Sleep and Breathing

, Volume 21, Issue 2, pp 289–294 | Cite as

Association of sleep time in supine position with apnea-hypopnea index as evidenced by successive polysomnography

  • Gokhan Yalciner
  • Mehmet Ali Babademez
  • Fatih Gul
Sleep Breathing Physiology and Disorders • Original Article



The purpose of this study is to evaluate the impact of body position during sleep on apnea-hypopnea index (AHI) and night-to-night variability in polysomnography (PSG) parameters.


Totally, 30 patients with obstructive sleep apnea syndrome (OSAS) were assessed prospectively with successive PSGs performed. The patients were categorized as increased (group A), decreased (group B), and unchanged (group C) AHI between the first and second PSG evaluations performed at least 1-week interval.


The mean AHI values were significantly higher in the second night (p = 0.02). A change in AHI was found in almost 85 % of the patients between two successive measurements. According to multivariate and correlation analyses and differences in total AHI in supine position (r = 0.897), it was found that the influence of the supine position was the primary factor contributing to the night-to-night variability. Supine AHI, non-supine AHI, and non-supine time findings did not add any significance on total AHI.


The variability observed in the AHI seems related to amount of sleeping time spent in supine position, suggesting that mean AHI alone is not that reliable in the accurate diagnosis of OSAS severity. A thorough evaluation of AHI in supine and non-supine positions is needed in order to understand better the severity of OSAS.


Sleep apnea Polysomnography Apnea-hypopnea index Sleep position Supin time 


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 performed in the studies involving human participants 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.


  1. 1.
    Richard W, Kox D, den Herder C, Laman M, van Tinteren H, de Vries N (2006) The role of sleep position in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 263(10):946–950CrossRefPubMedGoogle Scholar
  2. 2.
    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(3):629–639CrossRefPubMedGoogle Scholar
  3. 3.
    Le Bon O, Staner L, Hoffmann G, et al. (2001) The first-night effect may last more than one night. J Psychiatr Res 35:165–172CrossRefPubMedGoogle Scholar
  4. 4.
    Gouveris H, Selivanova O, Bausmer U, Goepel B, Mann W (2010) First-night-effect on polysomnographic respiratory sleep parameters in patients with sleep-disordered breathing and upper airway pathology. Eur Arch Otorhinolaryngol 267(9):1449–1453CrossRefPubMedGoogle Scholar
  5. 5.
    Stepnowsky CJ Jr, Orr WC, Davidson TM (2004) Nightly variability of sleep-disordered breathing measured over 3 nights. Otolaryngol Head Neck Surg 131(6):837–843CrossRefPubMedGoogle Scholar
  6. 6.
    White LH, Lyons OD, Yadollahi A, Ryan CM, Bradley TD (2015) Night-to-night variability in obstructive sleep apnea severity: relationship to overnight rostral fluid shift. J Clin Sleep Med 11(2):149–156PubMedPubMedCentralGoogle Scholar
  7. 7.
    Ahmadi N, Shapiro GK, Chung SA, Shapiro CM (2009) Clinical diagnosis of sleep apnea based on single night of polysomnography vs. two nights of polysomnography. Sleep Breath 13(3):221–226CrossRefPubMedGoogle Scholar
  8. 8.
    Maestri R, La Rovere MT, Robbi E, Pinna GD (2011) Night-to-night repeatability of measurements of nocturnal breathing disorders in clinically stable chronic heart failure patients. Sleep Breath 15(4):673–678CrossRefPubMedGoogle Scholar
  9. 9.
    Riedel BW, Winfield CF, Lichstein KL (2001) First night effect and reverse first night effect in older adults with primary insomnia: does anxiety play a role? Sleep Med 2(2):125–133CrossRefPubMedGoogle Scholar
  10. 10.
    Bittencourt LR, Suchecki D, Tufik S, Peres C, Togeiro SM, Bagnato MC, Nery LE (2001) The variability of the apnoea-hypopnoea index. J Sleep Res 10(3):245–251CrossRefPubMedGoogle Scholar
  11. 11.
    Randerath WJ, Verbraecken J, Andreas S, Bettega G, Boudewyns A, Hamans E, Jalbert F, Paoli JR, Sanner B, Smith I, Stuck BA, Lacassagne L, Marklund M, Maurer JT, Pepin JL, Valipour A, Verse T, Fietze I (2011) European Respiratory Society task force on non-CPAP therapies in sleep apnoea. Non-CPAP therapies in obstructive sleep apnoea. Eur Respir J 37(5):1000–1028CrossRefPubMedGoogle Scholar
  12. 12.
    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(4):376–383PubMedPubMedCentralGoogle Scholar
  13. 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(1):39–49CrossRefPubMedGoogle Scholar
  14. 14.
    Younes M (2003) Contributions of upper airway mechanics and control mechanisms to severity of obstructive apnea. Am J Respir Crit Care Med 168:645–658CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryAtaturk Training and Research HospitalAnkaraTurkey
  2. 2.Department of Otorhinolaryngology, Head and Neck SurgeryYıldırım Beyazıt University School of MedicineAnkaraTurkey
  3. 3.Department of Otorhinolaryngology, Head and Neck SurgeryBitlis Tatvan State HospitalTatvanTurkey

Personalised recommendations