Skip to main content
SpringerLink
Log in

Clinical features in patients with positional obstructive sleep apnea according to its subtypes

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to determine the prevalence of positional obstructive sleep apnea (OSA) and its subtypes in Korean adults with newly diagnosed OSA and document the clinical characteristics of positional OSA and its subtypes compared to non-positional OSA

Methods

In this cross-sectional study, we evaluated 1052 OSA adults. Positional OSA was defined as an overall apnea-hypopnea index (AHI) ≥5 and supine AHI to non-supine AHI ratio of ≥2. Positional OSA was subtyped depending on the degree of AHI while in the non-supine position: subtype I (a non-supine AHI <5/h), subtype II (a non-supine AHI ≥5/h and <15/h), and subtype III (a non-supine AHI ≥15/h). To compare clinical characteristics between patient groups depending on the positional tendency of OSA, statistical analyses were performed.

Results

The prevalence of positional OSA was 75.6 % with 39.9 % having AHI normalized <5/h while in non-supine position. Positional OSA patients had milder OSA, older age, and lower BMI than did non-positional OSA patients. However, having positional OSA did not influence daytime sleepiness, depressive symptoms, anxiety, and health-related quality of life. Unlike the subtype I and II positional OSAs, subtype III did not differ in clinical features from non-positional OSA. There were significant differences in supine sleep time depending on the positional tendency of OSA. Subtype III positional OSA had the shortest supine sleep time whereas subtype I positional OSA and non-positional OSA had the longest supine sleep time.

Conclusions

Positional OSA subtypes have different clinical characteristics. Subtyping of positional OSA is helpful for developing specific treatment strategies according to positional tendency

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  CAS  PubMed  Google Scholar 

  2. Kang K, Seo JG, Seo SH, Park KS, Lee HW (2014) Prevalence and related factors for high-risk of obstructive sleep apnea in a large Korean population: results of a questionnaire-based study. J Clin Neurol 10:42–49

    Article  PubMed  PubMed Central  Google Scholar 

  3. Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384

    Article  CAS  PubMed  Google Scholar 

  4. Joosten SA, O’Driscoll DM, Berger PJ, Hamilton GS (2014) Supine position related obstructive sleep apnea in adults: pathogenesis and treatment. Sleep Med Rev 18:7–17

    Article  PubMed  Google Scholar 

  5. Cartwright RD (1984) Effect of sleep position on sleep apnea severity. Sleep 7:110–114

    CAS  PubMed  Google Scholar 

  6. Bignold JJ, Mercer JD, Antic NA, McEvoy RD, Catcheside PG (2011) Accurate position monitoring and improved supine dependent obstructive sleep apnea with a new position recording and supine avoidance device. J Clin Sleep Med 7:376–383

    PubMed  PubMed Central  Google Scholar 

  7. Mador MJ, Kufel TJ, Magalang UJ, Rajesh SK, Watwe VGBJB (2005) Prevalence of positional sleep apnea in patients undergoing polysomnography. Chest 128:2130–2137

    Article  PubMed  Google Scholar 

  8. Permut I, Diaz-Abad M, Chatila W, Crocetti J, Gaughan JP, D’Alonzo GE, Krachman SL (2010) Comparison of positional therapy to CPAP in patients with positional obstructive sleep apnea. J Clin Sleep Med 6:238–243

    PubMed  PubMed Central  Google Scholar 

  9. Kim KT, Cho YW, Kim DE, Hwang SH, Song ML, Motamedi GK (2016) Two subtypes of positional obstructive sleep apnea: supine-predominant and supine-isolated. Clin Neurophysiol 127:565–570

    Article  PubMed  Google Scholar 

  10. Oksenberg A, Silverberg DS, Arons E, Radwan H (1997) Positional vs nonpositional obstructive sleep apnea patients: anthropomorphic, nocturnal polysomnographic, and multiple sleep latency test data. Chest 112:629–639

    Article  CAS  PubMed  Google Scholar 

  11. Joosten SA, Hamza K, Sands S, Turton A, Berger P, Hamilton G (2012) Phenotypes of patients with mild to moderate obstructive sleep apnoea as confirmed by cluster analysis. Respirology 17:99–107

    Article  PubMed  Google Scholar 

  12. vanMaanen JP, Meester KA, Dun LN, Koutsourelakis I, Witte BI, Laman DM, Hilgevoord AA, de Vries N (2013) The sleep position trainer: a new treatment for positional obstructive sleep apnoea. Sleep Breath 17:771–779

    Article  Google Scholar 

  13. Ravesloot MJ, van Maanen JP, Dun L, de Vries N (2013) The undervalued potential of positional therapy in position-dependent snoring and obstructive sleep apnea—a review of the literature. Sleep Breath 17:39–49

