[Show abstract][Hide abstract] ABSTRACT: To evaluate the effect of body position on REM-related obstructive sleep apnea (OSA) patients.
100 consecutive adult OSA patients (apnea-hypopnea index [AHI] > or = 5) who had > or = 10 min of REM sleep in both supine and lateral postures. REM-related OSA was defined by previously used criteria (REM AHI/Non-REM (NREM) AHI > or = 2) and was compared with data from Not-REM-related OSA (REM AHI/NREM AHI < 2).
Most (93%) of the REM-related OSA patients (n = 45) had a mild-moderate syndrome, compared to 50.9% in the Not-REM-related OSA patients (n = 55). REM-related OSA patients had a lower apnea index (AL), AHI, supine and lateral AHI, and NREM AHI, but similar REM AHI compared to the Not-REM-related OSA group. For the entire group, the following sequence was observed: AHI REM supine > AHI NREM supine > AHI REM lateral > AHI NREM lateral. Also, for the REM-related and Not-REM-related OSA patients, the interaction between supine posture and REM sleep led to the highest AHI. However, the average length of apnea and hypopneas during REM sleep was similar in the supine and lateral postures.
During REM sleep, the supine position is associated with increased frequency but not increased duration of apneas and hypopneas. These body position effects prevail over the differences between REM-related and Not-REM-related OSA patients.
Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 08/2010; 6(4):343-8. · 2.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare demographic and polysomnographic data of sleepy versus nonsleepy severe obstructive sleep apnea (OSA) patients according to the Epworth Sleepiness Scale (ESS).
Six hundred forty-four consecutive severe (apnea-hypopnea index [AHI] >or= 30) adult OSA patients who underwent a polysomnographic evaluation in our sleep disorders unit. ESS data were available in 569 (88.3%). Three hundred twenty-seven (57.5%) patients had ESS > 10.
Sleepy severe OSA patients are slightly younger and more obese than nonsleepy patients. These sleepy patients have shorter sleep latency and lower percentage of slow wave sleep. They consistently show a higher AHI, both supine and lateral AHI, have a higher number of short arousals, and a higher arousal index. They also have higher snoring loudness in the supine and both lateral positions and a lower minimal SaO(2) in rapid eye movement and non-rapid eye movement sleep. After adjusting for confounders, a logistic regression model points to apnea index as a significant prognostic factor for excessive daytime sleepiness.
Severe OSA sleepy patients have a syndrome that is significantly more severe than nonsleepy patients. Sleepy patients have worse sleep-related breathing parameters, and their sleep patterns are lighter and more fragmented than nonsleepy patients. Apnea index appears as an important prognostic factor for excessive daytime sleepiness.
The Laryngoscope 11/2009; 120(3):643-8. · 1.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate demographic and polysomnographic characteristics of positional (PPJ) and non-positional obstructive (NPP) sleep apnea (OSA) patients in 2077 OSA patients diagnosed in our Sleep Disorders Unit during a period of 10 years. An OSA patient is defined as positional if he has twice as many or more breathing abnormalities (apnea and hypopneas) while he sleeps in his supine posture compared to the lateral ones. Of the 2077 OSA patients, 1118 (53.8%) were positional and 959 (46.2%) were non-positional. No age differences were found between these two groups of patients. However, NPP were heavier and thus had a higher BMI than PP. PP had fewer and Less severe breathing abnormalities during sleep compared to NPP and thus, they enjoyed better sleep quality expressed by higher percentages of stage 2, 4 and 3+4 as well as a lower amount of short arousals than NPP. Also, PP patients are less sleepy during daytime hours than NPP. During the Multiple Sleep Latency Test (MSLT), NPP fall asleep faster in every nap than PP patients. No differences between these two patient groups were found for any parameter of Periodic Limb Movement Disorders. AHI and BMI are independently but inversely related to positional dependency. As AHI and BMI increase, the Likelihood to be a positional patient decreases. NPP have breathing abnormalities in the supine and lateral postures, thus, for them without question, CPAP is the treatment of choice. Since avoiding the supine posture during sleep may significantly improve the sleep quality and daytime alertness of many positional patients, it is imperative to carry out a high-quality study to evaluate if this is a real therapeutic alternative for many positional patients.
