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Clinical Investigations: SLEEP AND BREATHING |

The Sleep Supine Position Has a Major Effect on Optimal Nasal Continuous Positive Airway Pressure : Relationship With Rapid Eye Movements and Non-Rapid Eye Movements Sleep, Body Mass Index, Respiratory Disturbance Index, and Age

Arie Oksenberg, PhD; Donald S. Silverberg, MD; Elena Arons, PhD; Henryk Radwan, MD
Author and Funding Information

From the Sleep Disorders Unit (Drs. Oksenberg, Arons, and Radwan), Loewenstein Hospital Rehabilitation, Raanana, Israel; and the Department of Nephrology (Dr. Silverberg), Tel-Aviv Medical Center, Tel-Aviv, Israel.

Correspondence to: Arie Oksenberg, PhD, Sleep Disorders Unit, Loewenstein Hospital Rehabilitation Center, POB 3 Raanana, Israel; e-mail: psycot3@post.tau.ac.il



Chest. 1999;116(4):1000-1006. doi:10.1378/chest.116.4.1000
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Study objectives: To evaluate the impact of sleep position on optimal nasal continuous positive airway pressure (nCPAP[ op-nCPAP]) in obstructive sleep apnea (OSA) patients and to investigate how rapid eye movements (REM) and Non-REM (NREM) sleep, body mass index (BMI), respiratory disturbance index (RDI), and age are related to this effect.

Design: Retrospective analysis.

Setting: Sleep Disorders Unit at Loewenstein Hospital Rehabilitation Center.

Patients: Eighty-three consecutive adult OSA patients who underwent a complete nCPAP titration. From this group, 60 patients who spent at least 30 min in both the supine (Sup) and lateral (Lat) positions and 46 patients who had data on both positions during REM and NREM sleep were included in the analysis.

Results: In most OSA patients (52; 86.7%), the recommended op-nCPAP was obtained when the patients slept in the Sup posture. The mean op-nCPAP was significantly higher in the Sup posture (10.00 ± 2.20 cm H2O) than it was in the Lat posture (7.61 ± 2.69 cm H2O). The op-nCPAP was significantly higher in the Sup position than it was in the Lat position in both REM and NREM sleep, as well as in the severe BMI group (BMI ≥ 30) and in the less obese group (BMI < 30). Similarly, in the severe (RDI ≥ 40) and less severe groups (RDI < 40), as well as in both age groups (< and> 60 years of age), the op-nCPAP was significantly higher in the Sup posture than it was in the Lat posture. Irrespective of the four parameters mentioned, the actual differences in op-nCPAP between the two body postures were almost identical, ranging between 2.31 and 2.66 cm H2O.

Conclusions: For most OSA patients, the op-nCPAP level is significantly higher in the Sup position than it is in the Lat position. This is true for REM and NREM sleep, for obese and nonobese patients, for patients with different degrees of severity, and for young and old OSA patients. Since the op-nCPAP was highest in the Sup posture during REM sleep, no nCPAP titration should be considered complete without the patient having slept in the Sup posture during REM sleep.

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