Prevalence of Positional Obstructive Sleep Apnea in Patients Undergoing Polysomnography and the Effect of Sleep Stage

Chapter

Abstract

Determining whether sleep apnea is positional or not has important therapeutic consequences as discussed elsewhere in this book. In this chapter, we will discuss the prevalence of positional sleep apnea in patients with sleep apnea, factors that make positional sleep apnea more likely in a patient with sleep apnea, and the effect of sleep stage on positional sleep apnea. Using the standard definition for positional sleep apnea, the prevalence varies from 56 % to 71 %. Using a stricter definition where sleep apnea is only observed in the supine posture, the prevalence varies from 23 % to 27 %. Positional sleep apnea is substantially more common in patients with milder disease. Positional sleep apnea is present during both REM and NREM sleep.

References

  1. 1.
    Young T, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Peppard PE, et al. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006–14.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Cartwright RD. Effect of sleep position on sleep apnea severity. Sleep. 1984;7(2):110–4.PubMedGoogle Scholar
  4. 4.
    Gillman A, et al. Comparison of supine-only and REM-only obstructive sleep apnoea. Sleep Med. 2012;13(7):875–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Mador MJ, et al. Prevalence of positional sleep apnea in patients undergoing polysomnography. Chest. 2005;128(4):2130–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Lee CH, et al. The effect of positional dependency on outcomes of treatment with a mandibular advancement device. Arch Otolaryngol Head Neck Surg. 2012;138(5):479–83.PubMedCrossRefGoogle Scholar
  7. 7.
    Chung JW, et al. Treatment outcomes of mandibular advancement devices in positional and nonpositional OSA patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(5):724–31.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Richard W, et al. The role of sleep position in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol. 2006;263(10):946–50.PubMedCrossRefGoogle Scholar
  9. 9.
    Sunwoo WS, et al. Association between positional dependency and obstruction site in obstructive sleep apnea syndrome. Clin Exp Otorhinolaryngol. 2012;5(4):218–21.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Teerapraipruk B, et al. Clinical and polysomnographic data of positional sleep apnea and its predictors. Sleep Breath. 2012;16(4):1167–72.PubMedCrossRefGoogle Scholar
  11. 11.
    Oksenberg A, et al. Positional vs nonpositional obstructive sleep apnea patients: anthropomorphic, nocturnal polysomnographic, and multiple sleep latency test data. Chest. 1997;112(3):629–39.PubMedCrossRefGoogle Scholar
  12. 12.
    Metersky ML, Castriotta RJ. The effect of polysomnography on sleep position: possible implications on the diagnosis of positional obstructive sleep apnea. Respiration. 1996;63(5):283–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Ozeke O, et al. Influence of the right- versus left-sided sleeping position on the apnea-hypopnea index in patients with sleep apnea. Sleep Breath. 2012;16(3):617–20.PubMedCrossRefGoogle Scholar
  14. 14.
    Tiotiu A, et al. Body position and breathing abnormalities during sleep: a systematic study. Pneumologia. 2011;60(4):216–21.PubMedGoogle Scholar
  15. 15.
    Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22(5):667–89.Google Scholar
  16. 16.
    Mador MJ, et al. Are the adverse effects of body position in patients with obstructive sleep apnea dependent on sleep stage? Sleep Breath. 2010;14(1):13–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Chung JW, et al. Patients with positional versus nonpositional obstructive sleep apnea: a retrospective study of risk factors associated with apnea-hypopnea severity. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110(5):605–10.PubMedCrossRefGoogle Scholar
  18. 18.
