M J L Ravesloot1, P E Vonk2, J T Maurer3, A Oksenberg4, N de Vries5,6,7. 1. Department of Otorhinolaryngology - Head and Neck surgery, OLVG, location West, Jan Tooropstraat 164, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands. m.j.l.ravesloot@olvg.nl. 2. Department of Otorhinolaryngology - Head and Neck surgery, Amsterdam UMC, location AMC, Amsterdam, the Netherlands. 3. Department of Otorhinolaryngology, Head and Neck Surgery, Sleep Disorders Center, University Hospital Mannheim, Mannheim, Germany. 4. Sleep Disorders Unit, Loewenstein Hospital-Rehabilitation Center, Raanana, Israel. 5. Department of Otorhinolaryngology - Head and Neck surgery, OLVG, location West, Jan Tooropstraat 164, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands. 6. Department of Oral Kinesiology, ACTA, MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands. 7. Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium.
Abstract
PURPOSE: Sleep apnea is a multifactorial illness which can be differentiated in various physiological phenotypes as a result of both anatomical and non-anatomical contributors (e.g., low respiratory arousal threshold, high loop gain). In addition, the frequency and duration of apneas, in the majority of patients with OSA, are influenced by sleeping position. Differences in characteristics between non-positional patients (NPP) and positional patients (PP) suggest another crucial phenotype distinction, a clinical phenotype focusing on the role of sleeping position on sleep apnea. Since this clinical phenotype distinction has therapeutic implications, further research is necessary to better understand the pathophysiology behind this phenotypic trait and to improve management of PP. Therefore, we suggest a standardized framework that emphasizes the role of sleeping position when reporting clinical and research data on sleep apnea. METHODS: We identified 5 key topics whereby a standardized framework to report on the role of sleeping position would be of added value: (1) sleep study data, (2) anatomical, morphological and physiological factors, (3) drug-induced sleep endoscopy (DISE) findings, (4) sleep apnea management, and (5) effectiveness versus efficacy of positional therapy in sleep apnea management. We performed a literature search to identify evidence to describe and support the rationale behind these 5 main recommendations. RESULTS: In this paper, we present the rationale behind this construct and present specific recommendations such as reporting sleep study indices (disease severity) and sleep time spent in various sleeping positions. The same is suggested for DISE findings and effect of treatment. Sleep study indices (disease severity), anatomical, morphological, and physiological factors in sleep apnea patients should be reported separately for PP and NPP. CONCLUSION: Applying these suggestions in future research will improve patient care, assist in better understanding of this dominant phenotype, and will enhance accurate comparisons across studies and future investigations.
PURPOSE: Sleep apnea is a multifactorial illness which can be differentiated in various physiological phenotypes as a result of both anatomical and non-anatomical contributors (e.g., low respiratory arousal threshold, high loop gain). In addition, the frequency and duration of apneas, in the majority of patients with OSA, are influenced by sleeping position. Differences in characteristics between non-positional patients (NPP) and positional patients (PP) suggest another crucial phenotype distinction, a clinical phenotype focusing on the role of sleeping position on sleep apnea. Since this clinical phenotype distinction has therapeutic implications, further research is necessary to better understand the pathophysiology behind this phenotypic trait and to improve management of PP. Therefore, we suggest a standardized framework that emphasizes the role of sleeping position when reporting clinical and research data on sleep apnea. METHODS: We identified 5 key topics whereby a standardized framework to report on the role of sleeping position would be of added value: (1) sleep study data, (2) anatomical, morphological and physiological factors, (3) drug-induced sleep endoscopy (DISE) findings, (4) sleep apnea management, and (5) effectiveness versus efficacy of positional therapy in sleep apnea management. We performed a literature search to identify evidence to describe and support the rationale behind these 5 main recommendations. RESULTS: In this paper, we present the rationale behind this construct and present specific recommendations such as reporting sleep study indices (disease severity) and sleep time spent in various sleeping positions. The same is suggested for DISE findings and effect of treatment. Sleep study indices (disease severity), anatomical, morphological, and physiological factors in sleep apnea patients should be reported separately for PP and NPP. CONCLUSION: Applying these suggestions in future research will improve patient care, assist in better understanding of this dominant phenotype, and will enhance accurate comparisons across studies and future investigations.
Authors: Eric J Kezirian; Edward M Weaver; Mark A Criswell; Nico de Vries; B Tucker Woodson; Jay F Piccirillo Journal: Otolaryngol Head Neck Surg Date: 2011-02-14 Impact factor: 3.497
Authors: M Jeffery Mador; Thomas J Kufel; Ulysses J Magalang; S K Rajesh; Veena Watwe; Brydon J B Grant Journal: Chest Date: 2005-10 Impact factor: 9.410
Authors: Danny J Eckert; David P White; Amy S Jordan; Atul Malhotra; Andrew Wellman Journal: Am J Respir Crit Care Med Date: 2013-10-15 Impact factor: 21.405
Authors: Giannicola Iannella; Giovanni Cammaroto; Giuseppe Meccariello; Angelo Cannavicci; Riccardo Gobbi; Jerome Rene Lechien; Christian Calvo-Henríquez; Ahmed Bahgat; Giuseppe Di Prinzio; Luca Cerritelli; Antonino Maniaci; Salvatore Cocuzza; Antonella Polimeni; Giuseppe Magliulo; Antonio Greco; Marco de Vincentiis; Massimo Ralli; Annalisa Pace; Roberta Polimeni; Federica Lo Re; Laura Morciano; Antonio Moffa; Manuele Casale; Claudio Vicini Journal: J Clin Med Date: 2022-09-23 Impact factor: 4.964