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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 FREE TO VIEW

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.

Figures in this Article

The effect of body position during sleep on the severity of obstructive sleep apnea (OSA) is a well known phenomenon. Several studies carried out by Cartwright and collaborators12 have clearly shown that by avoiding the supine (Sup) position, there is often a significant decrease in the number and the severity of OSA episodes. Those authors defined OSA patients in whom the respiratory disturbance index (RDI) was more than twice as high in the Sup position than it was in the lateral (Lat) position as positional patients (PP).1,3Different authors have demonstrated not only that avoidance of the Sup posture during sleep dramatically reduces the appearance of OSA episodes, but that in some cases, this may be the only type of treatment needed to prevent the appearance of these breathing pauses during sleep.4The prevalence of PP in OSA patients varies from about 9%5 to 60%.3 We recently showed, in a large number of adult patients who received OSA diagnoses in our Sleep Disorders Unit, that 55.9% were PP.6These PP were thinner and younger than nonpositional patients (NPP), averaging 6.5 kg less and 2.0 years younger than NPP. Their breathing abnormality indexes were less severe than those in the NPP group. Consequently, they had better preserved sleep quality than NPP. These findings were also reflected in the multiple sleep latency test data, which showed that the NPP group had shorter sleep latencies than the PP group. A typical PP may resolve his breathing abnormalities during sleep merely by avoiding the Sup posture. On the contrary, NPP have breathing abnormalities in both the Sup and Lat postures, producing a disease with a higher degree of severity. For them, the treatment of choice is without question nasal continuous positive airway pressure (nCPAP). The use of nCPAP in the treatment of OSA patients has become widespread since its introduction in 19817and is generally considered to be the treatment of choice for moderate to severe OSA patients. The titration of the nCPAP pressure is a common procedure in every sleep disorders unit. Despite the fact that expert committees recommend that sleep position be taken into consideration when titrating optimal nCPAP pressures,8 little information is available on the actual influence of body position on these pressures.

The aim of this study was to estimate the impact that body position has on the titration of the optimal nCPAP (op-nCPAP) for the successful treatment of OSA patients and to evaluate how rapid eye movements (REM) and non-REM (NREM) sleep, body mass index (BMI), RDI, and age are related to the relationship between op-nCPAP and body posture during sleep.

Subjects

All of the patients were referred to the Sleep Disorders Unit at the Loewenstein Hospital Rehabilitation Center, Raanana because of snoring complaints and/or a suspicion of OSA. They had a polysomnographic (PSG) evaluation in which they were found to suffer from OSA with a degree of severity from moderate to severe (RDI ≥ 20) and agreed to undergo an nCPAP titration test.

The data on 83 consecutive OSA patients who underwent a complete nCPAP titration evaluation in our Sleep Disorders Unit between March 1991 and March 1994 were assessed. The titration nCPAP test was usually performed the night following the diagnostic PSG evaluation, but in some cases, the test was performed within 1 or 2 weeks after the diagnostic evaluation. The group included only six female OSA patients. In the total group, the mean ± SD for age was 53.08 ± 10.6 years, for BMI was 33.01 ± 5.59, and for RDI was 62.5 ± 23.3.

PSG Recordings

The patients arrived at the sleep unit around 8:00 pm, and the PSG recordings usually began between 10:00 pm and midnight. The PSG recordings were carried out using polygraphs (Nihon Koden 4321 and 4414; Nihon Koden; Tokyo, Japan) and included the parameters that have been detailed elsewhere.6 The recordings were carried out at a paper speed of 10 mm/s, and sleep stages were scored according to the standard.9

Changes in body position were marked in the polygraph and in a chart recorder by the PSG technician who followed the patient’s behavior through a closed-circuit TV monitor.

