체위성 폐쇄성 수면 무호흡증의 유병률과 특성
The Prevalence and Characteristics of Positional Obstructive Sleep Apnea
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Abstract
Patients with obstructive sleep apnea (OSA) often have more aggravated symptoms in the supine position. We tried to investigate the clinical characteristics and the predictive factors for positional OSA. Polysomnographic data were reviewed for OSA patients (apnea hypopnea index, AHI≥5) from April, 2008 to April, 2011 at the Asan Medical Center. Clinical data, comorbid medical condition data and questionnaires (SF-36, MFI-20, ESS, BDI, STAI) were assessed. All patients were classified into two groups: positional patients (PP) group and non-positional patients (NPP) group. PP was defined as a patient who had the AHI in the supine position was at least twice as high as that in the lateral position. The body position of patients was confirmed by sleep position sensor and video monitor. All patients had at least 30 minutes of positional and 30 minutes of non-positional sleep. We compared clinical, medical, polysomnographic data, and questionnaire results between two (PP and NPP) groups and investigated predictive factors for the PP group using binary logistic regression analysis. In total, 371 patients were investigated. 265 (71.4%) was categorized as PP group and 106 (28.5%) as NPP group. The mean age (mean±SD) was higher in the PP group (52.4±9.8) than in the NPP group (49.5±11.9) (p<0.05). Comparison of sleep parameters between the PP and the NPP group showed that the PP group had significantly lower BMI (PP: 26.1±3.2 kg/m2; NPP: 27.8±4.3kg/m2, p<0.001), neck circumference (PP: 39.7±2.8 cm; NPP: 41.5±3.7 cm, p<0.001) and hypertension rate (PP: n=89/265 (33.5%); NPP: n=48/106 (45.2%), p=0.0240). In the PP group, the percentage of deep sleep (PP: 8.7±8.1%; NPP: 5.6±7.0%, P=0.001) and rapid eye movement (REM) (PP: 17.5±6.1%; NPP: 14.0±6.9%, p<0.001) were significantly higher whereas the percentage of light sleep (stage N1) was significantly lower than the NPP group (PP: 30.4±12.3; NPP: 44.5±20.8%, p<0.001). During the sleep, the AHI in the supine position (PP: 48.6±19.5; NPP: 60.5±22.6, p<0.001) and in the non-supine position (PP: 9.4±8.9; NPP: 48.4±24.8, p=<0.001) were significantly lower and the minimal arterial oxygen saturation in non-REM sleep was significantly higher in the PP group (PP: 80.3±7.6; NPP: 75.1±9.9, p=<0.001). There were no significant differences in all questionnaires including quality of life. The results of the binary logistic regression analysis showed that age, the amount of REM sleep(%) and AHI were significant predictive factors for positional OSA. The significant predictive factors for positional OSA were older age, higher percentage of REM and lower AHI. The questionnaire results were not significantly different between the two groups.
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