Oksenberg Arie, Arons Elena, Greenberg-Dotan Sari, Nasser Khitam, Radwan Henryk
Sleep Disorders Unit, Loewenstein Hospital-Rehabilitation Center, Raanana.
Harefuah. 2009 May;148(5):304-9, 351, 350.
The aim of this study was to evaluate demographic and polysomnographic characteristics of positional (PPJ) and non-positional obstructive (NPP) sleep apnea (OSA) patients in 2077 OSA patients diagnosed in our Sleep Disorders Unit during a period of 10 years. An OSA patient is defined as positional if he has twice as many or more breathing abnormalities (apnea and hypopneas) while he sleeps in his supine posture compared to the lateral ones. Of the 2077 OSA patients, 1118 (53.8%) were positional and 959 (46.2%) were non-positional. No age differences were found between these two groups of patients. However, NPP were heavier and thus had a higher BMI than PP. PP had fewer and Less severe breathing abnormalities during sleep compared to NPP and thus, they enjoyed better sleep quality expressed by higher percentages of stage 2, 4 and 3+4 as well as a lower amount of short arousals than NPP. Also, PP patients are less sleepy during daytime hours than NPP. During the Multiple Sleep Latency Test (MSLT), NPP fall asleep faster in every nap than PP patients. No differences between these two patient groups were found for any parameter of Periodic Limb Movement Disorders. AHI and BMI are independently but inversely related to positional dependency. As AHI and BMI increase, the Likelihood to be a positional patient decreases. NPP have breathing abnormalities in the supine and lateral postures, thus, for them without question, CPAP is the treatment of choice. Since avoiding the supine posture during sleep may significantly improve the sleep quality and daytime alertness of many positional patients, it is imperative to carry out a high-quality study to evaluate if this is a real therapeutic alternative for many positional patients.
本研究的目的是评估在10年期间于我们睡眠障碍科确诊的2077例阻塞性睡眠呼吸暂停（OSA）患者中，体位性（PPJ）和非体位性阻塞性（NPP）睡眠呼吸暂停患者的人口统计学和多导睡眠图特征。如果一名OSA患者仰卧位睡眠时的呼吸异常（呼吸暂停和呼吸浅慢）是侧卧位时的两倍或更多，则该患者被定义为体位性患者。在2077例OSA患者中，1118例（53.8%）为体位性患者，959例（46.2%）为非体位性患者。这两组患者之间未发现年龄差异。然而，NPP患者体重更重，因此BMI高于PP患者。与NPP相比，PP患者睡眠期间的呼吸异常较少且较轻，因此，他们的睡眠质量更好，表现为2期、4期以及3+4期睡眠的百分比更高，且短觉醒次数比NPP患者少。此外，PP患者白天的嗜睡程度低于NPP患者。在多次睡眠潜伏期试验（MSLT）中，NPP患者在每次小睡时入睡都比PP患者快。在周期性肢体运动障碍的任何参数方面，这两组患者之间均未发现差异。AHI和BMI与体位依赖性独立但呈负相关。随着AHI和BMI的增加，成为体位性患者的可能性降低。NPP患者在仰卧位和侧卧位时均有呼吸异常，因此，对他们而言，持续气道正压通气（CPAP）无疑是首选治疗方法。由于睡眠期间避免仰卧位可能会显著改善许多体位性患者的睡眠质量和白天警觉性，因此必须开展一项高质量研究，以评估这是否对许多体位性患者是一种真正的治疗选择。
