We assessed the prevalence of positional patients (PPs) and the main predictors of positional dependency in severe obstructive sleep apnea (OSA). A simulated effect of positional therapy (PT) vs. continuous positive airway pressure (CPAP) was also assessed.
Polysomnographic recordings of 292 consecutive patients with severe OSA (Apnea-Hypopnea Index (AHI) ≥ 30) who slept > 4 h and had ≥ 30 min sleep in both supine and lateral positions were assessed. PPs were defined to have a supine AHI/lateral AHI ratio ≥ two and non-positional patients (NPPs) a supine AHI/lateral AHI ratio < two.
A total of 35.3% of the severe OSA patients were PPs. They were less obese and had less severe OSA (p < 0.001) compared with NPPs. The percentage of total apnea-hypopnea time from total sleep time (AHT%) was the most significant predictor for positional dependency. By sleeping in the lateral posture (i.e. after simulated PT), 78 (75.7%) PPs obtained significant improvement of their OSA severity and 9 (8.7%) of them became “non-OSA”. Moreover, if CPAP was used only for 50% of total sleep time, 53 patients (18.2%) gained more benefit from avoiding the supine posture than from CPAP therapy.
More than a third of the studied severe OSA patients were PPs. These patients could achieve a significant decrease in the number and severity of apneas and hypopneas by adopting the lateral posture, suggesting that PT may be a valuable therapy for a significant portion of these severe OSA patients who for whatever reason are not being treated by CPAP.
ClinicalTrials.gov Identifier: NCT03232658
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apnea hypopnea index
apnea + hypopnea time as percentage of total sleep time
area under a ROC curve
a partial regression coefficient
body mass index
continuous positive airway pressure
ear, nose, and throat
epworth sleepiness scale
degree of freedom
non-rapid eye movement sleep
obstructive sleep apnea
positional obstructive sleep apnea
rapid eye movement sleep
receiver operating characteristic
a variation of a partial regression coefficient
total apnea time
total hypopnea time
total sleep time
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This research was supported by the Academy of Finland (decision number 313697), Finnish-Norwegian Medical Foundation, the Research Committee of the Kuopio University Hospital Catchment Area for the State Research Funding (projects 5041767 and 5041768), Tampere Tuberculosis Foundation, and the Respiratory Foundation of Kuopio Region.
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The authors declare that they have no conflicts of interest.
This study was approved by the Helsinki ethical committee of the Loewenstein Hospital Rehabilitation Center (protocol 0006–17-LOE). For retrospective chart reviews, formal consent is not required.
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.
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Oksenberg, A., Gadoth, N., Töyräs, J. et al. Prevalence and characteristics of positional obstructive sleep apnea (POSA) in patients with severe OSA. Sleep Breath 24, 551–559 (2020). https://doi.org/10.1007/s11325-019-01897-1
- Obstructive sleep apnea (OSA)
- Severe OSA patients
- Positional patients
- Positional therapy
- Supine posture
- Lateral position
- OSA treatment