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Positional obstructive sleep apnea

An underestimated phenomenon

Lageabhängige obstruktive Schlafapnoe

Ein unterschätztes Phänomen

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Abstract

Background

The severity of obstructive sleep apnea (OSA) is, in 56–75 % influenced by body position. The prevalence of positional OSA (POSA) decreases as the severity of OSA increases, and 70–80% of POSA patients have mild to moderate OSA.

Materials and methods

The literature on POSA is reviewed. Many definitions have been applied using modified versions of Cartwright’s criteria (a difference in apnea index of 50% or more between supine and non-supine positions). Others have proposed a distinction among POSA patients (PP) between supine-isolated OSA (non-supine apnea–hypopnea index, AHI, < 5) and supine-predominant OSA (non-supine AHI ≥ 5).

Results

In PP, positional therapy (PT) as a standalone treatment or in combination with other treatment modalities has proven to be effective. To achieve high compliance, proper selection of PP suitable for treatment with PT remains of high importance. In 2014, the Amsterdam Positional OSA Classification (APOC) was proposed, which can be used to identify suitable candidates for PT.

Conclusion

There is strong evidence that PT is effective in reducing AHI during short- and long-term follow-up in PP, and can be used as a standalone treatment or in combination with other treatment modalities. Recently, several studies have pointed out the complexity of POSA pathophysiology, which leaves room for more understanding and knowledge of this underestimated phenomenon in the future.

Zusammenfassung

Hintergrund

Der Schweregrad der obstruktive Schlafapnoe (OSA) wird bei 56–75 % der Betroffenen durch die Lage des Körpers beeinflusst. Die Prävalenz der lageabhängigen OSA („positional OSA“, POSA) nimmt mit zunehmendem Schweregrad der OSA ab, und 70–80 % der POSA-Patienten weisen eine leicht- bis mittelgradige OSA auf.

Material und Methoden

Es wird ein Überblick über die Literatur zur POSA gegeben. Viele Definitionen sind unter Einsatz modifizierter Versionen der Cartwright-Kriterien (Unterschied im Apnoeindex von 50 % oder mehr zwischen Rückenlage und anderen Positionen) verwendet worden. Von anderen wurde eine Unterscheidung zwischen allein rückenlageabhängiger OSA (nichtrückenlagenabhängiger Apnoe-Hypopnoe-Index, AHI, < 5) und überwiegend rückenlageabhängiger OSA (nichtrückenlagenabhängiger AHI ≥ 5) bei POSA-Patienten (PP) vorgeschlagen.

Ergebnisse

Bei PP hat sich die Lagetherapie („positional therapy“, PT) als alleinige Behandlung oder in Kombination mit anderen Therapiemodalitäten als wirksam erwiesen. Um eine hohe Compliance zu erreichen, bleibt die entsprechende Auswahl für die Behandlung mit PT geeigneter PP von hoher Wichtigkeit. Im Jahr 2014 wurde die Amsterdam Positional OSA Classification (APOC) vorgeschlagen, die zur Identifizierung geeigneter Kandidaten für die PT verwendet werden kann.

Schlussfolgerung

Es gibt deutliche Belege dafür, dass die PT bei der Senkung des AHI während der Kurz- und Langzeitnachbeobachtung bei PP wirksam ist und als alleinige Behandlung oder in Kombination mit anderen Behandlungsmodalitäten verwendet werden kann. Kürzlich wurde in mehreren Studien auf die Komplexität der Pathophysiologie der POSA hingewiesen, was in der Zukunft noch Raum lässt für ein größeres Verständnis und tieferes Wissen um dieses unterschätzte Phänomen.

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Authors and Affiliations

  1. Department of Otorhinolaryngology Head and Neck surgery, OLVG West, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands

    P. E. Vonk MD & M. J. L. Ravesloot MD MSc PhD

  2. Department of Otorhinolaryngology Head and Neck surgery, Medisch Centrum Jan van Goyen, Amsterdam, The Netherlands

    M. J. L. Ravesloot MD MSc PhD

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Correspondence to P. E. Vonk MD.

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P. E. Vonk and M. J. L. Ravesloot declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Vonk, P.E., Ravesloot, M.J.L. Positional obstructive sleep apnea. Somnologie 22, 79–84 (2018). https://doi.org/10.1007/s11818-018-0152-x

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