Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2023, Vol. 37 ›› Issue (6): 101-105.doi: 10.6040/j.issn.1673-3770.0.2023.173

• Clinical Study • Previous Articles     Next Articles

Clinical characteristics of patients with positional obstructive sleep apnea and their correlations with low arousal threshold

WANG Yuyu, ZHU Mei   

  1. Department of Otorhinolaryngology & Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
  • Published:2023-12-15

Abstract: Objective To evaluate the clinical features and arousal threshold of patients with positional and non-positional obstructive sleep apnea. Methods All patients who underwent polysomnography(PSG)were enrolled, their demographic and polysomnographic data were collected, and arousal thresholds were calculated. These data were compared between the positional obstructive sleep apnea(POSA)and non-positional obstructive sleep apnea(NPOSA)groups. Results Among all the 322 patients with OSA, the prevalence of POSA was 48.8%. Patients with POSA had lower BMI, AHI and CT90(26.3 vs. 27.2, P=0.02; 23.2 vs. 56.2, P<0.001; 1.8 vs. 4.9, P=0.044), as well as higher lowest and average oxygen saturation(82.0 vs. 79.0, P=0.038; 95.0 vs. 94.1, P=0.019)compared to patients with NPOSA. Furthermore, a higher percentage of patients with POSA had a low arousal threshold compared to patients with NPOSA(29.3% vs. 8.5%, P<0.001). Conclusion POSA was associated with lower BMI and AHI. Low arousal threshold may play a role in the development of positional OSA.

Key words: Obstructive sleep apnea, Positional OSA, Clinical features, Arousal, Affect factor

CLC Number: 

