supine sleep
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Author(s):  
Wojciech Kukwa ◽  
Jonasz Łaba ◽  
Tomasz Lis ◽  
Krystyna Sobczyk ◽  
Ron B. Mitchell ◽  
...  

Abstract Purpose Polysomnography (PSG) is considered the best objective study to diagnose and quantify sleep disorders. However, PSG involves multiple electrodes and is usually performed in a sleep laboratory that in itself may change the physiology of sleep. One of the parameters that can change during PSG is the sleep position, leading to more supine sleep. The aim of this study was to quantify the amount of supine sleep during PSG and compare it to consecutive nights of a home sleep apnea test (HSAT) in the same patients. Methods This prospective study evaluated 22 consecutive patients undergoing PSG followed by HSAT. Sleep position was analyzed during PSG and subsequently on 2 to 6 nights (mean 3.7 nights) at home, and the amount of supine sleep was recorded during each night. Results Of 22 patients, there were 12 men (55%). The median age was 60.0 years for women and 45.5 years for men. Median proportion of supine sleep during PSG and HSAT was 61% and 26% (p < 0.001), respectively. Four “phenotypes” were identified according to their sleep position during PSG and HSAT, with 5 patients sleeping mainly supine during all nights, 7 patients sleeping mainly non-supine during all nights, 3 patients sleeping in different positions during each night, and 7 patients sleeping supine during PSG but non-supine at home, during HSAT. Conclusions There is a higher proportion of supine sleep during PSG compared to home sleep. We identified a subgroup of patients who slept mainly supine during PSG and mainly non-supine during HSAT. PSG may overestimate OSA severity in a specific phenotype of patients.


Sensors ◽  
2021 ◽  
Vol 21 (23) ◽  
pp. 8097
Author(s):  
Wen-Te Liu ◽  
Shang-Yang Lin ◽  
Cheng-Yu Tsai ◽  
Yi-Shin Liu ◽  
Wen-Hua Hsu ◽  
...  

Obstructive sleep apnoea (OSA) is a global health concern, and polysomnography (PSG) is the gold standard for assessing OSA severity. However, the sleep parameters of home-based and in-laboratory PSG vary because of environmental factors, and the magnitude of these discrepancies remains unclear. We enrolled 125 Taiwanese patients who underwent PSG while wearing a single-lead electrocardiogram patch (RootiRx). After the PSG, all participants were instructed to continue wearing the RootiRx over three subsequent nights. Scores on OSA indices—namely, the apnoea–hypopnea index, chest effort index (CEI), cyclic variation of heart rate index (CVHRI), and combined CVHRI and CEI (Rx index), were determined. The patients were divided into three groups based on PSG-determined OSA severity. The variables (various severity groups and environmental measurements) were subjected to mean comparisons, and their correlations were examined by Pearson’s correlation coefficient. The hospital-based CVHRI, CEI, and Rx index differed significantly among the severity groups. All three groups exhibited a significantly lower percentage of supine sleep time in the home-based assessment, compared with the hospital-based assessment. The percentage of supine sleep time (∆Supine%) exhibited a significant but weak to moderate positive correlation with each of the OSA indices. A significant but weak-to-moderate correlation between the ∆Supine% and ∆Rx index was still observed among the patients with high sleep efficiency (≥80%), who could reduce the effect of short sleep duration, leading to underestimation of the patients’ OSA severity. The high supine percentage of sleep may cause OSA indices’ overestimation in the hospital-based examination. Sleep recording at home with patch-type wearable devices may aid in accurate OSA diagnosis.


