ISSN: 1300 - 6525 E-ISSN: 2149 - 0880
kulak burun boğaz
ve baş boyun cerrahisi dergisi
http://dergi.kbb-bbc.org.tr
Kayıtlı İndeksler








ORIGINAL RESEARCH

Investigation of Clinical, Physiological, and Polysomnographic Parameters in Patients with Obstructive Sleep Apnea Syndrome
Obstrüktif Uyku Apne Sendromu Olan Hastalarda Klinik, Fizyolojik ve Polisomnografik Parametrelerin İncelenmesi
Received Date : 12 Oct 2024
Accepted Date : 27 Nov 2024
Available Online : 11 Dec 2024
Doi: 10.24179/kbbbbc.2024-106204 - Makale Dili: EN
Journal of Ear Nose Throat and Head Neck Surgery. 2025;33(1):23-32.
Copyright © 2020 by Turkey Association of Society of Ear Nose Throat and Head Neck Surgery. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
ABSTRACT
Objective: This study aimed to examine clinical, physiological, and polysomnographic parameters in patients with obstructive sleep apnea syndrome (OSAS), comparing positional and non-positional cases based on variations in the Apnea-Hypopnea Index (AHI) between sleep positions. Material and Methods: A retrospective analysis was conducted on the records of 46 patients diagnosed with OSAS via overnight polysomnography from December 2023 to May 2024. Based on AHI differences in supine and lateral positions, patients were classified as positional or non-positional. Parameters evaluated included demographic data, symptom prevalence, OSAS severity, polysomnographic metrics, and upper airway physical examination findings. Results: Non-positional patients reported more severe symptoms, with significantly higher Epworth Sleepiness Scale scores (13±4.6 vs. 8.18±3.21; p=0.032) and a greater prevalence of witnessed apnea (91% vs. 43.5%; p=0.023), insomnia (73.9% vs. 21.7%; p=0.002), and morning headaches (78.3% vs. 39%; p=0.034). Nasal obstruction was more common in positional patients (65% vs. 21.7%; p=0.008), who also demonstrated higher sleep efficiency (85.69±7.25% vs. 69.79±11.23%; p=0.003). Severe OSAS was more frequent in non-positional patients (65% vs. 22%; p=0.003). AHI values were significantly higher overall in non-positional patients (65.49±20.49 vs. 29.56±15.23; p=0.000*) and supine/lateral positions. Conclusion: This study underscores distinct clinical and polysomnographic profiles between positional and non-positional OSAS patients, suggesting that positional therapy may benefit positional cases, while non-positional patients may require more comprehensive treatment.
ÖZET
Amaç: Bu çalışma, obstrüktif uyku apne sendromu (OUAS) olan hastalarda klinik, fizyolojik ve polisomnografik parametreleri incelemeyi ve Apne-Hipopne İndeksi (AHİ) varyasyonlarına göre pozisyonel ve pozisyonel olmayan vakaları karşılaştırmayı amaçlamaktadır. Gereç ve Yöntemler: Aralık 2023-Mayıs 2024 tarihleri arasında gece boyunca yapılan polisomnografi ile OUAS tanısı alan 46 hastanın tıbbi kayıtları retrospektif olarak incelendi. Hastalar, sırtüstü ve yan pozisyonlardaki AHİ farklılıklarına göre pozisyonel veya pozisyonel olmayan olarak sınıflandırıldı. Değerlendirilen parametreler demografik veriler, semptom yaygınlığı, OUAS şiddeti, polisomnografik veriler ve üst solunum yolu fizik muayene bulgularını içermektedir. Bulgular: Pozisyonel olmayan hastalar daha ciddi semptomlar göstermiş olup, Epworth Uykululuk Ölçeği skorları (13±4,6’ya karşı 8,18±3,21; p=0,032) ve tanıklı apne (%91’e karşı %43,5; p=0,023), uykusuzluk (%73,9’a karşı %21,7; p=0,002) ve sabah baş ağrısı (%78,3’e karşı %39; p=0,034) gibi semptomlar açısından daha yüksek prevalans göstermiştir. Nazal tıkanıklık, pozisyonel hastalarda daha sık görülmüştür (%65’e karşı %21,7; p=0,008) ve bu grup daha yüksek uyku etkinliği göstermiştir (%85,69±7,25’e karşı %69,79±11,23; p=0,003). Şiddetli OUAS, pozisyonel olmayan hastalarda daha sık görülmüştür (%65’e karşı %22; p=0,003). AHİ değerleri, hem genel olarak (65,49±20,49’a karşı 29,56±15,23; p=0,000) hem de sırtüstü/yan pozisyonlarda pozisyonel olmayan hastalarda anlamlı derecede daha yüksektir. Sonuç: Bu çalışma, pozisyonel ve pozisyonel olmayan OUAS hastaları arasında belirgin klinik ve polisomnografik farklılıkları vurgulamaktadır; pozisyonel tedavinin pozisyonel vakalarda yarar sağlayabileceğini, pozisyonel olmayan hastaların ise daha kapsamlı bir tedaviye ihtiyaç duyabileceğini önermektedir.
