The role of sleep position in obstructive sleep apnea syndrome

  • Wietske Richard
  • Dennis Kox
  • Cindy den Herder
  • Martin Laman
  • Harm van Tinteren
  • Nico de Vries
Miscellaneous

Abstract

We analyzed the role of sleep position in obstructive sleep apnea syndrome (OSAS). The polysomnograms of 120 patients with sleep apnea syndrome were analyzed. We associated the apnea hypopnea index (AHI) of the supine position with the AHI of the other positions. Patients were stratified in a group of positional patients (PP) (AHI supine ≥ 2 × AHI other positions) and a group of non-positional patients (NPP). In 55.8% of our patients, OSAS was position dependent. PP patients were significantly (6.7 years) younger. BMI and AHI were higher in the NPP group, but the difference was not significant. Level of obstruction in the upper airway (retropalatinal vs retrolingual vs both levels) as assessed by sleep endoscopy was not significantly different between the two groups. Total sleep time (TST) was equal in both groups, but the average time in supine position was 37 min longer in the PP group. This study confirms the finding that in more than 50% of patients, OSAS is position dependent. Apart from age, no patient characteristics were found indicating the position dependency. Overall AHI does not identify positional OSAS.

Keywords

Body position Obstructive sleep apnea syndrome 

References

  1. 1.
    Flemons WW (2002) Clinical practice.Obstructive sleep apnea. N Engl J Med 347(7):498–504PubMedCrossRefGoogle Scholar
  2. 2.
    Young T, Palta M, Dempsey J, Skatrud J, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328(17):1230–1235PubMedCrossRefGoogle Scholar
  3. 3.
    Young T, Evans L, Finn L, Palta M (1997) Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 20(9):705–706PubMedGoogle Scholar
  4. 4.
    Shamsuzzaman ASM, Gersh BJ, Somers VK (2003) Obstructive sleep apnea, implications for cardiac and vascular disease. JAMA 290(14):1906–1914PubMedCrossRefGoogle Scholar
  5. 5.
    Phillipson EA (1993) Sleep apnea—a major public health problem. N Engl J Med 328:1271–1273PubMedCrossRefGoogle Scholar
  6. 6.
    Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F, O’Connor GT, Boland LL, Schwartz JE, Samet JM (2001) Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the sleep heart health study. Am J Respir Crit Care Med 163:19–25PubMedGoogle Scholar
  7. 7.
    Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea–hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365(9464):1046–1053PubMedGoogle Scholar
  8. 8.
    Dyken ME, Somers VK, Yamada T, Ren ZY, Zimmerman MB (1996) Investigating the relationship between stroke and obstructive sleep apnea. Stroke 27:401–407PubMedGoogle Scholar
  9. 9.
    Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384PubMedCrossRefGoogle Scholar
  10. 10.
    George CF, Smiley A (1999) Sleep apnea and automobile crashes. Sleep 22:790–795PubMedGoogle Scholar
  11. 11.
    Schmidt-Nowara W, Lowe A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S (1995) Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep 18(6):501–510PubMedGoogle Scholar
  12. 12.
    Jenkinson C, Davies RJ, Mullins R, Stradling JR (1999) Comparison of therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised prospective parallel trial. Lancet 353(9170):2100–2105PubMedCrossRefGoogle Scholar
  13. 13.
    Grunstein RR (1995) Nasal continuous positive airway pressure treatment for obstructive sleep apnoea. Thorax 50:1106–1113PubMedCrossRefGoogle Scholar
  14. 14.
    Indications and standards for use of nasal continuous positive airway pressure (CPAP) in sleep apnea syndromes: statement of the american thoracic society. (1994) Am J Crit Care Med 150:1738–1745Google Scholar
  15. 15.
    Cartwright RD (1984) Effect of sleep position on sleep apnea severity. Sleep 7:110–114PubMedGoogle Scholar
  16. 16.
    George CF, Millar TW, Kryger MH (1988) Sleep apnea and body position during sleep. Sleep 11(1):90–99PubMedGoogle Scholar
  17. 17.
    Cartwright RD, Diaz F, Lloyd S (1991) The effect of sleep posture and sleep stage on apnea frequency. Sleep 14(4):351–353PubMedGoogle Scholar
  18. 18.
    Oksenberg A, Silverberg DS, Arons E, Radwan H (1997) Positional versus non-positional obstructive sleep apnea patients. Chest 112:629–639PubMedCrossRefGoogle Scholar
  19. 19.
    Oksenberg A, Khamaysi I, Silverberg DS, Tarasiuk A (2000) Association of body position with severity of apneic events in patients with severe non-positional obstructive sleep apnea. Chest 118:1018–1024PubMedCrossRefGoogle Scholar
  20. 20.
    Itasaka Y, Miyazaki S, Ishikawa K, Togawa K (2000) The influence of sleep position and obesity on sleep apnea. Psychiatry Clin Neurosci 54(3):340–341PubMedCrossRefGoogle Scholar
  21. 21.
    Akita Y, Kawakatsu K, Hattori C, Hattori H, Suzuki K, Nishimura T (2003) Posture of patients with sleep apnea during sleep. Acta Otolaryngol 550:41–45CrossRefGoogle Scholar
  22. 22.
    Maurer JT, Stuck BA, Hein G, Verse T, Hörmann K (2003) Schlafapnoetherapie mit einer neuartigen rückenlage-verhinderungs-weste. Dtsch Med Wochenschr 128:71–75PubMedCrossRefGoogle Scholar
  23. 23.
    Hessel NS, de Vries N (2002) Diagnostic work-up of socially unacceptable snoring II Sleependoscopy. Eur Arch Otorhinolaryngol 259:158–161PubMedCrossRefGoogle Scholar
  24. 24.
    Den Herder C, van Tinteren H, de Vries N (2005) Sleep endoscopy versus modified Mallampati score in sleep apnea and snoring. Laryngoscope 115(4):735–739Google Scholar
  25. 25.
    Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research (1999) The report of an American academy of sleep medicine task force. Sleep 22(5):667–689Google Scholar
  26. 26.
    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Wietske Richard
    • 1
  • Dennis Kox
    • 1
  • Cindy den Herder
    • 1
  • Martin Laman
    • 2
  • Harm van Tinteren
    • 3
  • Nico de Vries
    • 1
  1. 1.Department of Otolaryngology/Head and Neck SurgerySt. Lucas Andreas HospitalAmsterdamThe Netherlands
  2. 2.Department of NeurophysiologySt. Lucas Andreas HospitalAmsterdamThe Netherlands
  3. 3.Department of Biostatistics St. Lucas Andreas HospitalAmsterdamThe Netherlands

Personalised recommendations