2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A73-A73
Author(s):  
D Wilson ◽  
C Whenn ◽  
S Walker ◽  
M Barnes ◽  
M Howard

Abstract Self-reported supine position at sleep onset during late pregnancy is related to a 2.6x increase in stillbirth risk, possibly due to the enlarged uterus compressing major blood vessels supplying the placenta. This study aimed to test the effectiveness of a pillow designed to decrease supine sleep in pregnant women. Twelve women in the third trimester of pregnancy used their own pillows for a control week and the intervention pillow for 1 week, in randomised order. Sleep position for each night of both weeks was monitored with the Night Shift Sleep Positioner, with a sleep study (WatchPat300) on the last night of each week to measure the impact of the intervention on SDB. During the control week, the women slept supine for a median of 19.9% (IQR = 11.6, 27.4) of total sleep time (TST), compared to a median of 20.4% (10.2, 31.0) TST using the intervention pillow (p = .64). Use of the intervention pillow did not impact sleep efficiency (control = 85.3% (80.7, 88.0) v. intervention = 85.2% (78.3, 89.0), p = .48). On the sleep study night, supine sleep was reduced in the intervention compared to control condition (12.9% vs. 17.7%, p = .04), but AHI did not differ (intervention = 2.6/hr (0.8, 6.7) vs. control = 1.5/hr (0.6, 3.6), p = .11). We found that the adoption of a pillow designed to discourage supine sleep was not effective in late pregnancy. Considering the reasonably high amount of supine sleep in our participants, alternative devices should be investigated.


2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A67-A68
Author(s):  
A Tate ◽  
V Kurup ◽  
B Shenoy ◽  
C Freakley ◽  
P Eastwood ◽  
...  

Abstract Introduction Recent work has shown that head flexion has a modest worsening effect and head rotation has a modest protective effect on OSA severity. However, there is substantial variability both within and between individuals. In this analysis we aimed to identify if this variability is explained by sleep-state, BMI, age or sex. Methods 28 participants provided informed consent and were studied using diagnostic polysomnography with the addition of a customised, accelerometry based, head posture measurement device. For each epoch during supine sleep, the sleep state (NREM/REM), average head flexion (degrees) and average head rotation (degrees) were recorded. A logistic mixed effects model was fit across all epochs with the anthropometrics (BMI, sex, age), sleep state, average head flexion and average head rotation as explanatory variables with the absence/presence of one or more respiratory event(s) as the binary outcome variable. Results In total, 2122 of 5369 supine sleep epochs had a respiratory event. Three participants had no supine sleep. There were significant interaction effects for flexion-rotation, BMI-rotation and REM-flexion. The REM-flexion interaction effect was the strongest interaction effect with an odds ratio per 5 degrees of head flexion in REM sleep of 1.47 (95% CI: 1.13 – 1.86). Discussion Head flexion related worsening of OSA severity is greatest during REM sleep. This may be explained by attenuated upper airway neuromuscular activation in REM sleep compared with NREM sleep.


2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A19-A19
Author(s):  
J Callum ◽  
L Stranks ◽  
K Melehan ◽  
B Yee

Abstract Introduction A conventional belief is that REM exacerbates positional OSA (POSA). Subsequently, PSGs often report on presence of supine REM with the presumption that without supine REM, the AHI may be underestimated. This study explores the impact of REM upon obstructive respiratory events in sleep when supine. Methods From 1/1/2019 through 31/12/2020 PSGs for OSA diagnosis performed using Sleepware G3 were reviewed. A subgroup analysis was conducted within POSA patients defined as 1) total AHI&gt;10/hour and non-supine AHI&lt;10/hr, 2) supine AHI&gt;2x non-supine AHI and 3) at least 15min of supine and non-supine sleep. Data was analysed with Pearson’s Chi Squared Test using Stata 16.1. Results Supine REM occurred in 97% of the 467 PSG’s. The supine REM AHI was 32.1(95%CI 29.1–35.2), compared to supine NREM AHI of 36.6(33.5–39.6), non-supine REM AHI of 21.3(18.8–23.9) and non-supine NREM AHI of 19.9(17.3–22.5). Among 109 POSA patients the supine REM AHI was 31.7(26.1–37.4) compared to 28.9(24.8–32.9) in supine NREM, 9.5(6.1–12.9) in non-supine REM and 3.5(3.0–4.0) in non-supine NREM. The average duration of obstructive respiratory events was 27.3 seconds (26.2–28.5) in REM compared to 23.5 seconds (22.8–24.2) in NREM. This statistically significant difference did not persist in POSA patients. Discussion The results do not support an additive effect of REM beyond supine positioning among patients with POSA, however there is evidence that REM lengthens respiratory events, which may reduce AHI. In the POSA subgroup analysis, there was an increased AHI in REM compared to NREM only in the non-supine position.