[Show abstract][Hide abstract] ABSTRACT: Cheyne-Stokes Respiration (CSR) is a common finding in Chronic Heart Failure and Stroke patients. The body position effect during sleep on obstructive breathing abnormalities is well known. However, the effect of body position during sleep on breathing abnormalities of central type like CSR has not been well documented.
Six sleep studies (two complete Polysomnographic (PSG) evaluations and four Pulse Oximetry recordings (PO)), were carried out in a 57-year-old female patient with a recent Cerebro Vascular Accident (CVA who had both Obstructive Sleep Apnea (OSA) and CSR.
The first PSG was carried out two months post-stroke and revealed a severe, continuous CSR pattern during Non Rapid Eye Movements (NREM) sleep (mainly with central apneas), and Obstructive Sleep Apnea (OSA) during Rapid Eye Movements (REM) sleep, independent of body position: Supine Respiratory Disturbance Index (SRDI) = 85.2 and Lateral RDI (LRDI) = 95.4. A second PSG was performed three months later after an overall clinical improvement and showed a complete disappearance of CSR during NREM sleep and OSA during REM sleep in her lateral posture (LRDI = 0), while the RDI in the supine posture was only slightly improved (SRDI = 73.2). The CSR pattern was less severe and was characterized mainly by central hypopneas. Two PO recordings between the PSG studies showed similar improvement trends. Two additional PO recordings, two and three weeks after the last PSG (the first one with the patient lying supine and the second one with the patient lying on her side throughout the night), revealed a further significant improvement in the supine posture (SRDI = 37.5).
The results of this study suggest that body posture may play a role not only in the prevalence and severity of obstructive breathing disorders, but also in CSR, a central type of breathing abnormalities during sleep.
Medical science monitor: international medical journal of experimental and clinical research 08/2002; 8(7):CS61-5. · 1.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Rapid Eye Movement (REM) sleep behavior disorder is characterized by the intermittent loss of REM-related muscle atonia and the appearance of elaborated motor behaviors (sometimes violent behavior) and vocalizations associated with dream mentation. Nine patients were diagnosed in our Sleep Disorders Unit with this syndrome during the period August 1997-April 2000. All were male, average age 67.9 +/- 6.9 years. The complaint of all our patients was the occurrence of violent or injurious sleep behavior mainly during the dream stage. Jumping or falling out of bed and slapping or beating their wives were more common. None had history or showed signs of dementia, Parkinson or other neurodegenerative diseases. A relative high amount of SWS (20.9%) was found. Seven showed an intermittent increase in chin EMG tonus while the other two had an almost continuous high chin EMG tonus during REM sleep. We did not observe any violent motor behavior during the polysomnographic recordings. Phasic activities during REM sleep were high but density quantification was not performed. Six patients had also Periodic Limb Movement (PLM) Disorders, four had also Obstructive Sleep Apnea (OSA) Syndrome. The treatment recommended to all patients was Clonazepam beginning with a 0.5-mg dose. Four patients reported a decrease or disappearance of sleep agitation and nightmares and were very happy with the treatment and without side effects. The others decided not to try Clonazepam or stopped after a few days of using it. RBD appears to be a sleep disturbance affecting mainly aged men. Its violent expression may frighten the patients and their bed-partners and may cause injury to both. In some cases this sleep disorder seems to be an early manifestation of a neurodegenerative disorder while in others it may represent only an idiopathic form. Clonazepam at lower doses is a good agent for the treatment of this condition.
The Israel journal of psychiatry and related sciences 02/2002; 39(1):28-35. · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine whether sleep-related erections occur in vegetative state and if so, to investigate their relationship with rapid eye movement (REM) sleep.
Major rehabilitation hospital.
Nine male patients in vegetative state aged 17-40 years.
Continuous 24-hour polysomnographic recordings including penile circumferencial changes.
Sleep-related erection episodes (SREe's) were noted in all nine patients, ranging in number from 1-7/24 hr (average 4.4+2.4) and lasting 6 to 50 min (average 22.0+5.7 min). The number of REM periods (REMp's) ranged from 4-11 (average 6.6+2.5) and lasted for 1.0 to 44.0 min (average 16.0+6.6 min). Ninety-five percent of the SREe's recorded were associated with REMp's, usually (76.3%) appearing simultaneously with the REMp or soon thereafter; 64.6% of the REMp's were associated with SRE's. For both the nocturnal and diurnal periods, there were more REMp's with SREe's than without, and the REMp's associated with SREe's were of longer duration (by 25.5% and 28.4%, respectively). There were no statistically significant differences for any of the REMp or SREe parameters between the recovered and nonrecovered patients.
