Oksenberg A, Khamaysi I, Silverberg D S, Tarasiuk A
Sleep Disorders Unit, Loewenstein Hospital-Rehabilitation Center, Raanana, Israel.
Chest. 2000 Oct;118(4):1018-24. doi: 10.1378/chest.118.4.1018.
To compare the severity of sleep apneic events occurring in the supine posture vs the severity of sleep apneic events occurring in the lateral posture in patients with severe obstructive sleep apnea (OSA).
A retrospective analysis of apneic event variables in a group of 30 OSA patients who underwent a complete polysomnographic evaluation in our sleep disorders unit.
Thirty patients with severe OSA (respiratory disturbance index [RDI] = 70.1+/-18.2) who were nonpositional patients (NPP), ie, in whom the ratio of the supine RDI to the lateral RDI is < 2 (supine RDI = 85.7+/-11.7, lateral RDI = 64.8+/-17.3), and who had > or =30 apneic events in the lateral position and 30 apneic events in the supine position during sleep stage 2 were included in the study.
For the 30 apneic events in each body position, the following variables were evaluated: apnea duration (ApDur), minimum desaturation (MinDes), Delta desaturation (Delta-Des), duration of arousal (DurArous), maximum snoring loudness (MaxSL), and Delta heart rate (Delta-HR). In addition, three other variables assessed as a ratio of ApDur (Rate-D = Delta-Des/ApDur, R-HR =Delta-HR/ApDur, and R-Arous = DurArous/ApDur) were also calculated.
For all variables evaluated, apneic events occurring in the supine posture were significantly more severe than those apneic events occurring in the lateral posture during sleep stage 2. ApDur of both body postures correlated significantly with DurArous, Delta-HR, and MaxSL, but not with Delta-Des and MinDes. ApDur correlated linearly with DurArous for both postures. The slopes of the two regression lines were similar (p = 0.578) but the regression line intercept for the supine apneas was significantly higher than that of lateral apneas (p<0.0001). In addition, the average number of supine apneic events that did not end with an arousal was smaller than the average number of lateral apneic events not ending with an arousal (4.4+/-6.0 vs. 10.5+/-6.7, respectively; p< 0.0001). Also, only 4 of 900 (0.44%) apneic events analyzed in the lateral posture ended with an awakening (> 15 s), whereas in the supine posture, there were 37 (4.1%) such events (p<0.001).
These results show that even in patients with severe OSA who have a high number of apneic events in the supine and lateral posture, the apneic events occurring in the supine position are more severe than those occurring while sleeping in the lateral position. Thus, it is not only the number of apneic events that worsen in the supine sleep position but, probably no less important, the nature of the apneic events themselves.
比较重度阻塞性睡眠呼吸暂停（OSA）患者仰卧位睡眠呼吸暂停事件的严重程度与侧卧位睡眠呼吸暂停事件的严重程度。
对在我们睡眠障碍科接受完整多导睡眠图评估的30例OSA患者的呼吸暂停事件变量进行回顾性分析。
30例重度OSA患者（呼吸紊乱指数[RDI]=70.1±18.2），为非体位性患者（NPP），即仰卧位RDI与侧卧位RDI之比<2（仰卧位RDI = 85.7±11.7，侧卧位RDI = 64.8±17.3），且在睡眠2期侧卧位有≥30次呼吸暂停事件、仰卧位有30次呼吸暂停事件的患者纳入研究。
对每个体位的30次呼吸暂停事件，评估以下变量：呼吸暂停持续时间（ApDur）、最低血氧饱和度（MinDes）、血氧饱和度下降幅度（Delta-Des）、觉醒持续时间（DurArous）、最大鼾声响度（MaxSL）和心率变化幅度（Delta-HR）。此外，还计算了作为ApDur比值评估的其他三个变量（Rate-D = Delta-Des/ApDur、R-HR = Delta-HR/ApDur和R-Arous = DurArous/ApDur）。
对于所有评估变量，睡眠2期仰卧位发生的呼吸暂停事件比侧卧位发生的呼吸暂停事件严重得多。两种体位的ApDur均与DurArous、Delta-HR和MaxSL显著相关，但与Delta-Des和MinDes无关。两种体位的ApDur与DurArous均呈线性相关。两条回归线的斜率相似（p = 0.578），但仰卧位呼吸暂停的回归线截距显著高于侧卧位呼吸暂停（p<0.0001）。此外，未以觉醒结束的仰卧位呼吸暂停事件的平均数量小于未以觉醒结束的侧卧位呼吸暂停事件的平均数量（分别为4.4±6.0和10.5±6.7；p<0.0001）。而且，在侧卧位分析的900次呼吸暂停事件中，只有4次（0.44%）以觉醒（>15秒）结束，而在仰卧位，有37次（4.1%）此类事件（p<0.001）。
这些结果表明，即使在仰卧位和侧卧位均有大量呼吸暂停事件的重度OSA患者中，仰卧位发生的呼吸暂停事件比侧卧位睡眠时发生的更严重。因此，不仅仰卧位睡眠时呼吸暂停事件的数量会增加，而且呼吸暂停事件本身的性质可能同样重要。
