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Influence of head position on obstructive sleep apnea severity

Abstract

Objective

Supine body orientation plays an important role in precipitating upper airway collapse in a significant proportion of obstructive sleep apnea (OSA) patients known to have supine-predominant OSA (OSAsup). Traditionally, trunk position is used to assess OSAsup, but the role of the head position has not been established. We hypothesized that head position influences OSA independently of trunk position.

Methods

Head and trunk positions were determined from subjects undergoing overnight polysomnography. The apnea-hypopnea index (AHI), rapid eye movement (REM), and non-REM sleep time of all trunk and head positions (lateral and supine) were calculated and compared against the complete supine position, i.e., head and trunk supine.

Results

In 26 subjects, lateral rotation of the head to the right or left with the trunk supine resulted in a significant reduction in AHI from 36.0 ± 22.5 to 25.8 ± 16.6 (p = 0.008), and an AHI drop <10 in 27% of patients. The “trunk lateral–head lateral” position resulted in a more dramatic reduction in AHI from 31.6 ± 20.2 to 4.1 ± 4.1 (p < 0.0001). The distributions of REM and non-REM sleep were not different among positions. In the subgroup with a body mass index (BMI) <32 kg/m2 (15 subjects), the AHI reduction with lateral head rotation was significant (p = 0.005) but not in remaining 11 obese patient with a BMI ≥32 kg/m2 (p = 0.24).

Conclusion

OSA severity with the trunk in the supine position decreased significantly when the head rotated from supine to lateral, particularly in non-obese patients. These results demonstrate an important influence of head position on the AHI, independently of trunk position and sleep stage, in patients with OSA.

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Abbreviations

AHI:

Apnea-hypopnea index

CPAP:

Continuous positive airway pressure

OSA:

Obstructive sleep apnea

OSAsup:

Supine-predominant obstructive sleep apnea

PSG:

Polysomnography

RIP:

Respiratory impedance plethysmography

REM:

Rapid eye movement

SaO2 :

Arterial oxyhemoglobin saturation

TSHS:

Trunk supine–head supine

TSHL:

Trunk supine–head left

TSHR:

Trunk supine–head right

TLHL:

Trunk left–head left

TRHR:

Trunk right–head right

TLHS:

Trunk left–head supine

TRHS:

Trunk right–head supine

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Acknowledgements

We would like to thank the technicians at the Toronto Rehab sleep laboratory for their support during data collection period; in particular, Fiona Rankin for her help in the interpretation of polysomnography data, and Wen-Hou Tseng for his aid in recruiting subjects for the study.

Author information

Correspondence to Hisham Alshaer.

Ethics declarations

Funding

This project has been supported partially by these grants: MaRS Innovation has provided financial support, Ontario Centre of Excellence has provided financial support, Johnson and Johnson Inc. has provided financial support, and Ontario Brain Institute via FedDev has provided financial support. Dr. Alshaer received the NSERC PhD scholarship. Dr. Bradley is supported by the Clifford Nordal Chair in Sleep Apnea and Rehabilitation Research. Maryam Patel received the Youth Employment Grant from the NRC (National Research Council of Canada) Industrial Research Assistance program.

Conflicts of interest

H. Alshaer, T.D. Bradley, M Patel have received grant funding from the agencies listed in the Funding section above. The results of this study are not influenced by any of the aforementioned grants as the granting agencies had no role in the design or conduct of this research nor had a bias towards a certain outcome.

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 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.

Additional information

Comment

Obstructive sleep apnea continues to be a significant problem affecting approximately 10% of the adult population in developed countries. Multiple therapeutic options exist today for treatment. Some of the least invasive include devices which maintain a lateral sleeping position at night. This article provides a new concept for patients who prefer to sleep supine - movement of the head alone to a lateral position.. While the study is small and should be reproduced in a larger cohort, the data supports that some patients with OSA may see a substantial benefit when their head is turned to a lateral position.

Robin Germany

Minnesota, USA

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Zhu, K., Bradley, T., Patel, M. et al. Influence of head position on obstructive sleep apnea severity. Sleep Breath 21, 821–828 (2017). https://doi.org/10.1007/s11325-017-1525-2

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Keywords

  • Trunk posture
  • Head position
  • Obstructive sleep apnea
  • Supine-predominant sleep apnea