Kaiyin Zhu1,2, T Douglas Bradley2,3, Maryam Patel2, Hisham Alshaer4,5,6. 1. Biomedical Engineering, Division of Engineering Science, University of Toronto, Toronto, ON, Canada. 2. Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada. 3. The Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, ON, Canada. 4. Sleep Research Laboratory, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada. Hisham.Alshaer@uhn.ca. 5. Home, Community and Institutional Environments Team, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada. Hisham.Alshaer@uhn.ca. 6. , Room Number 12-108. 550 University Ave, Toronto, ON, M5G 2A2, Canada. Hisham.Alshaer@uhn.ca.
Abstract
OBJECTIVE: Supine body orientation plays an important role in precipitating upper airway collapse in a significant proportion of obstructive sleep apnea (OSA) patients known to have supine-predominant OSA (OSAsup). Traditionally, trunk position is used to assess OSAsup, but the role of the head position has not been established. We hypothesized that head position influences OSA independently of trunk position. METHODS: Head and trunk positions were determined from subjects undergoing overnight polysomnography. The apnea-hypopnea index (AHI), rapid eye movement (REM), and non-REM sleep time of all trunk and head positions (lateral and supine) were calculated and compared against the complete supine position, i.e., head and trunk supine. RESULTS: In 26 subjects, lateral rotation of the head to the right or left with the trunk supine resulted in a significant reduction in AHI from 36.0 ± 22.5 to 25.8 ± 16.6 (p = 0.008), and an AHI drop <10 in 27% of patients. The "trunk lateral-head lateral" position resulted in a more dramatic reduction in AHI from 31.6 ± 20.2 to 4.1 ± 4.1 (p < 0.0001). The distributions of REM and non-REM sleep were not different among positions. In the subgroup with a body mass index (BMI) <32 kg/m2 (15 subjects), the AHI reduction with lateral head rotation was significant (p = 0.005) but not in remaining 11 obese patient with a BMI ≥32 kg/m2 (p = 0.24). CONCLUSION: OSA severity with the trunk in the supine position decreased significantly when the head rotated from supine to lateral, particularly in non-obese patients. These results demonstrate an important influence of head position on the AHI, independently of trunk position and sleep stage, in patients with OSA.
OBJECTIVE: Supine body orientation plays an important role in precipitating upper airway collapse in a significant proportion of obstructive sleep apnea (OSA) patients known to have supine-predominant OSA (OSAsup). Traditionally, trunk position is used to assess OSAsup, but the role of the head position has not been established. We hypothesized that head position influences OSA independently of trunk position. METHODS: Head and trunk positions were determined from subjects undergoing overnight polysomnography. The apnea-hypopnea index (AHI), rapid eye movement (REM), and non-REM sleep time of all trunk and head positions (lateral and supine) were calculated and compared against the complete supine position, i.e., head and trunk supine. RESULTS: In 26 subjects, lateral rotation of the head to the right or left with the trunk supine resulted in a significant reduction in AHI from 36.0 ± 22.5 to 25.8 ± 16.6 (p = 0.008), and an AHI drop <10 in 27% of patients. The "trunk lateral-head lateral" position resulted in a more dramatic reduction in AHI from 31.6 ± 20.2 to 4.1 ± 4.1 (p < 0.0001). The distributions of REM and non-REM sleep were not different among positions. In the subgroup with a body mass index (BMI) <32 kg/m2 (15 subjects), the AHI reduction with lateral head rotation was significant (p = 0.005) but not in remaining 11 obesepatient with a BMI ≥32 kg/m2 (p = 0.24). CONCLUSION: OSA severity with the trunk in the supine position decreased significantly when the head rotated from supine to lateral, particularly in non-obesepatients. These results demonstrate an important influence of head position on the AHI, independently of trunk position and sleep stage, in patients with OSA.
Authors: T Hori; Y Sugita; E Koga; S Shirakawa; K Inoue; S Uchida; H Kuwahara; M Kousaka; T Kobayashi; Y Tsuji; M Terashima; K Fukuda; N Fukuda Journal: Psychiatry Clin Neurosci Date: 2001-06 Impact factor: 5.188
Authors: Jennifer H Walsh; Matthew S Leigh; Alexandre Paduch; Kathleen J Maddison; Julian J Armstrong; David D Sampson; David R Hillman; Peter R Eastwood Journal: Sleep Date: 2008-11 Impact factor: 5.849
Authors: Luca Cerritelli; Alberto Caranti; Andrea Migliorelli; Giulia Bianchi; Luigi Marco Stringa; Anna Bonsembiante; Giovanni Cammaroto; Stefano Pelucchi; Claudio Vicini Journal: Sleep Breath Date: 2022-02-07 Impact factor: 2.816
Authors: Shaun W Yo; Simon A Joosten; Hari Wimaleswaran; Darren Mansfield; Luke Thomson; Shane A Landry; Bradley A Edwards; Garun S Hamilton Journal: J Clin Sleep Med Date: 2022-09-01 Impact factor: 4.324
Authors: Dominik Linz; Mathias Baumert; Lien Desteghe; Kadhim Kadhim; Kevin Vernooy; Jonathan M Kalman; Dobromir Dobrev; Michael Arzt; Manu Sastry; Harry J G M Crijns; Ulrich Schotten; Martin R Cowie; R Doug McEvoy; Hein Heidbuchel; Jeroen Hendriks; Prashanthan Sanders; Dennis H Lau Journal: Int J Cardiol Heart Vasc Date: 2019-10-18
Authors: Luca Cerritelli; Luigi Marco Stringa; Giulia Bianchi; Henry Zhang; Giovanni Cammaroto; Claudio Vicini; Stefano Pelucchi; Andrea Marco Minetti Journal: Acta Otorhinolaryngol Ital Date: 2021-12 Impact factor: 2.124