KAYNAKLAR
  1. Goyal M, Johnson J. Obstructive sleep apnea diagnosis and management. Mo Med. 2017;114(2):120-4. [PubMed]  [PMC] 
  2. Lv R, Liu X, Zhang Y, Dong N, Wang X, He Y, et al. Pathophysiological mechanisms and therapeutic approaches in obstructive sleep apnea syndrome. Signal Transduct Target Ther. 2023;8(1):218. [Crossref]  [PubMed]  [PMC] 
  3. Sforza E, Roche F, Chapelle C, Pichot V. Internight variability of apnea-hypopnea index in obstructive sleep apnea using ambulatory polysomnography. Front Physiol. 2019;10:849. [Crossref]  [PubMed]  [PMC] 
  4. Ozeke O, Erturk O, Gungor M, Hızel SB, Aydın D, Celenk MK, et al. Influence of the right- versus left-sided sleeping position on the apnea-hypopnea index in patients with sleep apnea. Sleep Breath. 2012;16(3):617-20. [Crossref]  [PubMed] 
  5. Boyd SB, Upender R, Walters AS, Goodpaster RL, Stanley JJ, Wang L, et al. Effective Apnea-Hypopnea Index ("Effective AHI"): a new measure of effectiveness for positive airway pressure therapy. Sleep. 2016;39(11):1961-72. [Crossref]  [PubMed]  [PMC] 
  6. Kim WY, Hong SN, Yang SK, Nam KJ, Lim KH, Hwang SJ, et al. The effect of body position on airway patency in obstructive sleep apnea: CT imaging analysis. Sleep Breath. 2019;23(3):911-6. [Crossref]  [PubMed] 
  7. Richard W, Kox D, den Herder C, Laman M, van Tinteren H, de Vries N. The role of sleep position in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol. 2006;263(10):946-50. [Crossref]  [PubMed] 
  8. McNicholas WT. Obstructive sleep apnoea: focus on pathophysiology. Adv Exp Med Biol. 2022;1384:31-42. [Crossref]  [PubMed] 
  9. Verbraecken J, Dieltjens M, Op de Beeck S, Vroegop A, Braem M, Vanderveken O, et al. Non-CPAP therapy for obstructive sleep apnoea. Breathe (Sheff). 2022;18(3):220164. [Crossref]  [PubMed]  [PMC] 
  10. Srijithesh PR, Aghoram R, Goel A, Dhanya J. Positional therapy for obstructive sleep apnoea. Cochrane Database Syst Rev. 2019;5(5):CD010990. [Crossref]  [PubMed]  [PMC] 
  11. Yingjuan M, Siang WH, Leong Alvin TK, Poh HP. Positional therapy for positional obstructive sleep apnea. Sleep Med Clin. 2020;15(2):261-75. [Crossref]  [PubMed] 
  12. American Academy of Sleep Medicine. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Westchester, IL: American Academy of Sleep Medicine; 2007.
  13. American Academy of Sleep Medicine. The International Classification of Sleep Disorders: Diagnostic & Coding Manual. 2nd ed. Westchester, IL: American Academy of Sleep Medicine; 2005.
  14. Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-5. [Crossref]  [PubMed] 
  15. Stavrou VT, Astara K, Tourlakopoulos KN, Papayianni E, Boutlas S, Vavougios GD, et al. Obstructive sleep apnea syndrome: the effect of acute and chronic responses of exercise. Front Med (Lausanne). 2021;8:806924. [Crossref]  [PubMed]  [PMC] 
  16. Aliyeva A. Obstructive sleep apnea and circadian rhythms. Journal of the Ear Nose Throat and Head Neck Surgery. 2023;31(3):179-88. [Crossref] 
  17. Gunta SP, Jakulla RS, Ubaid A, Mohamed K, Bhat A, López-Candales A, et al. Obstructive sleep apnea and cardiovascular diseases: sad realities and untold truths regarding care of patients in 2022. Cardiovasc Ther. 2022;2022:6006127. [Crossref]  [PubMed]  [PMC] 
  18. Lavalle S, Masiello E, Iannella G, Magliulo G, Pace A, Lechien JR, et al. Unraveling the complexities of oxidative stress and inflammation biomarkers in obstructive sleep apnea syndrome: a comprehensive review. Life (Basel). 2024;14(4):425. [Crossref]  [PubMed]  [PMC] 
  19. Bjornsdottir E, Keenan BT, Eysteinsdottir B, Arnardottir ES, Janson C, Gislason T, et al. Quality of life among untreated sleep apnea patients compared with the general population and changes after treatment with positive airway pressure. J Sleep Res. 2015;24(3):328-38. [Crossref]  [PubMed]  [PMC] 