Apnea was defined as an episode of complete breathing cessation of≥ 10 s. Hypopneas were considered as such if a partial breathing cessation (> 20% reduction in oral/nasal airflow compared with the level of the previous five breaths) occurred accompanied either by a drop of arterial oxygen saturation of at least 3% or by an arousal event. The apnea index and the RDI were calculated as the number of apneas per sleep hour and the number of apneas plus hypopneas per sleep hour, respectively. Arousals were scored according to accepted definitions.10

The CPAP system (Companion 318 unit; Puritan-Bennet; Lenexa, KS) used during the titration test was designed for clinical use, and it had a remote control unit connected to the polygraph. All of the op-nCPAP values are expressed in centimeters of H2O.

CPAP Titration Protocol

During the patients’ initial interview, they received the first explanation about the way the CPAP machine works and about the pros and cons of this type of treatment. Additional information about CPAP was provided during the summary meeting in which the patients received a detailed explanation of the results of the diagnostic PSG evaluation. Before beginning the nCPAP titration test, the PSG technician showed the patient the CPAP unit and the different types of masks available and explained how the mask with the headgear would be fitted. In addition, an adaptation trial of about 15 to 20 min was carried out with the CPAP unit running while the patient was sitting awake and relaxed. This procedure was always carried out in order to allow the patients to understand the way the system works and to adjust to it more easily.

The op-nCPAP level was defined as the minimal pressure that overcame apneas, hypopneas, and the arousals related to these breathing abnormalities, as well as the stabilizing arterial oxygen saturation levels. The op-nCPAP overcame snoring in most of the cases, but in some cases, a light snoring sound was heard. The op-nCPAP was titrated for the Sup and Lat body positions and in the different sleep stages. The op-nCPAP was defined as the minimum pressure that eliminated the above mentioned breathing abnormalities and that, by decreasing it, caused the reappearance of some of these breathing abnormalities.

Data Analysis

The comparison of op-nCPAP values between the Sup and Lat postures according to REM and NREM sleep, BMI, RDI, and age was carried out by using a simple or two-tailed paired Student’s t test. For the comparison between different BMI categories, analysis of variance (ANOVA) for unweighted means was used. Differences between the means were tested by using Scheffe’s post hoc test. All of the values are expressed as mean ± SD. A p value < 0.05 was considered significant. Data analysis was performed by using a statistical package (SAS Version 6.12; SAS Institute; Cary, NC).

In 3 of the 83 OSA patients (3.6%), op-nCPAP values could not be obtained during the titration test due to difficulties in adapting to the device. A group of 60 patients (72.3%) spent at least 30 min of sleep in both the Sup and Lat positions, and data of op-nCPAP for both positions were obtained. The comparison of the mean op-nCPAP values between the Sup and Lat postures, as well as the assessment of the effect of BMI, RDI, and age on op-nCPAP according to body position, were also performed in this group. For this group, mean ± SD for age was 52.4 ± 10.0 years, for BMI was 32.9 ± 5.52, and for RDI was 61.2 ± 23.3.

As seen in Figure 1 , in most of the 60 OSA patients (86.7%), the op-nCPAP levels were obtained when the patients slept in the Sup posture. In five patients (8.3%), the op-nCPAP level was the same in both postures, and in only three patients (5.0%), the op-CPAP level was higher in the Lat position.

Table 1 summarizes the effect of REM and NREM sleep, BMI, RDI, and age on the op-nCPAP according to body postures. For the whole group of 60 OSA patients, the mean op-nCPAP in the Sup position was significantly higher than it was in the Lat position (t = 10.52; p < 0.0001).

A group of 46 patients (55.4%) had op-nCPAP data in both positions and in both REM and NREM sleep. For this group, mean ± SD for age was 53.4 ± 9.77 years, for BMI was 33.3 ± 5.66, and for RDI was 58.6 ± 23.1. Also in this group, the mean op-nCPAP in the Sup position was significantly higher than it was in the Lat position irrespective of the sleep stages (10.14 ± 2.29 vs 7.77 ± 2.79; t = 10.42; p < 0.0001).

