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Ravesloot MJL. Positional Treatment of Obstructive Sleep Apnea. Otolaryngol Clin North Am 2024:S0030-6665(24)00002-1. [PMID: 38311472 DOI: 10.1016/j.otc.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Positional sleep apnea (POSA), a distinctive subtype of obstructive sleep apnea, underscores the critical influence of a patient's sleeping position on the severity of their condition. In the management of POSA, compliance with positional therapy (PT) is paramount, as it wields a profound impact on the treatment's efficacy and the overall alleviation of the disease. The advent of new-generation PT devices offers a promising alternative to conventional methods like the tennis ball technique, boasting higher compliance rates and substantial disease alleviation.
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Miyata S, Otake H, Fujishiro H, Iwamoto K, Noda A, Sone M, Ozaki N. Polysomnographic characteristics and predictors of positional obstructive sleep apnea in Japanese elderly. Sleep Biol Rhythms 2022; 20:403-411. [PMID: 38469417 PMCID: PMC10899911 DOI: 10.1007/s41105-022-00385-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
Abstract
Sleep problems and obstructive sleep apnea (OSA) increase with age and disturb life in old age. Positional therapy is one option to treat OSA, but the differences in clinical pathophysiology between elderly and other age groups have not been fully investigated. We explored the pathophysiological features of sleep apnea, factors that are independently associated with positional OSA and the prevalence in elderly patients. We studied demographic and polysomnographic data of 85 elderly individuals with OSA (age ≥ 65 years) and 124 non-elderly patients with OSA (age, 20-64 years). The Amsterdam Positional OSA Classification (APOC) was used to evaluate positional OSA. Body mass index (BMI) and Epworth sleepiness scale were both significantly lower in the elderly group than in the non-elderly group, although apnea/hypopnea index (AHI) did not differ between groups. OSA severity affected total sleep time, sleep efficiency, and waking after sleep onset more in the elderly than in the non-elderly. AHI in the lateral position was significantly lower in elderly than in non-elderly, although AHI in the supine position was almost the same between two groups. The distribution of APOC 1 and 2 (lateral sleep effective) was significantly higher in the elderly than in the non-elderly. Relative factors such as BMI, rate of hypopnea, and lowest SpO2 associated with positional OSA in non-elderly groups did not differ significantly among APOC subgroups in elderly patients. Our findings are suggesting that characteristics of the positional OSA is different between elderly and younger-age OSA patients.
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Affiliation(s)
- Seiko Miyata
- Department of Sleep Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hironao Otake
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, Aichi 466-8550 Japan
| | - Hiroshige Fujishiro
- Department of Sleep Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kunihiro Iwamoto
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akiko Noda
- Department of Biomedical Sciences, Chubu University Graduate School of Life and Health Sciences, Kasugai, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho Showa-ku, Nagoya, Aichi 466-8550 Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Mueller CE, Li H, Begasse SM, Sommer JU, Stuck BA, Birk R. Sleep position, patient comfort, and technical performance with two established procedures for home sleep testing. Sleep Breath 2021; 26:1673-1681. [PMID: 34970703 PMCID: PMC9663382 DOI: 10.1007/s11325-021-02530-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/12/2021] [Accepted: 11/16/2021] [Indexed: 12/02/2022]
Abstract
Purpose In patients with a high pre-test probability of suffering from obstructive sleep apnea (OSA), (cardio)-respiratory polygraphy (RP; level 3) is commonly used for home sleep testing (HST); however, testing based on peripheral arterial tonometry (PAT) is increasingly recognized as an alternative method. The aim of the study was to compare sleep position, patients’ comfort, and technical failure rates of HST with RP and PAT in patients with suspected OSA. Methods Sleep position, patients’ comfort, and technical failure rates of RP and PAT were compared in 56 patients receiving two nights of HST with either RP or PAT in a randomized fashion. Results Time in supine position with PAT was significantly lower (173.7±88 min) compared to RP (181.7±103.7 min; p < 0.001), although the absolute mean difference was not clinically significant. Patients reported to sleep better, feeling less disturbed when falling asleep, losing less sensors, and fewer nightly awakenings with PAT, but experienced more pain at the side of the finger probe. Forty-five out of 56 patients (80%) rated PAT as being the superior sleep test and 49 out of 56 (88%) would prefer PAT for further investigations (p<0.001). PAT testing was associated with less technical failures. Conclusion The results demonstrate that HST with PAT leads to less time in supine sleep positioning, which may be clinically relevant in selected patients. Moreover, PAT is associated with less technical failures and is perceived with less discomfort during testing and a reduced number of nocturnal awakenings in patient self-reports.
