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Influence of the right- versus left-sided sleeping position on the apnea-hypopnea index in patients with sleep apnea

Abstract

Purpose

Sleep and sleep position have a significant impact on physical, cardiac and mental health, and have been evaluated in numerous studies particularly in terms of lateral sleeping positions and their association with diseases. We retrospectively examined the relationship between the sleeping position and position-specific apnea-hypopnea index (AHI) in obstructive sleep apnea-hypopnea (OSA) patients.

Methods

We assessed the sleeping body position and the body position-specific AHI score in patients who were referred for suspected OSA and underwent diagnostic nocturnal polysomnography. In order to eliminate inter-individual differences, only those who had a similar percentage of time spent in the LSSP and RSSP for each patient were enrolled. To provide this validity, only subjects that had a similar percentage of left and right lateral sleep time (±10%) were included in the analysis.

Results

A total of 864 patients had nocturnal diagnostic PSG. Of them, 131 patients met the inclusion criteria. The percent rate spent in the supine sleeping position (SSP) was 31.3 ± 18.7%, in the LSSP was 31.8 ± 10% and in the RSSP was 32.6 ± 10.8%. Whereas the SSP-specific AHI score was the highest with 60.4 ± 36.2/h among all the sleeping position-specific AHI scores (p < 0.001), the LSSP-specific AHI score was statistically higher than that for RSSP (30.2 ± 32.6/h vs. 23.6 ± 30.1/h; p < 0.001). When comparing individuals sub-grouped based on OSA severity, there was a statistically significant difference between the LSSP-specific AHI score and RSSP-specific AHI score in patients with severe (p = 0.002) and moderate (p = 0.026), but not mild (p = 0.130) OSA.

Conclusion

We found that the sleeping position had a significant influence on apneic events and RSSP decreased the frequency of obstructive respiratory events in patients with moderate and severe disease.

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References

  1. Roffwarg HP, Muzio JN, Dement WC (1966) Ontogenetic development of the human sleep-dream cycle. Science 152:604

    PubMed  Article  CAS  Google Scholar 

  2. Johnson HM, Swan TH, Wiegand AB (1930) In what positions do healthy people sleep? J Am Med Assoc 94:2058–2062

    Article  Google Scholar 

  3. Dunkell S (1977) Sleep positions: the night language of the body. Heinemann, London

    Google Scholar 

  4. Pump B, Talleruphuus U, Chouristensen NJ, Warberg J, Norsk P (2002) Effects of supine, prone, and lateral positions on cardiovascular and renal variables in humans. Am J Physiol Regul Integr Comp Physiol 283:R174–R180

    PubMed  CAS  Google Scholar 

  5. Naughton MT, Lorenzi-Filho G (2009) Sleep in heart failure. Prog Cardiovasc Dis 51:339–349

    PubMed  Article  Google Scholar 

  6. Palermo P, Cattadori G, Bussotti M, Apostolo A, Contini M, Agostoni P (2005) Lateral decubitus position generates discomfort and worsens lung function in chronic heart failure. Chest 128:1511–1516

    PubMed  Article  Google Scholar 

  7. Hallberg O, Johansson O (2010) Sleep on the right side—get cancer on the left? Pathophysiol 17:157–160

    Article  Google Scholar 

  8. Phillips BA, Okeson J, Paesani D, Gilmore R (1986) Effect of sleep position on sleep apnea and parafunctional activity. Chest 90:424–429

    PubMed  Article  CAS  Google Scholar 

  9. D’Souza JM, D’Souza DH (2010) Sleeping position and the functioning of the brain: is there a link? Med Hypotheses 75:408

    PubMed  Article  Google Scholar 

  10. Pevernagie DA, Shepard JW Jr (1992) Relations between sleep stage, posture and effective nasal CPAP levels in OSA. Sleep 15:162–167

    PubMed  CAS  Google Scholar 

  11. Jones AY (2004) Body position change and its effect on hemodynamic and metabolic status. Heart Lung 33:281–290

    PubMed  Article  Google Scholar 

  12. Banasik JL, Emerson RJ (2001) Effect of lateral positions on tissue oxygenation in the critically ill. Heart Lung 30:269–276

    PubMed  Article  CAS  Google Scholar 

  13. Backon J, Kullok S (1990) Why asthmatic patients should not sleep in the right lateral decubitus position. Br J Clin Pract 44:448–449

    PubMed  CAS  Google Scholar 

  14. Khoury RM, Camacho-Lobato L, Katz PO, Castell DO (1999) Influence of spontaneous sleep positions on nighttime recumbent reflux in patients with gastroesophageal reflux disease. Am J Gastroenterol 94:2069–2073

    PubMed  Article  CAS  Google Scholar 

  15. Moreno MA, Furtner F (2009) Infant sleep position: back to sleep. Arch Pediatr Adolesc Med 163:1168

    PubMed  Article  Google Scholar 

  16. Farine D, Seaward PG (2007) When it comes to pregnant women sleeping, is left right? J Obstet Gynaecol Can 29:841–842

