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Standardized framework to report on the role of sleeping position in sleep apnea patients

  • Sleep Breathing Physiology and Disorders • Review
  • Published:
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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.

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Authors and Affiliations

  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 & N. de Vries

  2. Department of Otorhinolaryngology - Head and Neck surgery, Amsterdam UMC, location AMC, Amsterdam, the Netherlands

    P. E. Vonk

  3. Department of Otorhinolaryngology, Head and Neck Surgery, Sleep Disorders Center, University Hospital Mannheim, Mannheim, Germany

    J.T. Maurer

  4. Sleep Disorders Unit, Loewenstein Hospital-Rehabilitation Center, Raanana, Israel

    A. Oksenberg

  5. Department of Oral Kinesiology, ACTA, MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, the Netherlands

    N. de Vries

  6. Department of Otorhinolaryngology - Head and Neck Surgery, Antwerp University Hospital (UZA), Antwerp, Belgium

    N. de Vries

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  1. M. J. L. Ravesloot
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  3. J.T. Maurer
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  4. A. Oksenberg
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  5. N. de Vries
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Correspondence to M. J. L. Ravesloot.

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Nico de Vries is a member of the Medical Advisory Board of NightBalance. He is also an investigator of Inspire and Jazz Pharmaceutics, consultant of Philips, Olympus, and the AE Mann Foundation.

The authors have no other funding, financial relationships, or conflicts of interest to disclose.

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Ravesloot, M.J.L., Vonk, P.E., Maurer, J. et al. Standardized framework to report on the role of sleeping position in sleep apnea patients. Sleep Breath 25, 1717–1728 (2021). https://doi.org/10.1007/s11325-020-02255-2

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