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Affiliation(s)
- C Emika Mueller
- Department of Otorhinolaryngology, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Germany.
| | - Hansen Li
- Department of Otorhinolaryngology, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Sophia M Begasse
- Department of Otorhinolaryngology, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - J Ulrich Sommer
- Department of Otorhinolaryngology, University Hospital Munich, Technische Universität München, München, Germany
| | - Boris A Stuck
- Department of Otorhinolaryngology, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Germany
| | - Richard Birk
- Department of Otorhinolaryngology, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043, Marburg, Germany
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Rissanen M, Oksenberg A, Töyräs J, Myllymaa S, Leppänen T. Total durations of respiratory events are modulated within REM and NREM sleep by sleeping position and obesity in OSA patients. Sleep Med 2021; 81:394-400. [PMID: 33819842 DOI: 10.1016/j.sleep.2021.02.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Supine sleeping position and obesity are well-known risk factors for obstructive sleep apnea (OSA) and modulate the risk for OSA-related daytime symptoms. Although respiratory event durations are associated with OSA-related severe health consequences, it is unclear how sleeping position, obesity, and daytime sleepiness are associated with respiratory event durations during REM and NREM sleep. We hypothesize that irrespective of the apnea-hypopnea index (AHI), respiratory event durations differ significantly between various OSA subgroups during REM and NREM sleep. METHODS One night in-lab polysomnographic recordings were retrospectively analyzed from 1910 untreated suspected OSA patients. 599 patients (AHI ≥ 5) were included in study and divided into subgroups based on positional dependency, BMI, and daytime sleepiness (Epworth Sleepiness Scale and Multiple Sleep Latency Test). Differences in total hypopnea time (THT), total apnea time (TAT), and total apnea-hypopnea time (TAHT) within REM and NREM sleep between the subgroups were evaluated. RESULTS During REM sleep, positional OSA patients had lower THT (OR = 0.952, p < 0.001) and TAHT (OR = 0.943, p < 0.001) than their non-positional counterparts. Compared to normal-weight patients (BMI < 25 kg/m2), obese patients (BMI ≥ 30 kg/m2) had lower THT, TAT, and TAHT (ORs = 0.942-0.971, p ≤ 0.009) during NREM sleep but higher THT (OR = 1.057, p = 0.001) and TAHT (OR = 1.052, p = 0.001) during REM sleep. No significant differences were observed in THT, TAT, and TAHT between patients with and without daytime sleepiness. CONCLUSION Regardless of the AHI, respiratory event durations vary significantly between OSA sub-groups during REM and NREM sleep. Therefore, to personalize OSA severity estimation the diagnosis should be tailored based on patient's demographics, clinical phenotype, and PSG characteristics.
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Affiliation(s)
- M Rissanen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - A Oksenberg
- Sleep Disorders Unit, Loewenstein Hospital-Rehabilitation Center, Raanana, Israel
| | - J Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland; School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - S Myllymaa
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - T Leppänen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
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Abstract
Positional therapy appears to be an attractive strategy for many patients with positional obstructive sleep apnea (OSA). However, under the American Academy of Sleep Medicine OSA guidelines, positional therapy is considered as only an alternative therapy, because previous research has demonstrated poor treatment tolerance and adherence. Recent technological advances have renewed interest in positional therapy, with the invention of new sophisticated vibratory positional therapy devices. These devices have shown great promise with efficacy, markedly improved patient tolerance, and long-term adherence. We review the literature on positional therapy and explore the most current evidence on the new positional therapy devices.
