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POSITIONAL OBSTRUCTIVE SLEEP APNEA: A DISTINCT PHENOTYPE?
Obstructive sleep apnea (OSA) is prevalent and a public health problem. Among the patients with this sleep disorder, there are those with positional obstructive sleep apnea(POSA), either predominantly or isolated in the supine position. The characteristics of this subgroup are not fully elucidated.
To verify if positional-isolated obstructive sleep apnea (iPOSA) and positional-predominant obstructive sleep apnea (pPOSA) patients have different polysomnographic (PSG) presentations and compare those with the PSG features of non-apneics and of non-positional OSA patients.
Retrospective, cross-sectional study of patients screened for OSA with full night in-lab PSG at our institution from april 2017 to april 2019. All sleep studies were scored by the same sleep physician. POSA was defined as a total apnea-hypopnea index (AHI) ≥5 and a ratio supine AHI/non-supine AHI ≥2. The subgroups of POSA were iPOSA (AHI non-supine<5) and pPOSA (AHI non-supine>5). We compared POSA with non-POSA subjects as well as iPOSA with pPOSA regarding age, sex, body mass index (BMI) and polysomnographic parameters.
In the non-apneic group we had 112 (21.87%) subjects (AHI<5). In the OSA group, 143 (51.07%) subjects were classified as POSA group and 137 (48.93%) as non-POSA group. The POSA group was once more splited in two other subgroups: 73 (51.05%) subjects with pPOSA and 70 (48.95%) with iPOSA. After comparing the collected data of all groups, we found that POSA is a less severe kind of this breathing disorder in comparison to non-POSA group as well as iPOSA is less severe than pPOSA mainly concerning to AHI and lower oxygen levels. We also found that subjects with supine related apnea are more likely to spend more time in deep wave sleep and to have lower BMI.
Our findings suggest that positional obstructive sleep apnea is a milder presentation of OSA and that the severity of this breathing disorder increases according to the following sequence: non-apneic, isOSA, psOSA and non-POSA.
Sleep Apnea; Supine Position; Polysomnography; Obstructive; Sleep.
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo - Brasil
Camila Bae Uneda, Larissa Souza Barreto, Cássio Batista Lacerda, Alexandre Akio Nakasato, Gilberto Guanaes Simões Formigoni, Michel Burihan Cahali