  • R766
[1] Lee JJ, Sundar KM. Evaluation and management of adults with obstructive sleep apnea syndrome[J].Lung, 2021, 199(2): 87-101. doi:10.1007/s00408-021-00426-w
[2] Senaratna CV, Perret JL, Lodge CJ, et al. Prevalence of obstructive sleep apnea in the general population: a systematic review[J]. Sleep Med Rev, 2017, 34: 70-81. doi:10.1016/j.smrv.2016.07.002
[3] Joosten SA, O'Driscoll DM, Berger PJ, et al. Supine position related obstructive sleep apnea in adults: Pathogenesis and treatment[J]. Sleep Med Rev, 2014, 18(1): 7-17. doi:10.1016/j.smrv.2013.01.005
[4] Cartwright RD. Effect of sleep position on sleep apnea severity[J]. Sleep, 1984, 7(2): 110-114. doi:10.1093/sleep/7.2.110
[5] Frank MH, Ravesloot MJL, van Maanen JP, et al. Positional OSA part 1: towards a clinical classification system for position-dependent obstructive sleep apnoea[J]. Sleep Breath, 2015, 19(2): 473-480. doi:10.1007/s11325-014-1022-9
[6] Oksenberg A, Gadoth N, Töyräs J, et al. Prevalence and characteristics of positional obstructive sleep apnea(POSA)in patients with severe OSA[J].Sleep Breath, 2020, 24(2): 551-559. doi:10.1007/s11325-019-01897-1
[7] Heinzer R, Petitpierre NJ, Marti-Soler H, et al. Prevalence and characteristics of positional sleep apnea in the HypnoLaus population-based cohort[J]. Sleep Med, 2018, 48: 157-162. doi:10.1016/j.sleep.2018.02.011
[8] Garg H, ER XIN yi, Howarth T, et al. Positional sleep apnea among regional and remote Australian population and simulated positional treatment effects[J]. Nat Sci Sleep, 2020, 12: 1123-1135. doi:10.2147/nss.s286403
[9] Sabil A, Blanchard M, Trzepizur W, et al. Positional obstructive sleep apnea within a large multicenter French cohort: prevalence, characteristics, and treatment outcomes[J]. J Clin Sleep Med, 2020, 16(12): 2037-2046. doi:10.5664/jcsm.8752
[10] 李丹阳, 梁辉. 口面肌功能治疗对阻塞性睡眠呼吸暂停研究进展[J]. 山东大学耳鼻喉眼学报, 2021, 35(4): 108-114. doi: 10.6040/j.issn.1673-3770.0.2020.286 LI Danyang, LIANG Hui. Advancements in orofacial myofunctional therapy for obstructive sleep apnea[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(4): 108-114. doi: 10.6040/j.issn.1673-3770.0.2020.286
[11] Yingjuan M, Siang WH, Leong Alvin TK, et al. Positional therapy for positional obstructive sleep apnea[J]. Sleep Med Clin, 2020, 15(2): 261-275. doi:10.1016/j.jsmc.2020.02.012
[12] 陈坤, 冯晶, 徐云霞, 等. 体位性睡眠呼吸暂停患者临床与多导睡眠图特征分析[J]. 中风与神经疾病杂志, 2022, 39(3): 196-201. doi: 10.19845/j.cnki.zfysjjbzz.2022.0051 CHEN Kun, FENG Jing, XU Yunxia, et al. Clinical and polysomnogram characteristics of postural sleep apnea patients[J]. Journal of Apoplexy and Nervous Diseases, 2022, 39(3): 196-201. doi: 10.19845/j.cnki.zfysjjbzz.2022.0051
[13] Huang W, Wang X, Xu C, et al. Prevalence, characteristics, and respiratory arousal threshold of positional obstructive sleep apnea in China: a large scale study from Shanghai Sleep Health Study cohort[J]. Respir Res, 2022, 23(1): 240. doi: 10.1186/s12931-022-02141-3
[14] Edwards BA, Eckert DJ, McSharry DG, et al. Clinical predictors of the respiratory arousal threshold in patients with obstructive sleep apnea[J]. Am J Respir Crit Care Med, 2014, 190(11): 1293-1300. doi:10.1164/rccm.201404-0718oc
[15] Wang XN, Luo JM, Huang R, et al. Preliminary study on clinical characteristics of Chinese patients with positional obstructive sleep apnea[J].Sleep Breath, 2022, 26(1): 67-74. doi:10.1007/s11325-021-02346-8
[16] 韩莹莹, 李延忠. 阻塞性睡眠呼吸暂停低通气综合征与亚临床动脉粥样硬化[J]. 山东大学耳鼻喉眼学报, 2022, 36(2): 126-132. doi: 10.6040/j.issn.1673-3770.0.2022.011 HAN Yingying, LI Yanzhong. Obstructive sleep apnea hypopnea syndrome and subclinical arteriosclerosis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(2): 126-132. doi: 10.6040/j.issn.1673-3770.0.2022.011
[17] 杨晰珺, 关建, 吴海莺. 阻塞性睡眠呼吸暂停低通气综合征与血脂紊乱关系的研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(2): 133-138. doi: 10.6040/j.issn.1673-3770.0.2021.078 YANG Xijun, GUAN Jian,WU Haiying. Research progress on the relationship between obstructive sleep apnea-hypopnea syndrome and dyslipidemia[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(2): 133-138. doi: 10.6040/j.issn.1673-3770.0.2021.078
