The effects of the Thai traditional triangle cushion in treating positional obstructive sleep apnea: A pilot study

Objectives: Positional obstructive sleep apnea (POSA) is common and affects sleep quality. This study was to identify the efficacy of using a Thai traditional triangle cushion as a position device for therapy in POSA. Methods: This open-label, self-control, prospective intervention study enrolled adult patients with POSA. The 8-weeks positional advice was performed, followed by 8-weeks using a Thai triangle cushion. Study outcomes were to measure changes in Epworth sleepiness scale (ESS) scores and 36-Item Short Form Health Survey (SF-36) and problems/complaints during the study. Results: There were 10 patients enrolled in total, with a mean age of 55.8 years old (SD 11.3), with an average apnea-hypopnea index (AHI) of 26.1, a supine AHI of 35.3, a non-supine AHI of 8.6 and the average baseline ESS was 10 (SD3.5). The positional advice did not improve the ESS score from baseline [the mean difference in ESS score of +0.20 (95%CI-2.01 to 2.41, p-value 0.84)]. Using cushion intervention significantly reduced the ESS score from baseline [-3.6 (95%CI-5.00 to-2.20), p-value<0.001]. The period of using a cushion (intervention) also significantly reduced the ESS score when compared with the period of positional advice (control), with an ESS reduction of -3.8 (95%CI-6.47 to-1.13), p-value 0.011. The quality of life is improved only during the period of using a cushion. There were no complaints from the patients related to positional advice or using the intervention cushion. Conclusions: The Thai traditional triangle cushion, as a positional device in treating patients with positional obstructive sleep apnea, is effective and comfortable.

Assessment of Nocturnal Autonomic Cardiac Imbalance in Positional Obstructive Sleep Apnea. A Multiscale Nonlinear Approach

Positional obstructive sleep apnea (POSA) is a major phenotype of sleep apnea. Supine-predominant positional patients are frequently characterized by milder symptoms and less comorbidity due to a lower age, body mass index, and overall apnea-hypopnea index. However, the bradycardia-tachycardia pattern during apneic events is known to be more severe in the supine position, which could affect the cardiac regulation of positional patients. This study aims at characterizing nocturnal heart rate modulation in the presence of POSA in order to assess potential differences between positional and non-positional patients. Patients showing clinical symptoms of suffering from a sleep-related breathing disorder performed unsupervised portable polysomnography (PSG) and simultaneous nocturnal pulse oximetry (NPO) at home. Positional patients were identified according to the Amsterdam POSA classification (APOC) criteria. Pulse rate variability (PRV) recordings from the NPO readings were used to assess overnight cardiac modulation. Conventional cardiac indexes in the time and frequency domains were computed. Additionally, multiscale entropy (MSE) was used to investigate the nonlinear dynamics of the PRV recordings in POSA and non-POSA patients. A total of 129 patients (median age 56.0, interquartile range (IQR) 44.8–63.0 years, median body mass index (BMI) 27.7, IQR 26.0–31.3 kg/m2) were classified as POSA (37 APOC I, 77 APOC II, and 15 APOC III), while 104 subjects (median age 57.5, IQR 49.0–67.0 years, median BMI 29.8, IQR 26.6–34.7 kg/m2) comprised the non-POSA group. Overnight PRV recordings from positional patients showed significantly higher disorderliness than non-positional subjects in the smallest biological scales of the MSE profile (τ = 1: 0.25, IQR 0.20–0.31 vs. 0.22, IQR 0.18–0.27, p < 0.01) (τ = 2: 0.41, IQR 0.34–0.48 vs. 0.37, IQR 0.29–0.42, p < 0.01). According to our findings, nocturnal heart rate regulation is severely affected in POSA patients, suggesting increased cardiac imbalance due to predominant positional apneas.

Drug-Induced Sleep Endoscopy in Children With Positional Obstructive Sleep Apnea

Objective Positional obstructive sleep apnea (POSA)—defined as obstructive sleep apnea twice as severe supine than nonsupine—may offer clues to the underlying pattern of upper airway collapse in children. We compared drug-induced sleep endoscopy (DISE) findings in children with and without POSA. We hypothesized that children with POSA would have significantly higher obstruction at the gravity-dependent palate and tongue base but not at the adenoid, lateral wall, or supraglottis. Study Design Retrospective case series. Setting Tertiary pediatric hospital. Subjects and Methods We included children aged 1 to 12 years with obstructive sleep apnea diagnosed by polysomnography who underwent DISE from July 2014 to February 2019. Scores were dichotomized as ≥50% obstruction (Chan-Parikh 2 or 3) vs <50% obstruction (Chan-Parikh 0 or 1). Results Of 99 children included, 32 (32%) had POSA and 67 (68%) did not. Children with POSA did not differ from children without POSA in age, overall apnea-hypopnea index, sex, race, syndromic diagnoses, obesity, or history of adenotonsillectomy. In logistic regression models, odds of ≥50% obstruction were significantly higher at the tongue base (odds ratio, 2.77; 95% CI, 1.04-7.39) after adjustment for age, sex, obesity, previous adenotonsillectomy, and syndrome. No difference was noted at the adenoid, velum, lateral wall, or supraglottis. Conclusion POSA was associated with higher odds of obstruction on DISE at the tongue base but not at other levels.