Association of body position with severity of apneic events in patients with severe nonpositional obstructive sleep apnea

Study objective: To compare the severity of sleep apneic events occurring in the supine posture vs the severity of sleep apneic events occurring in the lateral posture in patients with severe obstructive sleep apnea (OSA). Design: A retrospective analysis of apneic event variables in a group of 30 OSA patients who underwent a complete polysomnographic evaluation in our sleep disorders unit. Patients: Thirty patients with severe OSA (respiratory disturbance index [RDI] = 70.1 ± 18.2) who were nonpositional patients (NPP), ie, in whom the ratio of the supine RDI to the lateral RDI is < 2 (supine RDI = 85.7 ± 11.7, lateral RDI = 64.8 ± 17.3), and who had ≥ 30 apneic events in the lateral position and 30 apneic events in the supine position during sleep stage 2 were included in the study. Measurements: For the 30 apneic events in each body position, the following variables were evaluated: apnea duration (ApDur), minimum desaturation (MinDes), Δ desaturation (Δ-Des), duration of arousal (DurArous), maximum snoring loudness (MaxSL), and Δ heart rate (Δ-HR). In addition, three other variables assessed as a ratio of ApDur (Rate-D = Δ-Des/ApDur, R-HR = Δ-HR/ApDur, and R-Arous = DurArous/ApDur) were also calculated. Results: For all variables evaluated, apneic events occurring in the supine posture were significantly more severe than those apneic events occurring in the lateral posture during sleep stage 2. ApDur of both body postures correlated significantly with DurArous, Δ-HR, and MaxSL, but not with Δ-Des and MinDes. ApDur correlated linearly with DurArous for both postures. The slopes of the two regression lines were similar (p = 0.578) but the regression line intercept for the supine apneas was significantly higher than that of lateral apneas (p < 0.0001). In addition, the average number of supine apneic events that did not end with an arousal was smaller than the average number of lateral apneic events not ending with an arousal (4.4 ± 8.0 vs 10.5 ± 6.7, respectively; p < 0.0001). Also, only 4 of 900 (0.44%) apneic events analyzed in the lateral posture ended with an awakening (> 15 s), whereas in the supine posture, there were 37 (4.1%) such events (p < 0.001). Conclusions: These results show that even in patients with severe OSA who have a high number of apneic events in the supine and lateral posture, the apneic events occurring in the supine position are more severe than those occurring while sleeping in the lateral position. Thus, it is hot only the number of apneic events that worsen in the supine sleep position but, probably no less important, the nature of the apneic events themselves.