    PubMed  Google Scholar 

  17. Domino G, Bohn SA (1980) Hypnagogic exploration: sleep positions and personality. J Clin Psychol 36:760–762

    Article  Google Scholar 

  18. Sahlin C, Franklin KA, Stenlund H, Lindberg E (2009) Sleep in women: normal values for sleep stages and position and the effect of age, obesity, sleep apnea, smoking, alcohol and hypertension. Sleep Med 10:1025–1030

    PubMed  Article  Google Scholar 

  19. Cartwright R (1984) Effect of sleep position on sleep apnea severity. Sleep 7:110–114

    PubMed  CAS  Google Scholar 

  20. Oksenberg A, Khamaysi I, Silverberg DS, Tarasiuk A (2000) Association of body position with severity of apneic events in patients with severe nonpositional obstructive sleep apnea. Chest 118:1018–1024

    PubMed  Article  CAS  Google Scholar 

  21. Elliott AR, Shea SA, Dijk DJ, Wyatt JK, Riel E, Neri DF, Czeisler CA, West JB, Prisk GK (2001) Microgravity reduces sleep disordered breathing in humans. Am J Respir Crit Care Med 164:478–485

    PubMed  CAS  Google Scholar 

  22. Tanaka F, Nakano H, Sudo N, Kubo C (2009) Relationship between the body position-specific apnea-hypopnea index and subjective sleepiness. Respiration 78:185–190

    PubMed  Article  Google Scholar 

  23. 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 267:1449–1453

    PubMed  Article  Google Scholar 

  24. The Report of an American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22:667–689

    Google Scholar 

  25. Leung RS, Bowman ME, Parker JD, Newton GE (2003) Avoidance of the left lateral decubitus position during sleep in patients with heart failure: relationship to cardiac size and function. J Am Coll Cardiol 41:227–230

    PubMed  Article  Google Scholar 

  26. Fujita M, Miyamoto S, Sekiguchi H, Sasayama S (2000) Effects of posture on sympathetic nervous modulation in patients with chronic heart failure. Lancet 356:1822–1823

    PubMed  Article  CAS  Google Scholar 

  27. Chen GY, Kuo CD (1997) The effect of the lateral decubitus position on vagal tone. Anaesthesia 52:653–657

    PubMed  Article  CAS  Google Scholar 

  28. Stein P (1952) Tendency toward hypotension in left lateral recumbency. AMA Arch Intern Med 90:234–242

    PubMed  Article  CAS  Google Scholar 

  29. Lange RA, Katz J, McBride W, Moore DM Jr, Hillis LD (1988) Effects of supine and lateral positions on cardiac output and intracardiac pressures. Am J Cardiol 62:330–333

    PubMed  Article  CAS  Google Scholar 

  30. Shanoudy H, Soliman A, Raggi P, Liu JW, Russell DC, Jarmukli NF (1998) Prevalence of patent foramen ovale and its contribution to hypoxemia in patients with obstructive sleep apnea. Chest 113:91–96

    PubMed  Article  CAS  Google Scholar 

  31. Beelke M, Angeli S, Del Sette M, Gandolfo C, Cabano ME, Canovaro P, Nobili L, Ferrillo F (2003) Prevalence of patent foramen ovale in subjects with obstructive sleep apnea: a transcranial Doppler ultrasound study. Sleep Med 4:219–223

    PubMed  Article  Google Scholar 

  32. Beelke M, Angeli S, Del Sette M, De Carli F, Canovaro P, Nobili L, Ferrillo F (2002) Obstructive sleep apnea can be provocative for right-to-left shunting through a patent foramen ovale. Sleep 25:856–862

    PubMed  Google Scholar 

  33. Chen GP, Goldberg SL, Gill EA Jr (2005) Patent foramen ovale and the platypnea-orthodeoxia syndrome. Cardiol Clin 23:85–89

    PubMed  Article  CAS  Google Scholar 

  34. Tada T, Fujita M, Goto T, Tamura T, Ono K, Kita T, Takahashi K, Osada H, Sakata R, Kimura T (2010) A case with sudden onset of position-dependent hypoxemia caused by reopening of foramen ovale. Journal of Cardiology Cases 1:e88–e91

    Article  Google Scholar 

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Acknowledgment

We wish to thank all personnel of the Archive Section and our secretaries in the Cardiology Departmant, Mrs. Selda Avci Bal and Mrs. Arzu Eryigit, for their kind help with data collection.

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Correspondence to Ozcan Ozeke.

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Ozeke, O., Erturk, O., Gungor, M. et al. Influence of the right- versus left-sided sleeping position on the apnea-hypopnea index in patients with sleep apnea. Sleep Breath 16, 617–620 (2012). https://doi.org/10.1007/s11325-011-0547-4

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  • DOI: https://doi.org/10.1007/s11325-011-0547-4

Keywords

  • Sleep
  • Sleeping position
  • Sleep apnea