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Positional Obstructive Sleep Apnea

Supine Sleep Position

Several factors affect the quality and quantity of your sleep. Your sleep environment, bedtime routine, body weight, and lifestyle all play a role in how well you sleep.

For millions of people, sleep apnea adversely affects sleep. Approximately 25 million people in the United States have obstructive sleep apnea (OSA). Anyone can develop obstructive sleep apnea, although there are certain risk factors that may increase your chances of developing this disorder including age, neck size, and being overweight. If you have obstructive sleep apnea, you might be surprised to learn that your sleep position can also affect how many apneic episodes you have each night.

Positional Obstructive Sleep Apnea (POSA)

Sleep apnea involves brief pauses in breathing. The most common form of sleep apnea is obstructive sleep apnea. Obstructive sleep apnea occurs when the soft tissues of the upper airway and tongue relax during sleep. When the tissues and muscles relax, they can block the flow of air into the lungs.

During an apneic episode breathing pauses for several seconds. Oxygen levels drop, which leads to a response by the sympathetic nervous system. Your blood pressure and heart rate increases. The nervous system kicks in and breathing resumes, often with snoring.

Positional obstructive sleep apnea occurs when the majority of apneic episodes can be attributed to sleep position.  When you are in a supine sleep position, lying flat on your back, the shape and size of your upper airway are altered. This sleep position, combined with gravity, increases the likelihood of obstructing the airway. With positional obstructive sleep apnea, the apnea-hypopnea index (AHI), which measures the severity of obstructive sleep apnea, is often twice as high as opposed to other sleep positions. It is thought that about 50 percent of people with obstructive sleep apnea have positional obstructive sleep apnea.

Watch this video to learn more about advances in potential obstructive sleep apnea treatment.

Complications of Untreated Positional Obstructive Sleep Apnea

Positional obstructive sleep apnea can interfere with getting enough rest, however, complications can go far beyond just being tired. Left untreated, positional obstructive sleep apnea can have serious health consequences.

Man sleeping in hospital bed

Effects of an apneic episode, such as repeated low oxygen levels, elevated blood pressure, and heart rate, can wreak havoc on the body, straining the circulatory system and the heart.

People with untreated sleep apnea, including positional obstructive sleep apnea, have an increased risk of the following:

  • Stroke: Apneic episodes can cause an increase in blood pressure. Eventually, the nocturnal rise in blood pressure may persist into the daytime and lead to hypertension, which is a risk factor for a stroke.
  • Heart Attack: Evidence exists that people with untreated sleep apnea may develop increased arterial stiffness and have less heart rate variability, which can raise the risk of a heart attack.  
  • Type 2 Diabetes: Sleep apnea is associated with an increased risk of developing type 2 diabetes. Being overweight is a risk factor for both obstructive sleep apnea and type 2 diabetes. According to research published in Frontiers in Neurology, obstructive sleep apnea may be linked to glucose intolerance and insulin resistance independent of obesity. The prevalence of sleep apnea in people with type 2 diabetes is about 71 percent.
  • Driving Accidents: Untreated obstructive sleep apnea  results in poor overall sleep quality. Daytime sleepiness is common. Sleep deprivation is a major cause of driving accidents.

Positional Sleep Therapy Positional sleep therapy for positional obstructive sleep apnea can be an effective form of treatment. Review the list below to choose a positional sleep therapy technique that will work best for you.

Sleep Position: Since individuals who have positional obstructive sleep apnea have the majority of apneic episodes when in a supine sleeping position, sleeping in a different position can reduce pauses in breathing.

Sleep Apnea Oral Devices: Sleep apnea oral devices hold the jaw or tongue in a specific position to minimize blocking of the airway, reducing the likelihood of sleep apnea.

CPAP Treatment: A study published in the Journal of Otolaryngology-Head and Neck Surgery involved a comprehensive systematic literature review. The review involved database searches over a 20-year period conducted using Embase, Medline, and PubMed. The research indicated that the non-adherence rate for CPAP was 34 percent. Philips Nightbalance

This device helps to prevent you from sleeping in the supine sleep position. By avoiding lying flat on your back, you can  decrease apneic episodes.  It assists you by promoting sleeping in other positions, such as on your side.

Positional Sleep Apnea Device

See the Philips NightBalance for the treatment of positional OSA

Positional Sleep Therapy vs. Sleep Therapy Devices 

In a randomized controlled clinical trial published in the Journal Sleep Medicine, people with mild to moderate positional obstructive sleep apnea were randomly assigned to use either positional sleep therapy or an oral device. A sleep study was conducted three months after starting the trial. The results indicated that positional therapy was as effective for treating positional obstructive sleep apnea as an oral device.

Another study published in the Journal of Clinical Sleep Medicine involved adults with positional obstructive sleep apnea. In the study participants used positional therapy, and a follow-up sleep study was performed after a median treatment time of 12 weeks. The results showed a significant decrease in apnea-hypopnea index or severity of POSA.

See article: Rethinking positional obstructive sleep apnea management

It is clear from the research that sleep position affects about half of people that have obstructive sleep apnea. As we know, leaving any form of sleep apnea untreated has health risks. The best treatment option for individuals will vary depending on the severity of the condition, compliance in using devices, and personal preferences.

One thing is clear, the most successful treatment for positional obstructive sleep apnea is the one that patients will adhere to. Evidence strongly suggests that compliance with CPAP and oral devices is often lacking. Fortunately, positional sleep therapy may also be a great option to treat positional obstructive sleep apnea.

Philips Better Sleep Program

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2 comments on “Positional Obstructive Sleep Apnea”

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