Influence of Sleep Stage on the Determination of Positional Dependency in Patients With Obstructive Sleep Apnea
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Objectives. The supine sleep position and the rapid eye movement (REM) stage are widely recognized to exacerbate the se- verity of obstructive sleep apnea (OSA). Position-dependent OSA is generally characterized by an apnea-hypopnea index (AHI) that is at least twice as high in the supine position compared to other sleep positions. However, this con- dition can be misdiagnosed if a particular sleep stage—REM or non-REM (NREM)—predominates in a specific posi- tion. We explored the impact of the sleep stage on positional dependency in OSA. Methods. Polysomnographic data were retrospectively analyzed from 111 patients with OSA aged 18 years or older, all of whom had an AHI exceeding five events per hour and slept in both supine and non-supine positions for at least 5% of the total sleep time. The overall ratio of non-supine AHI to supine AHI (NS/S-AHI ratio) was compared between total, REM, and NREM sleep. Additionally, a weighted NS/S-AHI ratio, reflecting the proportion of time spent in each sleep stage, was calculated and compared to the original ratio. Results. The mean NS/S-AHI ratio was consistent between the entire sleep period and the specific sleep stages. However, the NS/S-AHI ratios for individual patients displayed poor agreement between total sleep and the specific stages. Ad- ditionally, the weighted NS/S-AHI ratio displayed poor agreement with the original NS/S-AHI ratio, primarily due to discrepancies in patients with mild to moderate OSA. Conclusion. The weighted NS/S-AHI ratio may help precisely assess positional dependency.
Abstract
Objectives. The supine sleep position and the rapid eye movement (REM) stage are widely recognized to exacerbate the se- verity of obstructive sleep apnea (OSA). Position-dependent OSA is generally characterized by an apnea-hypopnea index (AHI) that is at least twice as high in the supine position compared to other sleep positions. However, this con- dition can be misdiagnosed if a particular sleep stage—REM or non-REM (NREM)—predominates in a specific posi- tion. We explored the impact of the sleep stage on positional dependency in OSA. Methods. Polysomnographic data were retrospectively analyzed from 111 patients with OSA aged 18 years or older, all of whom had an AHI exceeding five events per hour and slept in both supine and non-supine positions for at least 5% of the total sleep time. The overall ratio of non-supine AHI to supine AHI (NS/S-AHI ratio) was compared between total, REM, and NREM sleep. Additionally, a weighted NS/S-AHI ratio, reflecting the proportion of time spent in each sleep stage, was calculated and compared to the original ratio. Results. The mean NS/S-AHI ratio was consistent between the entire sleep period and the specific sleep stages. However, the NS/S-AHI ratios for individual patients displayed poor agreement between total sleep and the specific stages. Ad- ditionally, the weighted NS/S-AHI ratio displayed poor agreement with the original NS/S-AHI ratio, primarily due to discrepancies in patients with mild to moderate OSA. Conclusion. The weighted NS/S-AHI ratio may help precisely assess positional dependency.
