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睡眠姿势和睡眠阶段对阻塞性睡眠呼吸暂停严重程度的不同影响。

Differential effects of sleep position and sleep stage on the severity of obstructive sleep apnea.

作者信息

Lim Soyun, Lee Hyun-Kyung, Kang Yun Jin, Shin Hyun-Woo

机构信息

Seoul National University College of Medicine, Seoul, South Korea.

Obstructive Upper Airway Research (OUaR) Laboratory, Department of Pharmacology, Seoul National University College of Medicine, Seoul, South Korea.

出版信息

J Sleep Res. 2025 Aug;34(4):e14379. doi: 10.1111/jsr.14379. Epub 2024 Nov 18.

Abstract

This study compared the effects of sleeping in the supine position and rapid eye movement sleep on the severity of obstructive sleep apnea, and investigated the effect of sleep stage on position-dependent obstructive sleep apnea, and of sleep position on rapid eye movement-dependent obstructive sleep apnea. We analysed epoch-labelled polysomnographic readouts of 3843 patients, and calculated the apnea-hypopnea index for each sleep position and sleep stage. Subgroup analyses were performed to evaluate whether the proportion of position-dependent obstructive sleep apnea patients changed during rapid eye movement and non-rapid eye movement sleep, and whether that of rapid eye movement-dependent obstructive sleep apnea patients changed during supine/lateral sleep. The apnea-hypopnea index was highest in the rapid eye movement-supine position (50.7 ± 22.6 events per hr), followed by non-rapid eye movement-supine, rapid eye movement-lateral and non-rapid eye movement-lateral (39.2 ± 25.3, 22.9 ± 24.4, 15.9 ± 21.9 events per hr, respectively; p < 0.001). Patients with position-dependent obstructive sleep apnea had a higher ratio of rapid eye movement sleep, and those with rapid eye movement-dependent obstructive sleep apnea had a higher ratio of sleep time in the supine position (p < 0.001). During rapid eye movement sleep, position-dependent obstructive sleep apnea was not observed in 21.1% of patients who otherwise had position-dependent obstructive sleep apnea. In the lateral position, 36.9% of patients with rapid eye movement-dependent obstructive sleep apnea did not retain rapid eye movement dependency. Although sleeping in the supine position and rapid eye movement sleep were both associated with more frequent respiratory events, this was the first study to demonstrate that the former had a stronger correlation with obstructive sleep apnea severity. Position dependency in patients with obstructive sleep apnea decreased during rapid eye movement sleep, and worsening of rapid eye movement dependency was alleviated in the lateral position, suggesting potential for personalized obstructive sleep apnea management.

摘要

本研究比较了仰卧位睡眠和快速眼动睡眠对阻塞性睡眠呼吸暂停严重程度的影响,并调查了睡眠阶段对体位依赖性阻塞性睡眠呼吸暂停的影响,以及睡眠体位对快速眼动依赖性阻塞性睡眠呼吸暂停的影响。我们分析了3843例患者的带有时段标记的多导睡眠图读数,并计算了每个睡眠体位和睡眠阶段的呼吸暂停低通气指数。进行亚组分析以评估体位依赖性阻塞性睡眠呼吸暂停患者的比例在快速眼动睡眠和非快速眼动睡眠期间是否发生变化,以及快速眼动依赖性阻塞性睡眠呼吸暂停患者的比例在仰卧位/侧卧位睡眠期间是否发生变化。呼吸暂停低通气指数在快速眼动-仰卧位时最高(每小时50.7±22.6次事件),其次是非快速眼动-仰卧位、快速眼动-侧卧位和非快速眼动-侧卧位(分别为每小时39.2±25.3、22.9±24.4、15.9±21.9次事件;p<0.001)。体位依赖性阻塞性睡眠呼吸暂停患者的快速眼动睡眠比例较高,而快速眼动依赖性阻塞性睡眠呼吸暂停患者的仰卧位睡眠时间比例较高(p<0.001)。在快速眼动睡眠期间,21.1%原本患有体位依赖性阻塞性睡眠呼吸暂停的患者未观察到体位依赖性阻塞性睡眠呼吸暂停。在侧卧位时,36.9%的快速眼动依赖性阻塞性睡眠呼吸暂停患者不再具有快速眼动依赖性。虽然仰卧位睡眠和快速眼动睡眠均与更频繁的呼吸事件相关,但这是第一项表明前者与阻塞性睡眠呼吸暂停严重程度具有更强相关性的研究。阻塞性睡眠呼吸暂停患者的体位依赖性在快速眼动睡眠期间降低,而快速眼动依赖性在侧卧位时的恶化得到缓解,这表明个性化阻塞性睡眠呼吸暂停管理具有潜力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7f81/12215218/469935884d47/JSR-34-e14379-g003.jpg

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