[18] Carberry JC, Jordan AS, White DP, et al. Upper airway collapsibility(pcrit)and pharyngeal dilator muscle activity are sleep stage dependent[J]. Sleep, 2016, 39(3): 511-521. doi:10.5665/sleep.5516
[19] Malhotra A, Trinder J, Fogel R, et al. Postural effects on pharyngeal protective reflex mechanisms[J]. Sleep, 2004, 27(6): 1105-1112. doi:10.1093/sleep/27.6.1105
[20] Joosten SA, Landry SA, Sands SA, et al. Dynamic loop gain increases upon adopting the supine body position during sleep in patients with obstructive sleep apnoea[J]. Respirology, 2017, 22(8): 1662-1669. doi:10.1111/resp.13108
[21] Ong JSL, Touyz G, Tanner S, et al. Variability of human upper airway collapsibility during sleep and the influence of body posture and sleep stage[J]. J Sleep Res, 2011, 20(4): 533-537. doi:10.1111/j.1365-2869.2011.00925.x
[22] Oksenberg A, Goizman V, Eitan E, et al. Obstructive sleep apnea: do positional patients become nonpositional patients with time?[J]. Laryngoscope, 2020, 130(9): 2263-2268. doi:10.1002/lary.28387
[23] 李卓君, 宋西成, 陈秀梅. 阻塞性睡眠呼吸暂停低通气综合征患者的肺功能变化分析[J]. 山东大学耳鼻喉眼学报, 2023, 37(2): 45-50. doi:10.6040/j.issn.1673-3770.0.2022.043 LI Zhuojun, SONG Xicheng, CHEN Xiumei. Analysis of pulmonary function changes in patients with obstructive sleep apnea hypopnea syndrome[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(2): 45-50. doi:10.6040/j.issn.1673-3770.0.2022.043
[24] 杜剑霞, 王彦, 曹洁, 等. 阻塞性睡眠呼吸暂停低通气综合征觉醒机制的研究进展[J]. 中华结核和呼吸杂志, 2019, 42(8): 604-608. doi: 10.3760/cma.j.issn.1001-0939.2019.08.009 DU Jianxia, WANG Yan, CAO Jie, et al. The mechanism of arousal in patients with obstructive sleep apnea-hypopnea syndrome[J]. Chinese Journal of Tuberculosis and Respiratory Diseases, 2019, 42(8): 604-608. doi: 10.3760/cma.j.issn.1001-0939.2019.08.009
[25] Wu H, Fang F, Wu C, et al. Low arousal threshold is associated with unfavorable shift of PAP compliance over time in patients withOSA[J].Sleep Breath, 2021, 25(2): 887-895. doi:10.1007/s11325-020-02197-9
[26] Smales ET, Edwards BA, Deyoung PN, et al. Trazodone effects on obstructive sleep apnea and non-REM arousal threshold[J]. Ann Am Thorac Soc, 2015, 12(5): 758-764. doi:10.1513/AnnalsATS.201408-399OC
[1] REN Xiaoyong. Current status and future perspectives of research on obstructive sleep apnea comorbidities [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 1-5.
[2] HU Tingting, WANG Yuehua. Advances in research on the relationship between obstructive sleep apnea and breast cancer [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 41-45.
[3] ZHU Yaxin,LIU Feng,GUAN Jian,YIN Shankai. Advances in the changes of lymphocytes in pediatric adenoid and tonsil hypertrophy [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 62-67.
[4] WANG Lu, ZHANG Yunyun, GUO Hua, CUI Xiaochuan. Application value of lipid metabolism markers for the early screening of Alzheimer's disease in obstructive sleep apnea patients [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 68-74.
[5] WANG Lei, LI Baowei, WANG Gang, LIU Hongdan, HAN Haolun, ZHANG Xiaoli, WU Wei. A preliminary study on nocturnal alkali reflux in OSAHS patients [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 75-79.
[6] WANG Teng, YU Lin, LI Sui. The correlation between γ-glutamyl transferase and obstructive sleep apnea syndrome-related hypertension [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 80-84.
[7] YUAN Yuqi, CAO Zine, NIU Xiaoxin, XIE Yushan, SU Yonglong, ZHU Simin, ZHANG Yitong, LIU Haiqin, REN Xiaoyong, SHI Yewen. Clinical significance of peripheral blood inflammatory markers in obstructive sleep apnea hypopnea syndrome with hypertension [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 85-92.
