Sleep and Breathing

, Volume 21, Issue 1, pp 109–117 | Cite as

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

  • Sang-Ahm LeeEmail author
  • Joon-Hyun Paek
  • Yoo-Sam Chung
  • Woo Sung Kim
Sleep Breathing Physiology and Disorders • Original Article



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


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.


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.


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


Obstructive sleep apnea Sleep disordered breathing Positional Subtype Supine sleep Supine-predominant Supine-isolated 


Compliance with ethical standards


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.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of Neurology, Asan Medical CenterUniversity of Ulsan College of MedicineSongpa-guRepublic of Korea
  2. 2.Department of Otolaryngology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  3. 3.Department of Pulmonary Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea

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