  20. Zhang Y, Xiao A, Zheng T, Xiao H, Huang R. The relationship between sleeping position and sleep quality: a flexible sensor-based study. Sensors (Basel). 2022;22(16):6220. [Crossref]  [PubMed]  [PMC] 
  21. Tantawy SA, Kamel DM, Alsayed N, Rajab E, Abdelbasset WK. Correlation between body mass index, neck circumference, and waist-hip ratio as indicators of obesity among a cohort of adolescent in Bahrain: a preliminary cross-sectional study. Medicine (Baltimore). 2020;99(17):e19950. [Crossref]  [PubMed]  [PMC] 
  22. Mohsenin V. Effects of gender on upper airway collapsibility and severity of obstructive sleep apnea. Sleep Med. 2003;4(6):523-9. [Crossref]  [PubMed] 
  23. Bonsignore MR, Saaresranta T, Riha RL. Sex differences in obstructive sleep apnoea. Eur Respir Rev. 2019;28(154):190030. [Crossref]  [PubMed]  [PMC] 
  24. Chang JL, Goldberg AN, Alt JA, Mohammed A, Ashbrook L, Auckley D, et al. International consensus statement on obstructive sleep apnea. Int Forum Allergy Rhinol. 2023;13(7):1061-82. [PubMed]  [PMC] 
  25. Akashiba T, Inoue Y, Uchimura N, Ohi M, Kasai T, Kawana F, et al. Sleep Apnea Syndrome (SAS) clinical practice guidelines 2020. Sleep Biol Rhythms. 2022;20(1):5-37. [Crossref]  [PubMed]  [PMC] 
  26. Zonato AI, Bittencourt LR, Martinho FL, Júnior JF, Gregório LC, Tufik S. Association of systematic head and neck physical examination with severity of obstructive sleep apnea-hypopnea syndrome. Laryngoscope. 2003;113(6):973-80. [Crossref]  [PubMed] 
  27. Teculescu D, Hannhart B, Cornette A, Montaut-Verient B, Virion JM, Michaely JP. Prevalence of habitual snoring in a sample of French males. Role of "minor" nose-throat abnormalities. Respiration. 2001;68(4):365-70. [Crossref]  [PubMed] 
  28. Suratt PM, Turner BL, Wilhoit SC. Effect of intranasal obstruction on breathing during sleep. Chest. 1986;90(3):324-9. [Crossref]  [PubMed] 
  29. Tagaya M, Nakata S, Yasuma F, Noda A, Morinaga M, Yagi H, et al. Pathogenetic role of increased nasal resistance in obese patients with obstructive sleep apnea syndrome. Am J Rhinol Allergy. 2010;24(1):51-4. [Crossref]  [PubMed] 
  30. Pevernagie DA, De Meyer MM, Claeys S. Sleep, breathing and the nose. Sleep Med Rev. 2005;9(6):437-51. [Crossref]  [PubMed] 
  31. Scharf MT. Reliability and efficacy of the epworth sleepiness scale: is there still a place for it? Nat Sci Sleep. 2022;14:2151-6. [Crossref]  [PubMed]  [PMC] 
  32. Mador MJ, Kufel TJ, Magalang UJ, Rajesh SK, Watwe V, Grant BJ. Prevalence of positional sleep apnea in patients undergoing polysomnography. Chest. 2005;128(4):2130-7. [Crossref]  [PubMed] 
  33. de Vries GE, Hoekema A, Doff MH, Kerstjens HA, Meijer PM, van der Hoeven JH, et al. Usage of positional therapy in adults with obstructive sleep apnea. J Clin Sleep Med. 2015;11(2):131-7. [Crossref]  [PubMed]  [PMC] 
  34. Maurer JT, Stuck BA, Hein G, Verse T, Hörmann K. Schlafapnoetherapie mit einer neuartigen Rückenlage-Verhinderungs-Weste [Treatment of obstructive sleep apnea with a new vest preventing the supine position]. Dtsch Med Wochenschr. 2003;128(3):71-5. German. [Crossref]  [PubMed] 
  35. Martinho FL, Tangerina RP, Moura SM, Gregório LC, Tufik S, Bittencourt LR. Systematic head and neck physical examination as a predictor of obstructive sleep apnea in class III obese patients. Braz J Med Biol Res. 2008;41(12):1093-7. [Crossref]  [PubMed] 
  36. Goranović T, Milić M, Nesek Adam V, Šimunjak B. Assessment of standard anthropometric airway characteristics relevant for airway management of patients with obstructive sleep apnea syndrome during sleep breathing disorder surgery: a retrospective, single center study. Acta Clin Croat. 2023;62(Suppl1):21-8. [Crossref]  [PubMed]  [PMC] 
  37. Bins S, Koster TD, de Heij AH, de Vries AC, van Pelt AB, Aarts MC, et al. No evidence for diagnostic value of Mallampati score in patients suspected of having obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg. 2011;145(2):199-203. [Crossref]  [PubMed]