[8] XING Liang, YUAN Yuqi, XIE Yushan, SU Yonglong, NIU Xiaoxin, MA Lina, WANG Zitong, LIU Haiqin, SHI Yewen, REN Xiaoyong. Metabolic markers in obstruetive sleep apnea hypopnea syndrome patients with different arousal thresholds [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 106-111.
[9] ZHANG Yuhuan, ZHANG Junbo, YIN Guoping, YUAN Xuemei, CAO Xin, SUN Yu, CHEN Qiang, YE Jingying. Comparative analysis of polysomnography parameters between the first and second halves of the night in snoring patients [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 112-117.
[10] ZHANG Yitong, LI Qingxiang, SHI Zhenghao, SHANG Lei, YUAN Yuqi, CAO Zine, MA Lina, LIU Haiqin, REN Xiaoyong, SHI Yewen. The sleep structure of Children with obstructive sleep apnea and the development of a sleep structure interpretation model [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 126-132.
[11] ZONG Chunlin, LU Jinbiao, YANG Yong, SU Zhongping, YU Bo. Application study of the MDT module combined with a flipped classroom in clinical teaching of pediatric OSA [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 139-144.
[12] DING Longqing, LIU Yiming, CHENG Zhuo, SUN Ran, LIANG Hui. Observation on the therapeutic effect of oropharyngeal exercise on adult obstructive sleep apnea hypopnea syndrome [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(6): 153-158.
[13] CHEN Shangli, QIN Tao, CHEN Xuan, CHEN Ruojin, TANG Zhi. Association between homocysteine concentration and the MTHFR C677T polymorphism and hypertension in patients with obstructive sleep apnea hypopnea syndrome [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(4): 126-133.
[14] LI Zhuojun, SONG Xicheng, CHEN Xiumei. Analysis of pulmonary function changes in patients with obstructive sleep apnea hypopnea syndrome [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(2): 45-50.
[15] WANG Nan, HUANG Jing, PEN Tao, FENG Bo. Current research on the relationship between obstructive sleep apnea hypopnea syndrome and tinnitus [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(2): 122-127.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] HE Shou-huan,CHEN Bin,YIN Shan-kai,SU Kai-ming,JIANG Xiao . Morphological changes of the upper airway in OSAHS patients with UPPP
[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(5): 385 -388 .
[2] SONG Xi-cheng,ZHANG Qing-quan,XIA Yong-hong,LIU Lu-yi, YU Lu-xin,WANG Gao,JIANG Xiu-liang . Post-operative ICU monitoring and nursing for patients with OSAHS[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(5): 389 -392 .
[3] XUE Wei-guo,SUN Jie,JIN Zheng,SHI Wen-bin,XIN Lu,LIN Guo-Jing,LI Jia-yun . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2006, 20(4): 300 -303 .
[4] ZHANG Qing-quan,LI Xin-min,WANG Qiang,WANG Yong-fu . Some experience of the endoscopy treatment of maxillary sinus lesion with the canine tooth fossa approach[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2007, 21(1): 38 -39 .
[5] DONG Pin,LI Xiao-yan,TU Li-qiang,MENG Qing-hong,WANG Sang,XIE Jin,JIANG Yan . Reconstruction for advanced hypopharyngeal carcinoma and laryngeal recurrent carcinoma[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2007, 21(5): 385 -387 .
[6] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2008, 22(1): 74 -77 .
[7] LEIXun, LIU Qianghe, KONG Zhongyu, XIANG Qiu, GENG WANping, HUANG Hui, DONG Yiyuan, LIU Fangxian. ARelationship between expression of Survivin and radiosensitization effect of EGCG in xenotransplanted nasopharyngeal carcinoma[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2009, 23(1): 6 -9 .
[8] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2009, 23(2): 73 -74 .
[9] . [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2010, 24(01): 29 -33 .
[10] KE Zhaoyang, GONG Taogen, YANG Mingbao. Application of Otorhinlaryngology,The Second Clinical College of Jinan University,Shenzhen People's Hospital,Shenzhen 518020,Guangdong,China[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2010, 24(2): 21 -23 .