The effect of REM and NREM on op-nCPAP in these patients is shown in Table 1. The op-nCPAP was significantly higher in the Sup posture than it was in the Lat posture in both REM (t = 9.90; p < 0.0001) and NREM (t = 10.06; p < 0.0001) sleep. In addition, the op-nCPAP was significantly higher in REM sleep than it was in NREM sleep in both the Sup (t = 5.69; p < 0.0001) and Lat positions (t = 5.36; p < 0.0001). Thus, the sequence from highest to lowest op-nCPAP values was as follows: Sup REM > Sup NREM > Lat REM > Lat NREM.

The effect of BMI on op-nCPAP is also seen in Table 1 and Figure 2 . In Table 1, it can be seen that the op-nCPAP was significantly higher in the Sup position than it was in the Lat position in both the obese group (BMI ≥ 30; N = 39; t = 8.14; p < 0.0001) and the nonobese group (BMI < 30; N = 20; t = 6.24; p < 0.0001). Also, the op-nCPAP level was significantly higher in the obese group than it was in the nonobese group in both the Sup (t = 2.94; p < 0.0047) and Lat (t = 2.63; p < 0.010) positions. Thus, the sequence from highest to lowest op-nCPAP values was as follows: Sup obese > Sup nonobese > Lat obese > Lat nonobese. When the group was divided into four BMI categories (Fig 2) (1. BMI ≤ 30, N = 20; 2. BMI, 30 to 34.9, N = 19; 3. BMI, 35 to 39.9, N = 14; and 4. BMI> 40, N = 6), it was found that as BMI increased, the op-nCPAP also increased significantly for the Sup posture (ANOVA, F3,55 = 5.73; p < 0.0017) and for the Lat posture (ANOVA, F3,55 = 6.07; p < 0.001), but the differences between the means (Scheffe’s post hoctest) were significant in the Sup posture only between categories 1 and 4 (p < 0.05) and in the Lat posture between categories 1, 2, and 3 and category 4 (p < 0.05). For the three less severe BMI categories (categories 1, 2, and 3), the op-nCPAP was significantly higher in the Sup position than it was in the Lat position (t = 6.24, p < 0.0001; t = 6.27, p < 0.0001; and t = 5.24, p < 0.0002, respectively). The difference in op-nCPAP between Sup and Lat positions in the most severe BMI category was not statistically significant (t = 2.39; p < 0.062). The effect of RDI is also seen in Table 1. For the RDI ≥ 40 group (N = 47), as well as for the RDI < 40 group (N = 12), the op-nCPAP values were significantly higher in the Sup position (t = 8.63; p < 0.0001) than they were in the Lat position (t = 6.27; p < 0.0001). However, in the group with severe RDI (RDI ≥ 40) compared to the less severe group (RDI < 40), the op-nCPAP was significantly higher (t = 2.61; p < 0.013) only for the Sup posture.

The effect of age is also seen in Table 1. Similar to the effect observed for BMI and RDI, in both the older and in the younger group, the op-nCPAP was significantly higher in the Sup position (t = 7.83; p < 0.0001) than it was in the Lat posture (t = 7.82; p < 0.0001). No differences were obtained between the op-nCPAP in the two age categories. op-nCPAP in the Sup and Lat postures was similar for OSA patients ≥ 60 years old (N = 18) and patients< 60 years old (N = 42).

It is noteworthy that irrespective of the four parameters studied, the actual differences in op-nCPAP between the two body postures were almost identical, ranging between 2.31 and 2.66 cm H2O.

