How important is sleep posture in obstructive sleep apnea?

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Sleep Treatments | Sleep Review

Whether patients with OSA sleep on their back or flat on their chest, sleep specialists know that the sleeping position is important for the oxygen supply. New research attempts are trying to quantify the effects.

By Lisa Spear

It is safe to say that most people do not think too much when they sleep or are even aware of their posture. A person could fall on their back in the middle of the night before turning around to wake up on their side in the morning without changing position. Unknown to them, their posture at night could also interfere with their breathing.

In particular, the position of open sleeping, known as back sleep, is the worst culprit for people with obstructive sleep apnea (OSA) and contributes to a decrease in blood oxygen levels during the night. In the supine position, gravity pulls the muscles of the airways back, which can lead to further apneas. This is not new information. Sleep medicine doctors understand that position can change the way the human body takes in air.

“Interestingly, nobody sleeps on their back in our COVID units. Everyone is placed on their stomach or on their side. And that’s because the oxygen levels drop pretty much when people are on the back, and that’s obviously harmful to someone with a COVID-related infection, “says sleep scientist Mark Boulos, MD, MSc a associate neurologist at Sunnybrook Health Sciences Center in Canada.

Sleep medication providers routinely urge their patients to avoid sleeping on their back, and a number of products are marketed that promise to keep people in correct posture at night. However, there is little research that quantifies the physiological level of sleep in the supine position worsening OSA.

To fill this gap and examine the effects of supine sleep in more detail, Boulos and a team of other sleep scientists conducted retrospective studies on data obtained from patients in a sleep laboratory in Canada. The results showed that for every 10% increase in back sleep duration, the apnea-hypopnea index increased by 0.66, the respiratory disorder index by 0.65, and oxygen saturation by 0.19%. A summary of the work will be presented at the American Academy of Neurology’s virtual meeting this month.

“We were basically really interested in whether changes in posture actually changed your sleep physiology,” says co-author Boulos, an assistant professor at the University of Toronto.

“This is vital because the potential treatment or management solution doesn’t include a mask and you don’t have to pay for it: you just have to change your posture,” says Boulos.

[RELATED: Can Positional Therapy Help Treat Some Patients with Central Sleep Apnea?]

The scientists evaluated diagnostic polysomnography data in the laboratory from a total of 2,848 patients for six years. Of these, 48% were men with an average age of 53 years. Individuals who had previously undergone CPAP titration, as well as those who used an oral device, were excluded from the study.

According to the abstract, reduced back sleep showed a positive nonlinear relationship to both total sleep time and sleep efficiency and a negative nonlinear relationship to wakefulness after the onset of sleep.

According to Boulos, while there are many supine patients, there are simple, inexpensive solutions that can help them stay away from their backs. He often recommends that patients put a tennis ball in the breast pocket of a T-shirt and wear the shirt backwards before going to bed. Another method is sewing a tennis ball into the back of a shirt.

Boulos hopes the researchers will investigate how sleeping position can affect certain disease populations that may have a high incidence of OSA, including stroke patients.

For her, he says: “Posture could be a simple measure to modify and treat sleep apnea appropriately.”

Lisa Spear is co-editor of Sleep Review.



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