The sleep-related erection characteristics of patients in vegetative state are similar to those of normal individuals. These findings may have implications for the assessment of the reorganization of REM sleep during recovery from vegetative state and may further help in our understanding of the pathophysiology of vegetative state. More studies are needed in larger groups of patients.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the impact of sleep position on optimal nasal continuous positive airway pressure (nCPAP [op-nCPAP]) in obstructive sleep apnea (OSA) patients and to investigate how rapid eye movements (REM) and Non-REM (NREM) sleep, body mass index (BMI), respiratory disturbance index (RDI), and age are related to this effect.
Retrospective analysis. Setting: Sleep Disorders Unit at Loewenstein Hospital Rehabilitation Center.
Eighty-three consecutive adult OSA patients who underwent a complete nCPAP titration. From this group, 60 patients who spent at least 30 min in both the supine (Sup) and lateral (Lat) positions and 46 patients who had data on both positions during REM and NREM sleep were included in the analysis.
In most OSA patients (52; 86.7%), the recommended op-nCPAP was obtained when the patients slept in the Sup posture. The mean op-nCPAP was significantly higher in the Sup posture (10.00 +/- 2.20 cm H(2)O) than it was in the Lat posture (7.61 +/- 2.69 cm H(2)O). The op-nCPAP was significantly higher in the Sup position than it was in the Lat position in both REM and NREM sleep, as well as in the severe BMI group (BMI >/= 30) and in the less obese group (BMI < 30). Similarly, in the severe (RDI >/= 40) and less severe groups (RDI < 40), as well as in both age groups (< and > 60 years of age), the op-nCPAP was significantly higher in the Sup posture than it was in the Lat posture. Irrespective of the four parameters mentioned, the actual differences in op-nCPAP between the two body postures were almost identical, ranging between 2.31 and 2.66 cm H(2)O.
For most OSA patients, the op-nCPAP level is significantly higher in the Sup position than it is in the Lat position. This is true for REM and NREM sleep, for obese and nonobese patients, for patients with different degrees of severity, and for young and old OSA patients. Since the op-nCPAP was highest in the Sup posture during REM sleep, no nCPAP titration should be considered complete without the patient having slept in the Sup posture during REM sleep.
[Show abstract][Hide abstract] ABSTRACT: Obstructive sleep apnea (OSA), is a common clinical condition affecting at least 2-4% of the adult population. Hypertension is found in about half of all OSA patients, and about one-third of all patients with essential hypertension have OSA. There is growing evidence that successful treatment of OSA can reduce systemic blood pressure (BP). Body position appears to have an important influence on the incidence and severity of these sleep-related breathing disturbances. We have investigated the effect of avoiding the supine position during sleep for a 1 month period on systemic BP in 13 OSA patients (six hypertensives and seven normotensives) who by polysomnography (PSG) were found to have their sleep-related breathing disturbances mainly in the supine position. BP monitoring was performed by 24-h ambulatory BP measurements before and after a 1 month intervention period. We used a simple, inexpensive method for avoiding the supine posture during sleep, namely the tennis ball technique. Of the 13 patients, all had a reduction in 24-h mean BP (MBP). The mean 24-h systolic/diastolic (SBP/DBP) fell by 6.4/2.9 mm Hg, the mean awake SBP/DBP fell by 6.6/3.3 mm Hg and the mean sleeping SBP/DBP fell by 6.5/2.7 mm Hg, respectively. All these reductions were significant (at least P < 0.05) except for the sleeping DBP. The magnitude of the fall in SBP was significantly greater in the hypertensive than in the normotensive group for the 24 h period and for the awake hours. In addition, a significant reduction in BP variability and load were found. Since the majority of OSA patients have supine-related breathing abnormalities, and since about a third of all hypertensive patients have OSA, avoiding the supine position during sleep, if confirmed by future studies, could become a new non-pharmacological form of treatment for many hypertensive patients.
