A systematic comparison of factors that could impact treatment recommendations for patients with Positional Obstructive Sleep Apnea (POSA).

OBJECTIVE/BACKGROUND: Systematically compare four criteria for Positional Obstructive Sleep Apnea (POSA) based on AASM 2007 and 2012 hypopnea scoring definitions.

PATIENTS/METHODS: 142 records acquired by in-home polysomnography (Sleep Profiler PSG2™) were retrospectively analyzed using AHI based on the American Academy Sleep Medicine 2007 and 2012 criteria (AHI and AHI). Positional obstructive sleep apnea (POSA) was characterized using four criteria: Amsterdam Positional OSA Classification (APOC), supine AHI twice the non-supine AHI (Cartwright), Cartwright plus the non-supine AHI < 5 (Mador), and the overall AHI severity at least 1.4 times the non-supine severity (Overall/NS-AHI).

RESULTS

Correlations between the Cartwright and Overall/NS-AHI criteria increased with the inclusion of a more relaxed definition of hypopneas (AHI = 0.79 and AHI = 0.86, P < 0.00001). The prevalence of POSA based on the Cartwright and Overall/NS-AHI criteria was approximately 60% in those with at least mild OSA by AHIand AHI. A 16% reduction in POSA prevalence for AHI vs. AHI was attributed to the increased incident of mild OSA. For identification of those expected to have 25% or 35% reductions in SDB severity with positional therapy, Cartwright and Overall/NS-AHI exhibited the strongest sensitivity and Overall/NS-AHI and Mador the best specificity.

CONCLUSIONS

The four criteria used to identify POSA have similarities and differences. While there were similarities between the Cartwright and Overall/NS-AHI criteria in the detection of POSA prevalence across both scoring criteria, the Overall/NS-AHI provided the most consistent detection of those most likely to demonstrate important reductions in sleep disordered breathing severity if supine sleep is avoided.