Author(s):  
Sunah S. Hwang ◽  
Suhong Tong ◽  
Laura Pyle ◽  
Catherine Battaglia ◽  
Beth McManus ◽  
...  

Objective Investigate whether safe infant sleep prioritization by states through the Title V Maternal and Child Block Grant in 2010 differentially impacted maternal report of supine sleep positioning (SSP) for Non-Hispanic White (NHW) and Non-Hispanic Black (NHB) U.S.-born infants. Methods We analyzed retrospective cross-sectional data from the Pregnancy Risk Assessment Monitoring System (PRAMS) from 2005 to 2015 from 4 states: WV and OK (Intervention) and AR and UT (Control). PRAMS is a population-based surveillance system of maternal perinatal experiences which is linked to infant birth certificates. Piece-wise survey linear regression models were used to estimate the difference in the change in slopes of SSP percents in the pre- (2005–2009) and post- (2011–2015) periods, controlling for maternal and infant characteristics. Models were also stratified by race/ethnicity. Results From 2005 to 2015, for NHW infants, SSP improved from 61.5% and 70.2% to 82.8% and 82.3% for intervention and control states, respectively. For NHB infants, SSP improved from 30.6% and 26.5% to 64.5% and 53.1% for intervention and control states, respectively. After adjustment for maternal characteristics, there was no difference in the rate of SSP change from the pre- to post- intervention periods for either NHW or NHB infants in intervention or control groups. Conclusions and relevance Compared with control states that did not prioritize safe infant sleep in their 2010 Title V Block Grant needs assessment, intervention states experienced no difference in SSP improvement rates for NHW and NHB infants. While SSP increased for all infants during the study period, there was no causal relationship between states' prioritization of safe infant sleep and SSP improvement. More targeted approaches may be needed to reduce the racial/ethnic disparity in SSP and reduce the risk for sleep-associated infant death. Key Points


2021 ◽  
Author(s):  
Wen-Te Liu ◽  
Shang-Yang Lin ◽  
Cheng-Yu Tsai ◽  
Yi-Shin Liu ◽  
Chia-Mo Lin ◽  
...  

Abstract Purpose: Obstructive sleep apnoea (OSA) is a global health concern, and polysomnography (PSG) is the gold standard for assessing OSA severity. However, the sleep parameters of home-based and in-laboratory PSG vary because of environmental factors, and the magnitude of these discrepancies remains unclear.Methods: We enrolled 125 Taiwanese patients who underwent PSG while wearing a single-lead electrocardiogram patch (RootiRx). After the PSG, all participants were instructed to continue wearing the RootiRx over the 3 subsequent nights. Scores on OSA indexes, namely the apnoea–hypopnea index, chest effort index (CEI), cyclic variation of heart rate index (CVHRI), and combined CVHRI and CEI (Rx index), were determined. The patients were divided into 3 groups based on PSG-determined OSA severity. The variables (various severity groups and environmental measurements) were subjected to mean comparisons and their correlations were examined by Pearson’s correlation coefficient. Results: The hospital-based CVHRI, CEI, and Rx index differed significantly among the severity groups. All 3 groups exhibited a significantly lower percentage of supine sleep time in the home-based assessment relative to in the hospital-based assessment. Significant positive correlations were noted between the variations in the supine percentage (∆Supine%) and the OSA indexes. For the patients with high sleep efficiency (≥ 80%), significant correlations were observed between the ∆Supine% and ∆Rx index.Conclusion: The high supine percentage of sleep may cause OSA indexes’ overestimation in hospital-based PSG. Sleep recording at home with patch-type wearable devices may aid accurate OSA diagnosis.