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Affiliation(s)
- Mok Yingjuan
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
| | - Wong Hang Siang
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889
| | - Tan Kah Leong Alvin
- Department of Otorhinolaryngology, Head and Neck Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889
| | - Hsu Pon Poh
- Department of Otorhinolaryngology, Head and Neck Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889
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Carr M, Phillips D. Sleep endoscopy findings in children in supine versus left lateral position. Int J Pediatr Otorhinolaryngol 2020; 134:110056. [PMID: 32361256 DOI: 10.1016/j.ijporl.2020.110056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe how drug-induced sleep endoscopy (DISE) findings in children with obstructive sleep apnea (OSA) change with lateral positioning. METHODS Children undergoing DISE for OSA in 2018-19 at a tertiary care children's hospital were positioned first supine and then in left lateral (LL) and findings were compared. RESULTS 63 children were included, 30 (47.6%) female and 33 (52.4%) male, mean age 4.64 years, and a mean Z-score 0.70. Mean pre-op Apnea Hypopnea Index (AHI) was 6.41 and REM AHI was 15.04. In supine position, 20 had obstruction at the palate (31.7%), 39 (61.9%) had obstruction at each of the base of tongue and the larynx, 17 (27.0%) had obstruction at the tonsils. In LL position, 11 (17.5%) were obstructed at the palate, 21 (33.3%) at the tonsils, 8 (12.7%) at the base of tongue and 7 (11.1%) at the larynx. Larynx and base of tongue were most likely to improve in LL position, as 54% of patients obstructed in supine position were open in LL position. Overall 38 (60.3%) patients improved on LL, 18 (28.6%) had no change, and 7 (11.1%) worsened. 30 (47.6%) patients improved in 1 site while 12 (19.0%) improved in more than 1 site. 16 (25.4%) patients worsened in 1 site and 9 (56.3%) of these had improvement in another site. CONCLUSION A significant number of patients improved airway patency, particularly at the base of tongue/larynx, during DISE when placed in LL position as compared to standard supine positioning.
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Kukwa W, Migacz E, Lis T, Ishman SL. The effect of in-lab polysomnography and home sleep polygraphy on sleep position. Sleep Breath 2021; 25:251-5. [PMID: 32418018 DOI: 10.1007/s11325-020-02099-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 04/26/2020] [Accepted: 05/01/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Little is known regarding the influence of in-laboratory polysomnography (PSG) equipment on sleep position, especially on the prevalence of supine positioning, which in many cases may lead to a more severe sleep apnea diagnosis. The aim of this study was to assess the percentage of supine sleep during an in-laboratory PSG compared to that seen during a home sleep apnea test (HSAT). METHODS This was a retrospective cohort study comparing in-laboratory PSG and HSAT using a peripheral arterial tone (PAT) technology device. RESULTS Of 445 PSG and 416 HSAT studies analyzed, there was no significant difference in the proportion of supine sleep time between PSG (44%) and HSAT (45%, p = 0.53). Analysis of the differences in sleep position (supine versus non-supine), analyzed by sex, BMI (≥ 30 kg/m2 versus < 30 kg/m2), and age (≥ 60 years versus < 60 years), was significant only for women, who had more supine sleep during HSAT at 61 ± 24% than during PSG at 45 ± 26% (p < 0.001). CONCLUSION Overall there was no difference in the percentage of supine sleep when comparing in-laboratory PSG to HSAT. However, women had more supine sleep with HSAT than with PSG.
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Baranowski R, Kalin K, Marcinkiewicz K, Orczykowski M, Bilińska M, Szumowski Ł. Positional sleep disordered breathing in patients with arrhythmia. Should we advise our patients to avoid supine position during sleep? J Electrocardiol 2019; 57:138-142. [PMID: 31655416 DOI: 10.1016/j.jelectrocard.2019.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/27/2019] [Accepted: 09/18/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Sleep disordered breathing [SDB] is a well-known problem in patients with cardiovascular diseases. Around 50% of pts. with SDB present positional sleep disordered breathing [PSDB]. AIMS The aim of this study was the investigation of the frequency of PSDB in patients with different forms of arrhythmias. METHODS We analyzed the presence of SDB in 53 pts. with diagnosed atrial fibrillation (paroxysmal or persistent), 88 pts. before ablation of ventricular ectopy and 110 pts. that had Holter monitoring due to the symptoms suggesting arrhythmia. RESULTS Finally, we could collect all the data in 243 pts. - 150 men 93 women. AHI < 15 was recorded in 136 (56%) pts., AHI > 15 in 107 (44%) pts. Moderate sleep disordered breathing was diagnosed in 59 (24%) pts. (AHI 15-30), severe sleep disordered breathing (AHI > 30) was recognized in 48 (20%) pts. In all of the analyzed groups, AHI in supine position was significantly higher than in nonsupine position. PSDB was recorded in 55% of pts. with AHI > 15 and in 29% of pts. (n = 14) with AHI > 30. Percentage of time in supine position was an independent factor related with the presence of at least moderate or severe sleep disordered breathing. CONCLUSION 1. Moderate or severe SDB is recorded in 44% of pts. with arrhythmias, almost 50% of them have positional SDB. 2. Percent of time of sleeping in supine position has an important independent impact on the presence of SDB. 3. Big studies should be conducted to verify if avoidance of sleeping in supine position may improve clinical outcome. CONDENSED ABSTRACT Sleep disordered breathing SDB is a frequent problem of pts. with cardiovascular diseases. It may influence the prognosis. Moderate or severe SDB is recorded in 44% of pts. with arrhythmias, almost 50% of them have positional SDB. Percent of time of sleeping in supine position has an important independent impact on the presence of SDB. 3. Big studies should be conducted to verify if avoidance of sleeping in supine position may improve clinical outcome. What is new?
