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Rückenlage- und REM-Bezug bei obstruktiver Schlafapnoe. Kritische Modellbetrachtungen

Supine position and REM dependence in obstructive sleep apnea. Critical model considerations. German version

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Zusammenfassung

Hintergrund

Der bisherige Diskurs zum Rückenlage- und REM-Schlafbezug bei obstruktiver Schlafapnoe (OSA) übernimmt die tradierte Festlegung eines mindestens doppelt so hohen Schweregrads in der entsprechenden Körperlage bzw. im entsprechenden Schlafstadium (Cartwright-Index). Durch die fehlende Berücksichtigung des Zeitaspekts, in dem diese besondere Schlafsituation vorlag, können klinische Verzerrungen auftreten.

Material und Methoden

In 2 Kohorten von Patienten mit mindestens mittelgradiger OSA wurden diagnostische Polygraphien (PG; n = 48) und Polysomnographien (PSG; n = 222) retrospektiv ausgewertet, um anthropometrische und Schweregradassoziationen zu testen. Dabei wurde in den bisherigen Cartwright-Index eine relative Zeitkomponente in Rückenlage bzw. REM-Schlaf integriert.

Ergebnisse

Knapp 20 % der Patienten erfüllen die bisherigen Bedingungen für eine Lage- oder Stadienabhängigkeit. Klare Trennwerte für einen spezifischen klassischen oder modifizierten Cartwright-Index ergeben sich nicht. Beide Indizes zeigten, dass eine Korrelation zwischen OSA-Schweregrad und Übergewichtigkeit bestand.

Schlussfolgerung

Mit dem hier gezeigten modifizierten Cartwright-Index lassen sich Grenzfälle, die durch geringe Zeit in der entsprechenden Rückenlage- bzw. REM-Phase gekennzeichnet waren, besser hervorheben. Gerade für Vergleiche von Behandlungseffekten, die allein durch andere Anteile, z. B. von der Rückenlage, hervorgerufen sind, lassen sich klarer identifizieren. Es wird unterschiedliche Verhältnisse neben dem bisherigen 2:1 geben, wenn statistische Zielparameter wie Schweregradreduktion oder Therapietreue berücksichtigt werden.

Abstract

Background

When considering supine position and REM dependence, many previous studies have referred 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 the particular sleep situation could cause clinical bias.

Patients and methods

Two cohorts of patients with at least moderate OSA were analyzed retrospectively for anthropometric associations 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 cutoffs 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 identification of borderline cases that were characterized by a very low or high amount of time spent in the supine position or REM sleep situation. Treatment effects that could have been caused only by other components, e.g., different times spent in the supine position, could be better controlled for. In future studies there will be various other ratios besides the previously accepted 2:1 ratio when different statistical parameters are considered, such as the reduction of OSA severity or adherence to treatment.

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Danksagung

Wir bedanken uns bei Christian Lange und Gudrun Bunk für die herzliche Diskussion in der klinischen Anwendung.

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Authors and Affiliations

  1. Klinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, und Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    A. Steffen & L. Maibücher

  2. Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    I. R. König

Authors
  1. A. Steffen
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Correspondence to A. Steffen.

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Interessenkonflikt

A. Steffen erhielt Reisekostenzuschüsse, Vortragshonorare und Studienfinanzierungen der Fa. Resmed und Inspire Medical. L. Maibücher und I. R. König geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Redaktion

W. Baumgartner, Wien

P. K. Plinkert, Heidelberg

M. Ptok, Hannover

C. Sittel, Stuttgart

N. Stasche, Kaiserslautern

B. Wollenberg, Lübeck

Die englische Version dieses Beitrags ist unter doi: 10.1007/s00106-016-0265-0 zu finden.

In Auszügen vorgestellt bei der 86. Jahresversammlung der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e. V., 16.05.2015 in Berlin.

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Steffen, A., Maibücher, L. & König, I.R. Rückenlage- und REM-Bezug bei obstruktiver Schlafapnoe. Kritische Modellbetrachtungen. HNO 65, 141–147 (2017). https://doi.org/10.1007/s00106-016-0264-1

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  • DOI: https://doi.org/10.1007/s00106-016-0264-1

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