Prevalence of Positional Sleep Apnea in Patients Undergoing Polysomnography*

Mador, M Jeffery MD
Kufel, Thomas J. MD
Magalang, Ulysses J. MD
Rajesh, S K. MD
Watwe, Veena MD
Grant, Brydon J. B. MD

*From the Division of Pulmonary, Critical Care and Sleep Medicine, State University of New York at Buffalo and the Veterans Affairs Western New York Healthcare System, Buffalo, NY.

Manuscript received December 7, 2004; revision accepted April 25, 2005.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

Correspondence to: M. Jeffery Mador, MD, Associate Professor of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, Section 111S, State University of New York at Buffalo, Veterans Administration Medical Center, 3495 Bailey Ave, Buffalo, NY 14215; e-mail: [email protected]

Chest 128(4):p 2130-2137, October 2005.

Study objectives:

The primary aim of this study was to determine the prevalence of positional obstructive sleep apnea using a functional definition. Positional sleep apnea was defined as a total apnea-hypopnea index (AHI) ≥ 5 with a > 50% reduction in the AHI between the supine and nonsupine postures, and an AHI that normalizes (AHI < 5) in the nonsupine posture. A secondary aim was to determine if positional sleep apnea can be diagnosed accurately during a split-night study.

Design:

Retrospective chart review.

Setting:

Two sleep centers in Buffalo, NY, one a Veterans Affairs Western New York Healthcare System Sleep Center (VAWNY) and the other a freestanding ambulatory center (Associated Sleep Center [ASC]).

Patients:

Three hundred twenty-six patients from the VAWNY, including 57 patients who underwent a split-night study and 242 patients from the ASC who underwent polysomnography.

Interventions:

None.

Measurements:

Patient characteristics and sleep study results.

Results:

Positional sleep apnea was seen in 49 of 99 patients (49.5%) with mild sleep apnea (AHI, 5 to 15/h), 14 of 72 patients (19.4%) with moderate sleep apnea (AHI, 15 to 30/h), and 5 of 77 patients (6.5%) with severe sleep apnea (AHI > 30/h). Sufficient sleep (> 15 min) in both postures was not seen in 104 of 269 patients (38.7%) and 80 of 242 overnight studies (33.1%) at the VAWNY and ASC, respectively, and was not seen in 47 of 57 split-night studies (82.5%). The percentage of studies with insufficient sleep in both postures was significantly greater for split-night studies (p < 0.0001).

Conclusions:

Positional sleep apnea is common particularly in patients with mild disease. Positional sleep apnea cannot usually be assessed during a split-night study.

Abbreviations: AHI = apnea-hypopnea index; ASC = Associated Sleep Center; BMI = body mass index; CI = confidence interval; CPAP = continuous positive airway pressure; OSA = obstructive sleep apnea; REM = rapid eye movement; VAWNY = Veterans Affairs Western New York Healthcare System Sleep Center