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Affiliation(s)
- Rafał Baranowski
- Department of Heart Rhythm Disorders, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland.
| | - Katarzyna Kalin
- Department of Heart Rhythm Disorders, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Kamil Marcinkiewicz
- Department of Heart Rhythm Disorders, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Michał Orczykowski
- Department of Heart Rhythm Disorders, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Maria Bilińska
- Department of Heart Rhythm Disorders, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Łukasz Szumowski
- Department of Heart Rhythm Disorders, Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
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Abstract
Positional therapy appears to be an attractive strategy for many patients with positional obstructive sleep apnea (OSA). However, under the American Academy of Sleep Medicine OSA guidelines, positional therapy is considered as only an alternative therapy, because previous research has demonstrated poor treatment tolerance and adherence. Recent technological advances have renewed interest in positional therapy, with the invention of new sophisticated vibratory positional therapy devices. These devices have shown great promise with efficacy, markedly improved patient tolerance, and long-term adherence. We review the literature on positional therapy and explore the most current evidence on the new positional therapy devices.
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Affiliation(s)
- Mok Yingjuan
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
| | - Wong Hang Siang
- Department of Respiratory and Critical Care Medicine, Changi General Hospital, 2 Simei Street 3, Singapore 529889
| | - Tan Kah Leong Alvin
- Department of Otorhinolaryngology, Head and Neck Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889
| | - Hsu Pon Poh
- Department of Otorhinolaryngology, Head and Neck Surgery, Changi General Hospital, 2 Simei Street 3, Singapore 529889
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Sorscher AJ, Anzivino AP, Mackenzie T. Patient-predicted sleep position vs. HST data: a tendency to underestimate supine sleep. Sleep Breath 2018; 22:625-30. [PMID: 29149438 DOI: 10.1007/s11325-017-1589-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/18/2017] [Accepted: 10/24/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE The purpose of this study is to measure people's accuracy when they estimate what proportion of their nightly sleep at home is supine vs. non-supine. METHODS A series of patients referred for obstructive sleep apnea (OSA) evaluation were asked if they "knew with confidence" how they slept with regard to their body position. "Yes" responders were then asked to estimate what percentage of their sleep was supine vs. non-supine. This value was compared with the actual proportion of supine vs. non-supine sleep that they exhibited in a home sleep test (HST) that followed. RESULTS We obtained data from 49 subjects who expressed that they "knew with confidence" how they sleep in terms of body position. Subjects in aggregate underestimated their proportion of supine sleep by 21.6% (p < .001). Thirty-nine subjects (80%) slept supine more in the HST whereas 8 (16%) slept supine less compared to their pre-test estimates. Using a common classification of OSA severity, 9 subjects (18%) demonstrated a more severe degree of OSA than would have occurred had they slept as they had predicted. CONCLUSIONS Subjects in this study frequently underestimated their proportion of supine sleep compared to values measured in an HST. Because of the increased supine sleep they exhibited, the severity of their OSA was often greater in the test than it would have been had the subjects slept as they predicted. Sleep physicians should take into account the tendency of people to underestimate supine sleep. If patients with positional sleep apnea assert that they "always sleep laterally" when at home, they may be underestimating their true night-by-night OSA disease burden.
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