Journal of Human Hypertension 10/1997; 11(10):657-64. · 2.82 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare anthropomorphic, nocturnal polysomnographic (PSG), and multiple sleep latency test (MSLT) data between positional (PP) and nonpositional (NPP) obstructive sleep apnea (OSA) patients.
This is a retrospective analysis of anthropomorphic, PSG, and MSLT data of a large group of OSA patients who underwent a complete PSG evaluation in our sleep disorders unit. The patients were divided in two groups: the PP group, those patients who had a supine respiratory disturbance index (RDI) that was at least two times higher than the lateral RDI, and the NPP group, those patients in whom the RDI in the supine position was less than twice that in the lateral position.
From a group of 666 consecutive OSA patients whose conditions were diagnosed in our unit from September 1990 to February 1995, 574 patients met the following criteria and were included in the study: RDI > 10; age > 20 years, and body mass index (BMI) > 20.
Of all 574 patients, 55.9% were found to be positional. No differences in height were observed but weight and BMI were significantly higher in the NPP group, these patients being on the average 6.5 kg heavier than those in the PP group. The PP group was, on average, 2 years younger than the NPP group. Nocturnal sleep quality was better preserved in the PP group. In this group, sleep efficiency and the percentages of deep sleep (stages 3 and 4) were significantly higher while the percentages of light sleep (stages 1 and 2) were significantly lower than in the NPP group. No differences for rapid eye movement (REM) sleep were found. In addition, wakefulness after sleep onset and the number of short arousals (< 15 s) were significantly lower in the PP group. Apnea index and total RDI were significantly higher and the minimal arterial oxygen saturation in REM and non-REM sleep was significantly lower in the NPP. No differences in periodic limb movements data were found between the two groups. The average MSLT was significantly shorter in the NPP group. Univariate and multivariate stepwise logistic regression analysis showed that the most dominant variable that correlates with positional dependency in OSA patients is RDI, followed by BMI which also adds a significant contribution to the prediction of positional dependency. Age, although significant, adds only a minor improvement to the prediction of this positional dependency phenomenon. A severe, obese, and older OSA patient is significantly less likely to be positional than a mild-moderate, thin, and young OSA patient. In four obese OSA patients who lost weight, a much more pronounced reduction was seen in the lateral RDI than in the supine RDI, and three of these cases who were previously NPP became PP.
In a large population of OSA patients, most were found to have at least twice as many apneas/hypopneas in the supine than in the lateral position. These so-called "positional patients" are on the average thinner and younger than "nonpositional patients." They had fewer and less severe breathing abnormalities than the NPP group. Consequently their nocturnal sleep quality was better preserved and, according to MSLT data, they were less sleepy during daytime hours. RDI was the most dominant factor that could predict the positional dependency followed by BMI and age. RDI showed a threshold effect, the prevalence of PP in those with severe RDI (RDI > or = 40) was significantly lower than in those OSA patients with mild-moderate RDI. BMI showed a major significant inverse relationship with positional dependency, while age had only a minor although significant inverse relationship with it. Body position during sleep has a profound effect on the frequency and severity of breathing abnormalities in OSA patients.
[Show abstract][Hide abstract] ABSTRACT: Obstructive sleep apnea (OSA) occurs in about 10% of the middle-aged population but in about 30% of the hypertensive population of the same age. About 20% of the middle-aged population has hypertension but about 50% of patients with OSA have hypertension. Despite this close relationship between these two entities, previous attempts to determine whether the respiratory abnormalities in OSA were responsible for the hypertension were inconclusive, particularly because of the confounding effect of obesity which is common to both conditions. Data from recent observational and intervention studies, however, have succeeded in avoiding many of the pitfalls of earlier studies and it is now becoming evident that OSA may be a major cause of hypertension--responsible for about 30% of all cases. Successful treatment of OSA by any means has been shown in most studies to cause significant reductions in blood pressure throughout the 24 h period, while at the same time alleviating the vast array of symptoms and clinical abnormalities associated with this common and serious condition. Despite the encouraging results of these recent data, more studies are urgently required which should include larger numbers of patients and controls in order to clarify further the relationship between OSA and hypertension.
Israel journal of medical sciences 10/1995; 31(9):527-35.