참고문헌 (26)
- Nair SC, "Proportion of rapid eye movement sleep related obstructive sleep apnea(REM related OSA)in patients with sleep disordered breathing : a cross sectional study", Lung India, 39(1), pp.38~43 (2022)
- American Academy of Sleep Medicine, "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, 22(5), pp.667~689 (1999)
- Kapur VK, "Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea : an American Academy of Sleep Medicine Clinical Practice Guideline", J Clin Sleep Med, 13(3), pp.479~504 (2017)
- Young T, "Risk factors for obstructive sleep apnea in adults", JAMA, 291(16), pp.2013~2016 (2004)
- Uzer F, "Comparison of positional and rapid eye movement-dependent sleep apnea syndromes", Ann Thorac Med, 13(1), pp.42~47 (2018)
- Steffen A, "Supine position and REM dependence in obstructive sleep apnea : critical model considerations", HNO, 65(Suppl 1), pp.52~58 (2017)
- Cartwright RD, "Effect of sleep position on sleep apnea severity", Sleep, 7(2), pp.110~114 (1984)
- Lee SC, "Does REM sleep-dependent obstructive sleep apnea have clinical significance?", Int J Environ Res Public Health, 19(21), pp.14147~ (2022)
- Berry RB, "Rules for scoring respiratory events in sleep : update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine", J Clin Sleep Med, 8(5), pp.597~619 (2012)
- Mador MJ, "Prevalence of positional sleep apnea in patients undergoing polysomnography", Chest, 128(4), pp.2130~2137 (2005)
- Lee CH, "Effect of uvulopalatopharyngoplasty on positional dependency in obstructive sleep apnea", Arch Otolaryngol Head Neck Surg, 137(7), pp.675~679 (2011)
- Kakkar RK, "Positive airway pressure treatment for obstructive sleep apnea", Chest, 132(3), pp.1057~1072 (2007)
- Chang JL, "International Consensus Statement on Obstructive Sleep Apnea", Int Forum Allergy Rhinol, 13(7), pp.1061~1482 (2023)
- Nelson B, "A more expansive approach to obstructive sleep apnea : multiple studies have linked poor sleep to cancer and other negative health outcomes; in part 2 of a 2-part series, we explore how sleep apnea diagnostics and interventions have expanded to include more patients and new treatment options. : multiple studies have linked poor sleep to cancer and other negative health outcomes; in part 2 of a 2-part series, we explore how sleep apnea diagnostics and interventions have expanded to include more patients and new treatment options", Cancer Cytopathol, 130(3), pp.168~169 (2022)
- ALQarni AS, "Efficacy of vibrotactile positional therapy devices on patients with positional obstructive sleep apnoea : a systematic review and meta-analysis", Thorax, 78(11), pp.1126~1134 (2023)
- Liu Y, "NREM-AHI greater than REM-AHI versus REM-AHI greater than NREM-AHI in patients with obstructive sleep apnea : clinical and polysomnographic features", Sleep Breath, 15(3), pp.463~470 (2011)
- Lee SA, "Clinical features in patients with positional obstructive sleep apnea according to its subtypes", Sleep Breath, 21(1), pp.109~117 (2017)
- Marklund M, "Treatment success with a mandibular advancement device is related to supine-dependent sleep apnea", Chest, 114(6), pp.1630~1635 (1998)
- Iannella G, "Positional obstructive sleep apnea syndrome in elderly patients", Int J Environ Res Public Health, 17(3), pp.1120~ (2020)
- Dieltjens M, "Prevalence and clinical significance of supine-dependent obstructive sleep apnea in patients using oral appliance therapy", J Clin Sleep Med, 10(9), pp.959~964 (2014)
- Ahn HK, "Analysing the impact of body position shift on sleep architecture and stage transition : a comprehensive multidimensional study using event-synchronised polysomnography data", J Sleep Res (2023)[DOI]
- Rey M, "Relation between polysomnographic parameters and apnea index in obstructive sleep apnea syndrome", Respiration, 61(1), pp.14~18 (1994)
- Bignold JJ, "Accurate position monitoring and improved supine-dependent obstructive sleep apnea with a new position recording and supine avoidance device", J Clin Sleep Med, 7(4), pp.376~383 (2011)
- Frank MH, "Positional OSA part 1 : towards a clinical classification system for position-dependent obstructive sleep apnoea", Sleep Breath, 19(2), pp.473~480 (2015)
- Sunwoo WS, "Association between positional dependency and obstruction site in obstructive sleep apnea syndrome", Clin Exp Otorhinolaryngol, 5(4), pp.218~221 (2012)
- Tschopp S, "Night-to-night variability in obstructive sleep apnea using peripheral arterial tonometry : a case for multiple night testing", J Clin Sleep Med, 17(9), pp.1751~1758 (2021)