In this study, we have shown that in the great majority of moderate to severe OSA patients (86.7%) who agreed to have a CPAP titration, the op-nCPAP pressure needed to prevent their sleep-related breathing abnormalities was determined when the patient slept in the Sup position. It was also found that the mean op-nCPAP obtained in the Sup posture was significantly higher than that it was in the Lat posture. This body posture effect was seen consistently in REM and NREM sleep, for different levels of BMI and RDI, and for OSA patients> and < 60 years old. Unrelated to the above parameters, the differences in op-nCPAP between the Sup and Lat postures were similar, ranging between 2.31 and 2.66 cm H2O. Thus, irrespective of the above parameters, the Sup sleep posture is a major determinant of the op-nCPAP for OSA patients.

Our results are not surprising, however, since the detrimental effect of the Sup posture on the incidence and severity of breathing abnormalities during sleep has been well described.1 In addition, the results of this study provide more evidence that shows that there is a greater upper airway resistance1112 and greater tendency for the upper airway to collapse1314 in the Sup position than there is in the Lat position during sleep.

We found that the op-nCPAP was higher in the Sup position in both REM and NREM sleep, and it presents the following sequence: Sup REM > Sup NREM > Lat REM > Lat NREM. These data confirm the data of Issa and Sullivan.13 This effect is probably due to the marked atonia characterizing REM sleep, which results in an increased upper airway resistance.

Patients with higher BMIs, as well as those with higher RDIs, require higher op-nCPAP values to eliminate their breathing abnormalities than the less severe ones do, but here again, the Sup position played a dominant role. Similar data have been obtained by others.15 No differences in op-nCPAP were seen in OSA patients who were < or > 60 years of age, but as for BMI and RDI, in both groups of patients the op-nCPAP was higher in the Sup position than it was in the Lat position. Thus, irrespective of the BMI, RDI, and age, in order to recommend an adequate op-nCPAP, the nCPAP titration test must include the evaluation of the patient in the Sup position and during REM sleep.

The significant differences between the op-nCPAP in the Lat vs the Sup position, together with the differences in the op-nCPAP needed to overcome the breathing abnormalities during REM vs NREM sleep, could be used as a strong argument for the use of “smart” CPAP machines, which adapt the pressure according to the different needs of the OSA patients.16

Only a few articles have investigated the effect of body position on op-nCPAP.

Pevernagie and Shepard,17 in a retrospective study of 100 OSA patients, compared the op-nCPAP (which they defined as the pressure that eliminated sleep-disordered breathing events and snoring in the Sup position) in 79 patients. Forty-nine PP (62%) had a lower op-nCPAP (8.0 ± 2.2) than the 30 NPP (38%; 9.1 ± 1.8). This difference between PP and NPP was significant but small. This small difference is not surprising since the RDI in the back posture was similar for both groups of patients, and by definition, the op-nCPAP level was that pressure that overcame the breathing abnormalities in the Sup posture. Unfortunately, not enough data were available for the comparison of the op-nCPAP in the Lat posture.

Neill et al14 compared the upper airway closing pressure (UACP), which is the mean of the minimum pressures generated in the last two breaths before an arousal occurred in a nasal occlusion test, and the upper airway opening pressure (UAOP), which is the minimal CPAP required to prevent apneas and hypopneas, in eight obese males with severe OSA in three postures (Sup, Sup elevated to 30°, and Lat) during NREM sleep. They found that the upper airway became less collapsible (reduced UACP) and easier to open (reduced UAOP) in the 30° elevated posture compared with the Sup sleep posture. Compared to the Sup posture, the Lat posture had a similar UACP but did allow the upper airway to open more easily (reduced UAOP). Both the elevation and Lat positioning produced a reduction of about 50% in the therapeutic CPAP pressure compared to the Sup posture. The eight patients in this study were obese and had severe OSA, and six were found to be nonpositional. It would be interesting to carry out a similar study that uses the same protocol but investigates only positional OSA patients. It would be expected that in this population, the adoption of the Lat posture would demonstrate a significant improvement in UACP. This study and the previous one from the same group18 showed that adopting the reclining sitting position produced a significant improvement of breathing function during sleep. These studies demonstrate again that changes in body posture during sleep have important therapeutic implications for patients with breathing disorders.

