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Supine position and REM dependence in obstructive sleep apnea

Critical model considerations

Rückenlage- und REM-Bezug bei obstruktiver Schlafapnoe

Kritische Modellbetrachtungen

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Abstract

Background

When considering supine position and REM dependence, many studies refer to the traditional definition in which obstructive sleep apnea (OSA) severity is at least doubled in the corresponding position/sleep stage (Cartwright index). The lack of consideration of the time spent in that particular sleep situation can lead to clinical bias.

Patients and methods

Two cohorts of patients with at least moderate OSA were analyzed retrospectively for anthropometric associations and correlations with OSA severity. One group consisted of 48 patients diagnosed using a polygraph, and the other group of 222 patients underwent polysomnography. First, the conventional Cartwright index was used, and a modified index was later applied to integrate the relative time component for REM sleep and the supine position.

Results

Less than a fifth of the patients fulfilled the classic conditions for supine position or REM sleep dependency. There were no definitive cut-offs in the classic or modified Cartwright index with regard to daytime sleepiness. Both indices show there was a correlation between OSA severity and being overweight.

Conclusion

The modified Cartwright index allowed us to identify borderline cases that were characterized by a very low or high amount of time spent in the supine position or REM sleep situation. Therapy effects that could have been biased only by varying amounts of time spent in the supine position could be better controlled for. Future studies will possibly include various other ratios besides the previously accepted 2:1 ratio when different statistical parameters are considered, such as the reduction of OSA severity or therapy adherence.

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Acknowledgements

We are very thankful to Christian Lange and Gudrun Bunk for their productive discussion of the clinical impact of this study.

Funding

The supplement containing this article is not sponsored by industry.

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Authors and Affiliations

  1. Department for Otorhinolaryngology, Head and Neck Surgery, University of Luebeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    A. Steffen MD & L. Maibücher

  2. Institute of Medical Biometry and Statistics, University of Luebeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    I. R. König

Authors
  1. A. Steffen MD
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  2. L. Maibücher
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  3. I. R. König
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Corresponding author

Correspondence to A. Steffen MD.

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Conflict of interest

L. Maibücher and I. R. König declare that they have no competing interests. A. Steffen received travel support and is a study investigator for Resmed, Martiensried, and Inspire Medical, Minnesota, and he received an honorarium for invited talks for Inspire Medical, Inc., outside of the submitted work.

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

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Editors

W. Baumgartner, Wien

P. K. Plinkert, Heidelberg

M. Ptok, Hannover

C. Sittel, Stuttgart

N. Stasche, Kaiserslautern

B. Wollenberg, Lübeck

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Steffen, A., Maibücher, L. & König, I.R. Supine position and REM dependence in obstructive sleep apnea. HNO 65 (Suppl 1), 52–58 (2017). https://doi.org/10.1007/s00106-016-0265-0

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  • DOI: https://doi.org/10.1007/s00106-016-0265-0

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