George C F, Millar T W, Kryger M H
Department of Respiratory Medicine, University of Manitoba, Canada.
Sleep. 1988 Feb;11(1):90-9. doi: 10.1093/sleep/11.1.90.
In patients with obstructive sleep apnea, it is believed that body position influences apnea frequency. Sleeping in the lateral decubitus position often results in significantly fewer apneas, and some have recommended sleeping on the side as the major treatment intervention. Previous studies, although calculating apnea-hypopnea index (AHI) for supine and lateral decubitus positions, have not taken sleep stage into account. To examine the effect of both sleep stage and body position on apnea duration (AD) and frequency, we determined AHI and AD in all spontaneous body positions during rapid eye movement (REM) and non-REM (NREM) sleep by reviewing videotapes and polysomnograms from 11 overnight studies of 7 obese patients with severe sleep apnea. Consistent with previous work, AD was significantly longer in REM then in NREM (32.5 +/- 2.3 s versus 23.5 +/- 1.9 s; p less than 0.05). This difference persisted when adjusting for body position. AHI was greater on the back than on the sides (84.4 +/- 4.9/h versus 73.6 +/- 7.5/h, p less than 0.05), but after accounting for sleep stage, this difference remained only for NREM (103 +/- 4.8/h versus 80.3 +/- 9.2/h, p less than 0.05) and not for REM (83.6 +/- 5.3/h versus 71.1 +/- 4.2/h, p NS). Although reduced, AHI on the sides still remained clinically very high. Body position changed frequently throughout the night, but some patients spent little or no time on their back. We conclude that AD is longer in REM than NREM, regardless of position, and AHI is higher on the back only in NREM. As AHI remains very high on the sides, favoring the lateral decubitus position may not be as beneficial as previously thought in very obese patients. Less obese patients are more likely to benefit by position changes.
在阻塞性睡眠呼吸暂停患者中，人们认为体位会影响呼吸暂停频率。侧卧睡眠通常会使呼吸暂停显著减少，因此一些人建议将侧卧作为主要的治疗干预措施。以往的研究虽然计算了仰卧位和侧卧位的呼吸暂停低通气指数（AHI），但并未考虑睡眠阶段。为了研究睡眠阶段和体位对呼吸暂停持续时间（AD）及频率的影响，我们通过回顾7例重度睡眠呼吸暂停肥胖患者11次夜间研究的录像带和多导睡眠图，确定了快速眼动（REM）睡眠期和非快速眼动（NREM）睡眠期所有自然体位下的AHI和AD。与以往研究一致，REM期的AD显著长于NREM期（32.5±2.3秒对23.5±1.9秒；p<0.05）。调整体位后，这种差异仍然存在。仰卧位的AHI高于侧卧位（84.4±4.9次/小时对73.6±7.5次/小时，p<0.05），但在考虑睡眠阶段后，这种差异仅在NREM期存在（103±4.8次/小时对80.3±9.2次/小时，p<0.05），而在REM期不存在（83.6±5.3次/小时对71.1±4.2次/小时，p无统计学意义）。虽然侧卧位的AHI有所降低，但临床上仍非常高。夜间体位频繁变化，但一些患者仰卧的时间很少或几乎没有。我们得出结论，无论体位如何，REM期的AD都长于NREM期，且仅在NREM期仰卧位的AHI更高。由于侧卧位的AHI仍然非常高，因此对于极度肥胖的患者，偏好侧卧位可能并不像之前认为的那样有益。肥胖程度较低的患者更可能从体位改变中获益。