Issa and Sullivan13described three OSA patients in whom the UACP was significantly lower in the Sup posture compared to the Lat position in all sleep stages. Although details of the weight and severity of these patients was not provided, it appears that they were less obese than the patients of Neill et al.14 As a result, it is probable that they were positional OSA patients, which would explain the differences in the results.

One limitation of our study is that during the nCPAP titration test, we did not monitor upper airway resistance, and it is probable that if an oesophageal pressure sensor were used, the op-nCPAP values would have been a little different. Also, recent data have shown that after the disappearance of arousal caused by apneas, hypopneas, and snoring, there is still high negative intrathoracic pressure with limited inspiratory flow. Thus, if the end point of an adequate nCPAP titration is to reach a normal oesophageal pressure or the normal contour shape of the inspiratory flow, higher CPAP pressures will probably be needed.1920 Nevertheless, in the present study, the same protocol was used for all of the OSA patients investigated so that the differences observed for op-nCPAP between the Sup and Lat postures and the effects of REM and NREM sleep, BMI, RDI, and age on the patients were independent of this mentioned limitation.

We recently6 demonstrated in a large population of OSA patients that PP represent more than one half of the patients who received OSA diagnoses in our Sleep Disorders Unit. These OSA patients have, in most of the cases, a mild to moderate form of the disease since they have the Lat posture for sleep, in which the number of breathing abnormalities is significantly much less than it is in the Sup posture. However, the critical issue is that the severity of the disease of these PP is markedly related to the amount of sleep spent or not spent in the Sup position. Sometimes a total absence of these breathing disturbances are observed in the Lat posture, and for those cases and those patients who have an RDI < 10 in the Lat posture, avoiding the Sup position during sleep (positional therapy) represents a valuable and effective form of therapy.

In addition, we showed21in a group of 13 positional OSA patients that avoiding the Sup position during sleep for 1 month caused a significant reduction in 24 h BP values in hypertensive and normotensive patients. Based on these results, we argue that since about 30 to 40% of all essential hypertensive patients have OSA, and since more than one half of OSA patients are positional, avoiding the Sup position during sleep could, if verified by larger studies, become a new nonpharmacologic treatment for many hypertensive patients. The results of the previous studies, together with the results obtained in the present study, clearly demonstrate the detrimental impact that the Sup posture has on breathing function during sleep. It is not completely clear by which mechanism the Sup posture produces a deleterious effect on the upper airway during sleep, but most of the evidence reported up to now suggests that the gravitational factor is the most dominant element responsible for this effect.22 However, it is still not clear what the relative contribution of anatomic and physiologic components is to this effect. Further data on the effect of the Sup posture on breathing function during sleep have been recently reviewed.23

In summary, this study has shown that, for most of the OSA patients who underwent a nCPAP titration evaluation, the recommended op-nCPAP was obtained during sleep in the Sup posture. The mean op-nCPAP for the Sup posture was significantly higher than that for the Lat posture. The op-nCPAP was higher in the Sup posture in both REM and NREM sleep. OSA patients with a higher BMI required higher op-nCPAP, but for both obese and nonobese OSA patients, the op-nCPAP was higher in the Sup posture. The op-nCPAP was higher in the most severe RDI group compared with the less severe RDI group but again, for both groups, the op-nCPAP values were higher in the Sup position than they were in the Lat position. OSA patients < and > 60 years of age had similar op-nCPAP, but in both groups, the op-nCPAP was higher in the Sup posture than it was in the Lat posture.

These results demonstrate that body position has a profound effect, not only on the occurrence and severity of breathing abnormalities during sleep, but also on the adequate titration of the op-nCPAP. Since OSA patients may change their body posture several times during the night, these results also support the use of “smart” CPAP machines, which have the capability to adapt the op-nCPAP to the needs of the patient.

