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

• DOI: 10.1007/s11325-019-01897-1
• Publication Date: 2019-07-19T23:02:42Z
• Authors: Arie Oksenberg; Natan Gadoth; Juha Töyräs; Timo Leppänen
• Keywords: positional patients; Adult; Male; Polysomnography; Posture; severe OSA patients; 610; Obstructive sleep apnea (OSA); positional therapy; Lateral position; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Prevalence; Humans; Aged; Aged, 80 and over; Sleep Apnea, Obstructive; Continuous Positive Airway Pressure; Severe OSA patients; Supine posture; Patient Acuity; lateral position; Positional therapy; obstructive sleep apnea (OSA); Middle Aged; 2733 Otorhinolaryngology; OSA treatment; Positional patients; Female; 2728 Clinical Neurology; supine posture

We assessed the prevalence of positional patients (PPs) and the main predictors of positional dependency in severe obstructive sleep apnea (OSA). A simulated effect of positional therapy (PT) vs. continuous positive airway pressure (CPAP) was also assessed.Polysomnographic recordings of 292 consecutive patients with severe OSA (Apnea-Hypopnea Index (AHI) ≥ 30) who slept > 4 h and had ≥ 30 min sleep in both supine and lateral positions were assessed. PPs were defined to have a supine AHI/lateral AHI ratio ≥ two and non-positional patients (NPPs) a supine AHI/lateral AHI ratio < two.A total of 35.3% of the severe OSA patients were PPs. They were less obese and had less severe OSA (p < 0.001) compared with NPPs. The percentage of total apnea-hypopnea time from total sleep time (AHT%) was the most significant predictor for positional dependency. By sleeping in the lateral posture (i.e. after simulated PT), 78 (75.7%) PPs obtained significant improvement of their OSA severity and 9 (8.7%) of them became "non-OSA". Moreover, if CPAP was used only for 50% of total sleep time, 53 patients (18.2%) gained more benefit from avoiding the supine posture than from CPAP therapy.More than a third of the studied severe OSA patients were PPs. These patients could achieve a significant decrease in the number and severity of apneas and hypopneas by adopting the lateral posture, suggesting that PT may be a valuable therapy for a significant portion of these severe OSA patients who for whatever reason are not being treated by CPAP.ClinicalTrials.gov Identifier: NCT03232658.