Sensors ◽  
2021 ◽  
Vol 21 (13) ◽  
pp. 4531
Author(s):  
Ignasi Ferrer-Lluis ◽  
Yolanda Castillo-Escario ◽  
Josep Maria Montserrat ◽  
Raimon Jané

Poor sleep quality or disturbed sleep is associated with multiple health conditions. Sleep position affects the severity and occurrence of these complications, and positional therapy is one of the less invasive treatments to deal with them. Sleep positions can be self-reported, which is unreliable, or determined by using specific devices, such as polysomnography, polygraphy or cameras, that can be expensive and difficult to employ at home. The aim of this study is to determine how smartphones could be used to monitor and treat sleep position at home. We divided our research into three tasks: (1) develop an Android smartphone application (‘SleepPos’ app) which monitors angle-based high-resolution sleep position and allows to simultaneously apply positional treatment; (2) test the smartphone application at home coupled with a pulse oximeter; and (3) explore the potential of this tool to detect the positional occurrence of desaturation events. The results show how the ‘SleepPos’ app successfully determined the sleep position and revealed positional patterns of occurrence of desaturation events. The ‘SleepPos’ app also succeeded in applying positional therapy and preventing the subjects from sleeping in the supine sleep position. This study demonstrates how smartphones are capable of reliably monitoring high-resolution sleep position and provide useful clinical information about the positional occurrence of desaturation events.


SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A163-A163
Author(s):  
Scott Schecter ◽  
Junjie Liu

Abstract Introduction Obstructive sleep apnea (OSA) is a heterogeneous disease dependent on many factors including the sleep stage and the body position. OSA is often more severe during the rapid eye movement (REM) sleep stage, a phenomenon known as REM predominance. Prior studies suggested associations of higher REM predominance of OSA with younger age, higher obesity, and lower adherence to continuous positive airway pressure (CPAP) therapy, but these studies had small cohort sizes. Here we leverage home-based sleep tests (HST) that estimate REM sleep and measure body position to study REM predominance in a larger cohort of OSA patients. Methods We retrospectively reviewed patients who took HST at our clinic using devices based on peripheral arterial tonometry (WatchPAT, Itamar Medical). The HST results included estimated REM sleep periods and measured body positions. Auto-titrating CPAP therapy was prescribed for the majority of OSA patients diagnosed by the HST. Our inclusion criteria were: apnea-hypopnea index (AHI) above 5 /hour, estimated REM sleep time above 30 minutes, oxygen saturation below 90% (T90) for less than 10 minutes, and successful retrieval of CPAP usage data. CPAP adherence was defined as the percentage of nights with CPAP usage above four hours, and REM predominance as the ratio between REM AHI and non-REM AHI. Additionally, the percentage of estimated sleep time in supine position was calculated. Results Among 292 consecutive patients whose HST were reviewed, 113 patients met the inclusion criteria. The 25th-75th percentile ranges of age, body mass index (BMI), AHI, REM predominance, CPAP adherence and supine sleep percentage were 36–56 years, 28.1–38.4 kg/m2, 8.9–25.9 /hour, 1.27–2.89, 40%-97% and 28%-72%, respectively. REM predominance was not associated with CPAP adherence (P &gt; 0.05), but was significantly associated with lower age, higher BMI, and higher supine sleep percentage (all P &lt; 0.01). Conclusion We found that REM-predominant OSA is relatively more prevalent not only in young and obese patients, but in patients who sleep relatively more in the supine position. This association of REM predominance with body position is a novel finding to our knowledge. Contrary to prior studies, we did not find association of REM predominance with adherence to CPAP therapy. Support (if any):


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