ≥ 15/h; a supine AHI ≥ twice that of the nonsupine AHI ≥ 20 min of sleep in the supine and nonsupine positions; and a nonsupine AHI < 15 (Bignold’s definition). Results The prevalence of POSA was 54% (Cartwright), 38.6% (Mador), 33.8% (Marklund) and 8.3% (Bignold). Multivariate regression analysis showed a body mass index (BMI) < 35 kg/m2 was the only significant predictor of POSA. Mador’s definition had the highest diagnostic yield (sensitivity 63%; specificity 100%; area under the receiver operating characteristic curve 90.2%). Conclusion POSA is common, but its prevalence depends on the definition used. Low BMI was identified as a significant predictor.

Causal association of gastroesophageal reflux disease with obstructive sleep apnea and sleep-related phenotypes: a bidirectional two-sample Mendelian randomization study

“…Additionally, acid reflux may stimulate the vagus nerve, inhibiting the medullary respiratory center and preventing proper contraction of the respiratory muscles ( 41 ), which may also lead to apnea. From a sleep position perspective, the supine position not only facilitates airway obstruction due to tongue and throat tissue collapse ( 42 ) but also increases the likelihood of gastroesophageal reflux ( 43 ), which can exacerbate respiratory issues by causing breathing pauses and snoring. A study on the relationship between renalase and OSA found that more severe OSA patients often have more shallow sleep ( 44 ), which may also help explain why GERD can simultaneously lead to OSA, insomnia, and subjectively shortened sleep duration.…”

Exploring the Impact of Positional Sleep Apnea in a Turkish Population: Unveiling the Untold Story

“…Using the definitions of POSA and e-POSA previously defined by Cartwright [ 12 ] and Mador et al [ 15 ], respectively, POSA and e-POSA were found to have a prevalence of 60.1% and 26.1% in our study population. Other studies across many countries using the similar definitions also reported the prevalence of POSA and e-POSA to range from 53% to 62.3% and from 20.1% to 33.8%, respectively [ 2 , 9 , 12 , 13 , 21 , 22 ]. In a study by Sabil et al in a French population of OSA patients (n=6437), the prevalence of POSA and e-POSA were reported to be 53.5% and 20.1%, respectively, and both were independently associated with time in supine position, male sex, younger age, lower AHI, and lower BMI [ 12 ].…”

“…Different definitions of positional sleep apnea have been developed in regards to the severity of OSA, as defined by the apnea-hypopnea index (AHI) in supine and non-supine positions [ 2 , 11 ]. Accordingly, 3 distinct clinical types of OSA have been defined, namely POSA, exclusive POSA (e-POSA), and non-positional OSA (non-POSA) [ 2 , 9 , 12 , 13 ]. POSA is OSA with at least double frequency of breathing abnormalities during supine than during the lateral position, OSA occurring exclusively in the supine position (normalized AHI in non-supine positions) is defined as e-POSA, and non-POSA is defined as a high frequency of breathing abnormalities in all positions [ 2 , 12 – 16 ].…”

“…In addition, since the POSA definition addresses a large OSA patient population, the e-POSA definition has been widely preferred for defining patients that would particularly benefit from PT devices and automatic PAP devices [ 13 , 14 , 16 ]. In this regard, given that PAP adherence remains a major problem in OSA patients, POSA patients treated with CPAP can also have low adherence, and thus may be confronting unwanted cardiometabolic consequences [ 13 , 18 , 19 ]. In contrast, although they represent young populations with mild OSA severity, e-POSA patients that are exposed to significant hypoxic burden may be underestimated and undertreated [ 2 , 7 , 9 , 12 , 13 ].…”

“…In this regard, given that PAP adherence remains a major problem in OSA patients, POSA patients treated with CPAP can also have low adherence, and thus may be confronting unwanted cardiometabolic consequences [ 13 , 18 , 19 ]. In contrast, although they represent young populations with mild OSA severity, e-POSA patients that are exposed to significant hypoxic burden may be underestimated and undertreated [ 2 , 7 , 9 , 12 , 13 ]. Despite the significant differences between positional and non-positional OSA types in terms of clinical manifestations and treatment options, few studies investigated the differences between clinical types of OSA and the risk factors that incite the emergence of POSA, e-POSA, or non-POSA, and findings were often contradictory [ 2 , 7 – 9 , 12 , 13 , 20 ].…”