Sebastian Zaremba1, Noomi Mueller2, Anne M Heisig2, Christina H Shin2, Stefanie Jung3, Lisa R Leffert2, Brian T Bateman4, Lori J Pugsley5, Yasuko Nagasaka2, Ingrid Moreno Duarte2, Jeffrey L Ecker5, Matthias Eikermann6. 1. Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Sleep Medicine, Department of Neurology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-University, Bonn, Germany. 2. Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA. 3. Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Pediatric Surgery, DRK-Kinderklinik Siegen, Teaching Hospital of Philipps University, Marburg, Germany; Department of Pediatric Urology, DRK-Kinderklinik Siegen, Teaching Hospital of Philipps University, Marburg, Germany. 4. Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA. 5. Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA. 6. Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA; Department of Anesthesia and Critical Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany. Electronic address: meikermann@partners.org.
Abstract
BACKGROUND: During pregnancy, upper airway resistance is increased, predisposing vulnerable women to pregnancy-related OSA. Elevation of the upper body increases upper airway cross-sectional area (CSA) and improves severity of OSA in a subgroup of nonpregnant patients (positional-dependent sleep apnea). We tested the hypothesis that elevated position of the upper body improves OSA early after delivery. METHODS: Following institutional review board approval, we conducted a randomized, crossover study on two postpartum units of Massachusetts General Hospital. Women during the first 48 h after delivery were included. Polysomnography was performed in nonelevated and 45° elevated upper body position. Upper airway CSA was measured by acoustic pharyngometry in nonelevated, 45° elevated, and sitting body position. RESULTS:Fifty-five patients were enrolled, and measurements of airway CSA obtained. Thirty patients completed polysomnography in both body positions. Elevation of the upper body significantly reduced apnea-hypopnea index (AHI) from 7.7 ± 2.2/h in nonelevated to 4.5 ± 1.4/h in 45° elevated upper body position (P = .031) during sleep. Moderate to severe OSA (AHI > 15/h) was diagnosed in 20% of postpartum patients and successfully treated by elevated body position in one-half of them. Total sleep time and sleep architecture were not affected by upper body elevation. Change from nonelevated to sitting position increased inspiratory upper airway CSA from 1.35 ± 0.1 cm2 to 1.54 ± 0.1 cm2 during wakefulness. Position-dependent increase in CSA and decrease in AHI were correlated (r = 0.42, P = .022). CONCLUSIONS: Among early postpartum women, 45° upper body elevation increased upper airway CSA and mitigated sleep apnea. Elevated body position might improve respiratory safety in women early after delivery. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01719224; URL: www.clinicaltrials.gov.
RCT Entities:
BACKGROUND: During pregnancy, upper airway resistance is increased, predisposing vulnerable women to pregnancy-related OSA. Elevation of the upper body increases upper airway cross-sectional area (CSA) and improves severity of OSA in a subgroup of nonpregnant patients (positional-dependent sleep apnea). We tested the hypothesis that elevated position of the upper body improves OSA early after delivery. METHODS: Following institutional review board approval, we conducted a randomized, crossover study on two postpartum units of Massachusetts General Hospital. Women during the first 48 h after delivery were included. Polysomnography was performed in nonelevated and 45° elevated upper body position. Upper airway CSA was measured by acoustic pharyngometry in nonelevated, 45° elevated, and sitting body position. RESULTS: Fifty-five patients were enrolled, and measurements of airway CSA obtained. Thirty patients completed polysomnography in both body positions. Elevation of the upper body significantly reduced apnea-hypopnea index (AHI) from 7.7 ± 2.2/h in nonelevated to 4.5 ± 1.4/h in 45° elevated upper body position (P = .031) during sleep. Moderate to severe OSA (AHI > 15/h) was diagnosed in 20% of postpartum patients and successfully treated by elevated body position in one-half of them. Total sleep time and sleep architecture were not affected by upper body elevation. Change from nonelevated to sitting position increased inspiratory upper airway CSA from 1.35 ± 0.1 cm2 to 1.54 ± 0.1 cm2 during wakefulness. Position-dependent increase in CSA and decrease in AHI were correlated (r = 0.42, P = .022). CONCLUSIONS: Among early postpartum women, 45° upper body elevation increased upper airway CSA and mitigated sleep apnea. Elevated body position might improve respiratory safety in women early after delivery. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT01719224; URL: www.clinicaltrials.gov.
Authors: Sebastian Zaremba; Christina H Shin; Matthew M Hutter; Sanjana A Malviya; Stephanie D Grabitz; Teresa MacDonald; Daniel Diaz-Gil; Satya Krishna Ramachandran; Dean Hess; Atul Malhotra; Matthias Eikermann Journal: Anesthesiology Date: 2016-07 Impact factor: 7.892
Authors: Najib T Ayas; Cheryl R Laratta; John M Coleman; Anthony G Doufas; Matthias Eikermann; Peter C Gay; Daniel J Gottlieb; Indira Gurubhagavatula; David R Hillman; Roop Kaw; Atul Malhotra; Babak Mokhlesi; Timothy I Morgenthaler; Sairam Parthasarathy; Satya Krishna Ramachandran; Kingman P Strohl; Patrick J Strollo; Michael J Twery; Phyllis C Zee; Frances F Chung Journal: Ann Am Thorac Soc Date: 2018-02
Authors: Greta B Raglan; Galit Levi Dunietz; Louise M O'Brien; Katherine L Rosenblum; Maria Muzik; Leslie M Swanson Journal: Sleep Health Date: 2021-02-10
Authors: Christina H Shin; Sebastian Zaremba; Scott Devine; Milcho Nikolov; Tobias Kurth; Matthias Eikermann Journal: BMJ Open Date: 2016-01-13 Impact factor: 2.692