The Effects of Body Position on the Distribution of Obstructive, Mixed and Central Sleep Apnoea

Overview

Journal Afr J Thorac Crit Care Med

Date 2021 Jul 21

PMID 34286265

Citations 1

Authors

G van der Colff

P R Bartel

P Becker

L T Hazelhurst

Affiliations

Soon will be listed here.

Abstract

Background: Obstructive sleep apnoea is commonly aggravated by the supine body position. The impact of body position on the severity of mixed and central sleep apnoeas is understudied.

Objectives: To evaluate the impact of body position on obstructive, mixed and central apnoea indices in subjects presenting with this triform of sleep apnoea during a single polysomnogram.

Methods: We retrospectively analysed 26 polysomnograms where obstructive, mixed and central apnoeas each occurred at a rate >5/hr. Comparisons between lateral and supine body positions were made for obstructive apnoea index (OAI), mixed apnoea index (MAI), central apnoea index (CAI), apnoea-hypopnoea index (AHI) and obstructive apnoea-hypopnoea index (OAHI).

Results: Mean (SD) apnoea indices were significantly lower in lateral v. supine positions, respectively: MAI 15.06 (18.34) v. 32.09 (17.05); p<0.001, CAI 11.82 (11.77) v. 23.82 (14.18); p<0.001, AHI 79.46 (31.17) v. 99.47 (26.33); p<0.001, OAHI 67.87 (28.25) v. 76.00 (23.21); p=0.039. Unexpectedly, the converse was seen for OAI when comparing the lateral v. supine position: 53.10 (30.64) v. 43.58 (25.83); p=0.009, respectively.

Conclusion: It may be beneficial for subjects with a combination of obstructive, mixed, and central apnoeas to avoid the supine body position. In this triform phenotype, mixed apnoeas are neither purely obstructive nor purely centrally mediated. Furthermore, obstructive, mixed, and central apnoeas may be different representations of a single respiratory abnormality.

Citing Articles

Diagnosis of obstructive sleep apnoea.

Raine R Afr J Thorac Crit Care Med. 2021; 25(4).

PMID: 34286266 PMC: 8278852. DOI: 10.7196/AJTCCM.2019.v25i4.037.

References

Yamauchi M, Tamaki S, Yoshikawa M, Ohnishi Y, Nakano H, Jacono F . Differences in breathing patterning during wakefulness in patients with mixed apnea-dominant vs obstructive-dominant sleep apnea. Chest. 2011; 140(1):54-61. PMC: 3130526. DOI: 10.1378/chest.10-1082. View

Morgenthaler T, Gay P, Gordon N, Brown L . Adaptive servoventilation versus noninvasive positive pressure ventilation for central, mixed, and complex sleep apnea syndromes. Sleep. 2007; 30(4):468-75. DOI: 10.1093/sleep/30.4.468. View

Oksenberg A, Khamaysi I, Silverberg D, Tarasiuk A . Association of body position with severity of apneic events in patients with severe nonpositional obstructive sleep apnea. Chest. 2000; 118(4):1018-24. DOI: 10.1378/chest.118.4.1018. View

Xie A, Bedekar A, Skatrud J, Teodorescu M, Gong Y, Dempsey J . The heterogeneity of obstructive sleep apnea (predominant obstructive vs pure obstructive apnea). Sleep. 2011; 34(6):745-50. PMC: 3099495. DOI: 10.5665/SLEEP.1040. View

White L, Bradley T . Role of nocturnal rostral fluid shift in the pathogenesis of obstructive and central sleep apnoea. J Physiol. 2012; 591(5):1179-93. PMC: 3607865. DOI: 10.1113/jphysiol.2012.245159. View

Issa F, Sullivan C . Reversal of central sleep apnea using nasal CPAP. Chest. 1986; 90(2):165-71. DOI: 10.1378/chest.90.2.165. View

Sahlin C, Svanborg E, Stenlund H, Franklin K . Cheyne-Stokes respiration and supine dependency. Eur Respir J. 2005; 25(5):829-33. DOI: 10.1183/09031936.05.00107904. View

Eiseman N, Westover M, Ellenbogen J, Bianchi M . The impact of body posture and sleep stages on sleep apnea severity in adults. J Clin Sleep Med. 2012; 8(6):655-66A. PMC: 3501662. DOI: 10.5664/jcsm.2258. View

Leung R, Bowman M, Parker J, Newton G, Bradley T . Avoidance of the left lateral decubitus position during sleep in patients with heart failure: relationship to cardiac size and function. J Am Coll Cardiol. 2003; 41(2):227-30. DOI: 10.1016/s0735-1097(02)02717-1. View

10.

Szollosi I, Roebuck T, Thompson B, Naughton M . Lateral sleeping position reduces severity of central sleep apnea / Cheyne-Stokes respiration. Sleep. 2006; 29(8):1045-51. DOI: 10.1093/sleep/29.8.1045. View

11.

Chou Y, Yang T, Lin C, Huang S, Tsai Y, Chang J . Pay attention to treating a subgroup of positional obstructive sleep apnea patients. J Formos Med Assoc. 2016; 116(5):359-365. DOI: 10.1016/j.jfma.2016.06.007. View

12.

Eijsvogel M, Ubbink R, Dekker J, Oppersma E, de Jongh F, van der Palen J . Sleep position trainer versus tennis ball technique in positional obstructive sleep apnea syndrome. J Clin Sleep Med. 2014; 11(2):139-47. PMC: 4298771. DOI: 10.5664/jcsm.4460. View

13.

de Vries G, Hoekema A, Doff M, Kerstjens H, Meijer P, van der Hoeven J . Usage of positional therapy in adults with obstructive sleep apnea. J Clin Sleep Med. 2014; 11(2):131-7. PMC: 4298770. DOI: 10.5664/jcsm.4458. View

14.

Zaharna M, Rama A, Chan R, Kushida C . A case of positional central sleep apnea. J Clin Sleep Med. 2013; 9(3):265-8. PMC: 3578677. DOI: 10.5664/jcsm.2496. View