    Oksenberg A, et al. Association of body position with severity of apneic events in patients with severe nonpositional obstructive sleep apnea. Chest. 2000;118(4):1018–24.PubMedCrossRefGoogle Scholar
  19. 19.
    Oksenberg A, et al. Obstructive sleep apnoea in adults: body postures and weight changes interactions. J Sleep Res. 2012;21(4):402–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Pevernagie DA, et al. Effects of body position on the upper airway of patients with obstructive sleep apnea. Am J Respir Crit Care Med. 1995;152(1):179–85.PubMedCrossRefGoogle Scholar
  21. 21.
    Isono S, Tanaka A, Nishino T. Lateral position decreases collapsibility of the passive pharynx in patients with obstructive sleep apnea. Anesthesiology. 2002;97(4):780–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Saigusa H, et al. Three-dimensional morphological analyses of positional dependence in patients with obstructive sleep apnea syndrome. Anesthesiology. 2009;110(4):885–90.PubMedCrossRefGoogle Scholar
  23. 23.
    Weihu C, et al. Relationship of body position, upper airway morphology, and severity of obstructive sleep apnea/hypopnea syndrome among Chinese patients. Acta Otolaryngol. 2011;131(2):173–80.PubMedCrossRefGoogle Scholar
  24. 24.
    Soga T, et al. Upper airway morphology in patients with obstructive sleep apnea syndrome: effects of lateral positioning. Auris Nasus Larynx. 2009;36(3):305–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Ong JS, et al. Variability of human upper airway collapsibility during sleep and the influence of body posture and sleep stage. J Sleep Res. 2011;20(4):533–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Walsh JH, et al. Effect of body posture on pharyngeal shape and size in adults with and without obstructive sleep apnea. Sleep. 2008;31(11):1543–9.PubMedCentralPubMedGoogle Scholar
  27. 27.
    Chang ET, Shiao GM. Craniofacial abnormalities in Chinese patients with obstructive and positional sleep apnea. Sleep Med. 2008;9(4):403–10.PubMedCrossRefGoogle Scholar
  28. 28.
    Peppard PE, et al. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015–21.PubMedCrossRefGoogle Scholar
  29. 29.
    Itasaka Y, et al. The influence of sleep position and obesity on sleep apnea. Psychiatry Clin Neurosci. 2000;54(3):340–1.PubMedCrossRefGoogle Scholar
  30. 30.
    Akita Y, et al. Posture of patients with sleep apnea during sleep. Acta Otolaryngol Suppl. 2003;550:41–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Oksenberg A, et al. The significance of body posture on breathing abnormalities during sleep: data analysis of 2077 obstructive sleep apnea patients. Harefuah. 2009;148(5):304–9. 350, 351.PubMedGoogle Scholar
  32. 32.
    Penzel T, et al. Effect of sleep position and sleep stage on the collapsibility of the upper airways in patients with sleep apnea. Sleep. 2001;24(1):90–5.PubMedGoogle Scholar
  33. 33.
    Ratnavadivel R, et al. Marked reduction in obstructive sleep apnea severity in slow wave sleep. J Clin Sleep Med. 2009;5(6):519–24.PubMedCentralPubMedGoogle Scholar
  34. 34.
    Eiseman NA, et al. The impact of body posture and sleep stages on sleep apnea severity in adults. J Clin Sleep Med. 2012;8(6):655–6A.PubMedCentralPubMedGoogle Scholar
  35. 35.
    Kryger MH, Roth T, Dement WC. Principles and practice of sleep medicine. 5th ed. Philadelphia, PA: Saunders/Elsevier; 2011.Google Scholar
  36. 36.
    Pevernagie DA, Shepard Jr JW. Relations between sleep stage, posture and effective nasal CPAP levels in OSA. Sleep. 1992;15(2):162–7.PubMedGoogle Scholar
  37. 37.
    George CF, Millar TW, Kryger MH. Sleep apnea and body position during sleep. Sleep. 1988;11(1):90–9.PubMedGoogle Scholar
  38. 38.
    Oksenberg A, et al. REM-related obstructive sleep apnea: the effect of body position. J Clin Sleep Med. 2010;6(4):343–8.PubMedCentralPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Division of Pulmonary, Critical Care and Sleep MedicineUniversity at BuffaloBuffaloUSA
  2. 2.Western New York Veteran Affairs Healthcare SystemBuffaloUSA

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