Abstract
Background
The severity of position-dependent obstructive sleep apnea (POSA) depends on the nonsupine and supine apnea–hypopnea index (AHI) as well as the time spent in supine position. The latter in particular is susceptible to variation. Several small-scale studies suggest that wearing polysomnography (PSG) apparatus leads to an increase in supine sleeping position.
Objectives
The aim of this study was to evaluate the effect of wearing PSG apparatus on sleeping position and on OSA severity.
Material and methods
A large-scale, retrospective study was performed, including a consecutive series of POSA and non-apneic snoring patients who were prescribed positional therapy (Sleep Position Trainer [SPT]). The effect of wearing PSG apparatus on sleeping position was evaluated by comparing body position during the PSG night and inactive (diagnostic) phase of SPT.
Results
The mean percentage of total recording time (TRT) in supine position was 43.1% during the PSG night phase compared with 28.6% of TRT during the inactive (diagnostic) phase of SPT; i.e., a significant decrease of 33.6% (p < 0.001). When adjusting the AHI using TRT in different sleeping positions measured with the SPT, the median AHI decreased from 13.3/h (9.0–20.4) to 10.3/h (6.8–16.2); p < 0.001. When using the adjusted AHI, 33% (N = 66) of all patients had a change in OSA severity.
Conclusions
The results of this study indicate that wearing PSG apparatus leads to an increase in the percentage of supine sleeping position causing an overestimation of OSA severity, especially in patients with POSA. This can have significant impact on both clinical and scientific practice.
Zusammenfassung
Hintergrund
Der Schweregrad der positionsabhängigen obstruktiven Schlafapnoe (POSA) hängt vom Apnoe-Hypopnoe-Index (AHI) in anderer Haltung als Rückenlage und in Rückenlage sowie der Verweildauer in Rückenlage ab. Insbesondere Letztere ist anfällig für Schwankungen. Mehrere kleinere Studien deuten darauf hin, dass das Tragen von Polysomnographiegeräten (PSG) zu einer erhöhten Dauer der Schlafposition in Rückenlage führt.
Ziele
Ziel dieser Studie war es, die Auswirkungen des Tragens von PSG-Geräten auf die Schlafposition und dessen Einfluss auf den OSA-Schweregrad zu beurteilen.
Material und Methoden
Es erfolgte eine groß angelegte retrospektive Studie mit einer konsekutiven Serie von POSA- und nichtapnoischen Schnarchpatienten, die eine vordefinierte Positionstherapie (Sleep Position Trainer, SPT) erhielten. Der Einfluss des Tragens von PSG-Geräten auf die Schlafposition wurde durch den Vergleich der Körperposition während der PSG-Nacht und der inaktiven (diagnostischen) Phase der SPT bewertet.
Ergebnisse
Der mittlere Prozentsatz der Gesamtaufnahmezeit („total recording time“, TRT) in Rückenlage betrug 43,1 % während der PSG-Nacht gegenüber 28,6 % der TRT während der inaktiven (diagnostischen) Phase der SPT; ein signifikanter Rückgang von 33,6 % (p < 0,001). Bei Einstellung des AHI mit TRT in verschiedenen Schlafpositionen mit SPT sank der mittlere AHI von 13,3/h (9,0–20,4) auf 10,3/h (6,8–16,2); p < 0,001. Bei Verwendung des angepassten AHI war bei 33 % (n = 66) aller Patienten der OSA-Schweregrad verändert.
Schlussfolgerungen
Den Ergebnissen dieser Studie zufolge kommt es durch das Tragen von PSG-Geräten zum Anstieg des Prozentsatzes der Schlafposition in Rückenlage und somit zur Überschätzung des OSA-Schweregrads, v. a. bei Patienten mit POSA. Dies kann in der klinischen und in der wissenschaftlichen Praxis erhebliche Auswirkungen haben.
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N. de Vries is a member of the Medical Advisory Board of NightBalance and has shares in NightBalance. He is also an investigator for Inspire and Jazz Pharmaceutics, a consultant for Philips, Olympus, and the AE Mann Foundation and has an inventor patent on PCT/US2010/062576 including devices, systems, and methods for monitoring sleep position. P.E. Vonk and M.J.L. Ravesloot declare that they have no conflicts of interest or financial ties to disclose.
All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was not required for this type of study.
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Vonk, P.E., de Vries, N. & Ravesloot, M.J.L. Polysomnography and sleep position, a Heisenberg phenomenon?. HNO 67, 679–684 (2019). https://doi.org/10.1007/s00106-019-0678-7
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DOI: https://doi.org/10.1007/s00106-019-0678-7