    Article  CAS  PubMed  Google Scholar 

  14. Frank MH, Ravesloot MJ, van Maanen JP, Verhagen E, de Lange J, de Vries N (2015) Positional OSA part 1: towards a clinical classification system for position dependent obstructive sleep apnoea. Sleep Breath 19:473–480

    Article  CAS  PubMed  Google Scholar 

  15. American Academy of Sleep Medicine (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Westchester, IL

  16. Cho YW, Lee JH, Son HK, Lee SH, Shin C, Johns MW (2011) The reliability and validity of the Korean version of the Epworth sleepiness scale. Sleep Breath 15:377–384

    Article  PubMed  Google Scholar 

  17. Kim MK, You JA, Lee JH, Lee SA (2011) The reliability and validity of the Korean version of the medical outcomes study—sleep scale in patients with obstructive sleep apnea. Sleep Med Res 2:89–95

    Article  Google Scholar 

  18. Lee YH, Song JY (1991) A study of the reliability and the validity of the BDI, SDS, and MMPI-D scales. J Korean Neuropsychiatr Assoc 10:93–113

    Google Scholar 

  19. Kim JT, Shin DK (1978) A study based on the standardization of the STAI for Korea. Recent Med 2:69–75

    Google Scholar 

  20. Han CW, Lee EJ, Iwaya T, Kataoka H, Kohzuki M (2004) Development of the Korean version of short-form 36-item health survey: health related QOL of healthy elderly people and elderly patients in Korea. Tohoku J Exp Med 203:189–194

    Article  PubMed  Google Scholar 

  21. Teerapraipruk B, Chirakalwasan N, Simon R, Hirunwiwatkul P, Jaimchariyatam N, Desudchit T, Charakorn N, Wanlapakorn C (2012) Clinical and polysomnographic data of positional sleep apnea and its predictors. Sleep Breath 16:1167–1172

    Article  PubMed  Google Scholar 

  22. Mo JH, Lee CH, Rhee CS, Yoon IY, Kim JW (2011) Positional dependency in Asian patients with obstructive sleep apnea and its implication for hypertension. Arch Otolaryngol Head Neck Surg 137:786–790

    Article  PubMed  Google Scholar 

  23. Richard W, Kox D, den Herder C, Laman M, van Tinteren H, de Vries N (2006) The role of sleeping position in obstructive sleep apnea. Eur Arch Otorhinolaryngol 263:946–950

    Article  PubMed  Google Scholar 

  24. Sunnergren O, Brostrom A, Svanborg E (2013) Positional sensitivity as a confounder in diagnosis of severity of obstructive sleep apnea. Sleep Breath 17:173–179

    Article  PubMed  Google Scholar 

  25. Chang ET, Shiao GM (2008) Craniofacial abnormalities in Chinese patients with obstructive and positional sleep apnea. Sleep Med 9:403–410

    Article  PubMed  Google Scholar 

  26. Pevernagie DA, JW S Jr (1992) Relations between sleep stage, posture and effective nasal CPAP levels in OSA. Sleep 15:162–167

    CAS  PubMed  Google Scholar 

  27. Conwell W, Patel B, Doeing D, Pamidi S, Knutson KL, Ghods F, Mokhlesi B (2012) Prevalence, clinical features, and CPAP adherence in REM-related sleep-disordered breathing: a cross-sectional analysis of a large clinical population. Sleep Breath 16:519–526

    Article  PubMed  Google Scholar 

  28. Metersky ML, Castriotta RJ (1996) The effect of polysomnography on sleep position: possible implications on the diagnosis of positional obstructive sleep apnea. Respiration 63:283–287

    Article  CAS  PubMed  Google Scholar 

  29. Levendowski DJ, Zack N, Rao S, Wong K, Gendreau M, Kranzler J, Zavora T, Westbrook PR (2009) Assessment of the test-retest reliability of laboratory polysomnography. Sleep Breath 13:163–167

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea

    Sang-Ahm Lee & Joon-Hyun Paek

  2. Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Yoo-Sam Chung

  3. Department of Pulmonary Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Woo Sung Kim

Authors
  1. Sang-Ahm Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joon-Hyun Paek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoo-Sam Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Woo Sung Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sang-Ahm Lee.

Ethics declarations

Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, SA., Paek, JH., Chung, YS. et al. Clinical features in patients with positional obstructive sleep apnea according to its subtypes. Sleep Breath 21, 109–117 (2017). https://doi.org/10.1007/s11325-016-1379-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-016-1379-z

Keywords

Search

Navigation