Determining optimal sleep position in patients with positional sleep‐disordered breathing using response surface analysis

A lateral position (LP) during sleep is effective in reducing sleep disorder symptoms in mild or moderate sleep apnea patients. However, the effect of head and shoulder posture in LP on reducing sleep disorders has not been reported. In this study, effective sleeping positions and a combination of sleep position determinants were evaluated with respect to their ability to reduce snoring and apnea. The positions evaluated included the following: cervical vertebrae support with head tilting (CVS‐HT), scapula support (SS), and LP. A central composite design was applied for response surface analysis (RSA). Sixteen patients with mild or moderate positional sleep apnea and snoring who underwent polysomnography for two nights were evaluated. Based on an estimated RSA equation, LP (with a rotation of at least 30°) had the most dominant effect [P = 0.0057 for snoring rate, P = 0.0319 for apnea–hypopnea index (AHI)]. In addition, the LP was found to interact with CVS‐HT (P = 0.0423) for snoring rate and CVS‐HT (P = 0.0310) and SS (P = 0.0265) for AHI. The optimal sleep position reduced mild snoring by more than 80% (i.e. snoring rate in the supine position was <20%) and the snoring rate was approximately zero with a 40° rotation. To achieve at least 80% reduction of AHI, LP and SS should be >30° and/or 20 mm respectively. To determine an effective sleep position, CVS‐HT and SS, as well as the degree of the LP, should be concurrently considered in patients with positional sleep apnea or snoring.

[1]  Margaret J. Robertson,et al.  Design and Analysis of Experiments , 2006, Handbook of statistics.

[2]  A. Rechtschaffen.  A manual of standardized terminology, techniques and scoring system for sleep of human subjects , 1968 .

[3]  E. Wolpert.  A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. , 1969 .

[4]  V. Polezhaev.  Effect of a , 1974 .

[5]  R. Cartwright,et al.  Effect of sleep position on sleep apnea severity. , 1984, Sleep.

[6]  N B Kavey,et al.  Sleeping position and sleep apnea syndrome. , 1985, American journal of otolaryngology.

[7]  R. Cartwright,et al.  Sleep position training as treatment for sleep apnea syndrome: a preliminary study. , 1985, Sleep.

[8]  Braver Hm,et al.  Effect of Nasal Spray, Positional Therapy, and the Combination Thereof in the Asymptomatic Snorer , 1994 .

[9]  H. Zwick,et al.  Nasal continuous positive airway pressure for nonapneic snoring? , 1995, Chest.

[10]  D. Loube,et al.  The mandibular repositioning device: role in the treatment of obstructive sleep apnea. , 1996, Sleep.

[11]  A. Oksenberg,et al.  Avoiding the supine position during sleep lowers 24 h blood pressure in obstructive sleep apnea (OSA) patients , 1997, Journal of Human Hypertension.

[12]  A. Oksenberg,et al.  Positional vs Nonpositional Obstructive Sleep Apnea Patients* Anthropomorphic, Nocturnal Polysomnographic, and Multiple Sleep Latency Test Data , 1997 .

[13]  A. Oksenberg,et al.  The effect of body posture on sleep-related breathing disorders: facts and therapeutic implications. , 1998, Sleep medicine reviews.

[14]  M. Crossley,et al.  Positional treatment vs continuous positive airway pressure in patients with positional obstructive sleep apnea syndrome. , 1999, Chest.

[15]  A. Oksenberg,et al.  Association of body position with severity of apneic events in patients with severe nonpositional obstructive sleep apnea. , 2000, Chest.

[16]  Y. Itasaka,et al.  The influence of sleep position and obesity on sleep apnea , 2000, Psychiatry and clinical neurosciences.

[17]  G. Clark,et al.  Effect of Jaw and Head Position on Airway Resistance in Obstructive Sleep Apnea , 2000, Sleep and Breathing.

[18]  T. Ono,et al.  Supine cephalometric study on sleep-related changes in upper-airway structures in normal subjects. , 2000, Sleep.

[19]  T Penzel,et al.  Effect of sleep position and sleep stage on the collapsibility of the upper airways in patients with sleep apnea. , 2001, Sleep.

[20]  C. Kushida,et al.  Cervical Positioning for Reduction of Sleep-Disordered Breathing in Mild-to-Moderate OSAS , 2001, Sleep and Breathing.

[21]  H. Nakano,et al.  Effects of body position on snoring in apneic and nonapneic snorers. , 2003, Sleep.

[22]  T. Ono,et al.  Effects of mandibular advancement on supine airway size in normal subjects during sleep. , 2003, Sleep.

[23]  C. Shin,et al.  Prevalence of sleep-disordered breathing in middle-aged Korean men and women. , 2004, American journal of respiratory and critical care medicine.

[24]  M. Skinner,et al.  Elevated Posture for the Management of Obstructive Sleep Apnea , 2004, Sleep and Breathing.

[25]  David A. Schulman,et al.  Improvement in Obstructive Sleep Apnea in the Supine “Knees-Up” Position , 2004, Sleep and Breathing.

[26]  Effect of supine knee position on obstructive sleep apnea , 2006, Sleep and Breathing.

[27]  R. Stoohs,et al.  Sleep apnea avoidance pillow effects on obstructive sleep apnea syndrome and snoring , 2005, Sleep and Breathing.

[28]  B. Grant,et al.  Prevalence of positional sleep apnea in patients undergoing polysomnography. , 2005, Chest.

[29]  A. Oksenberg,et al.  Positional Therapy for Obstructive Sleep Apnea Patients: A 6‐Month Follow‐Up Study , 2006, The Laryngoscope.