Abbreviations: ANOVA = analysis of variance; BMI = body mass index; CPAP = continuous positive airway pressure; Lat = lateral; nCPAP = nasal continuous positive airway pressure; NREM = non-rapid eye movements sleep; NPP = nonpositional patients; op-nCPAP = optimal nCPAP; OSA = obstructive sleep apnea; PP = positional patients; PSG = polysomnographic; RDI = respiratory disturbance index; REM = rapid eye movements sleep; Sup = supine; UACP = upper airway closing pressure; UAOP = upper airway opening pressure

Figure Jump LinkFigure 1. The effect of body posture on op-nCPAP. In most of the moderate to severe OSA patients who underwent a nCPAP titration evaluation, the recommended op-nCPAP was obtained while the patients slept in the supine posture.Grahic Jump Location
Table Graphic Jump Location
Table 1. The Effect of Body Posture on op-nCPAP: Relationship With REM-NREM Sleep, BMI, RDI, and Age*
* 

Values are mean (± SD). The op-nCPAP values are in centimeters of H2O. The total group includes 60 moderate to severe OSA patients. The comparison of op-nCPAP data for REM and NREM sleep, BMI, RDI, and age was obtained from 46 OSA patients who had data in both positions during REM and NREM sleep.

 

p < 0.0001.

 

p < 0.0047.

§ 

p < 0.013.

 

Not significant.

 

p < 0.010.

Figure Jump LinkFigure 2. Effect of the BMI on op-nCPAP: for the three less severe BMI categories (1. BMI ≤ 30, N = 20; 2. BMI, 30 to 34.9, N = 19; and 3. BMI, 35 to 39.9, N = 14), the Sup op-nCPAP was significantly higher than the Lat op-nCPAP. However, in the most severe BMI category (4. BMI > 40, N = 6), the op-nCPAP in the Sup and Lat postures were not significantly different. As the BMI categories increased in severity, the op-nCPAP increased for the Sup posture (ANOVA, F3,55 = 5.73; p < 0.0017) and the Lat posture (ANOVA, F 3,55 = 6.07; p < 0.0012), but Scheffe’s post hoc test demonstrated that the differences were only significant between Sup category 1 vs category 4 (p < 0.05) and between Lat categories 1, 2, and 3 vs category 4 (p < 0.05; see text). Values are mean ± SD.Grahic Jump Location

We would like to thank Dorit Vigiser for her advice and assistance in the statistical analysis, Eyal Shuval for preparing the figures, Yael Pasternak for collecting the data during the first part of this research, and the technical team of the Sleep Disorders Unit at the Loewenstein Hospital Rehabilitation Center for the dedicated and responsible work that they performed.

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Figures

Figure Jump LinkFigure 1. The effect of body posture on op-nCPAP. In most of the moderate to severe OSA patients who underwent a nCPAP titration evaluation, the recommended op-nCPAP was obtained while the patients slept in the supine posture.Grahic Jump Location
Figure Jump LinkFigure 2. Effect of the BMI on op-nCPAP: for the three less severe BMI categories (1. BMI ≤ 30, N = 20; 2. BMI, 30 to 34.9, N = 19; and 3. BMI, 35 to 39.9, N = 14), the Sup op-nCPAP was significantly higher than the Lat op-nCPAP. However, in the most severe BMI category (4. BMI > 40, N = 6), the op-nCPAP in the Sup and Lat postures were not significantly different. As the BMI categories increased in severity, the op-nCPAP increased for the Sup posture (ANOVA, F3,55 = 5.73; p < 0.0017) and the Lat posture (ANOVA, F 3,55 = 6.07; p < 0.0012), but Scheffe’s post hoc test demonstrated that the differences were only significant between Sup category 1 vs category 4 (p < 0.05) and between Lat categories 1, 2, and 3 vs category 4 (p < 0.05; see text). Values are mean ± SD.Grahic Jump Location

Tables

Table Graphic Jump Location
Table 1. The Effect of Body Posture on op-nCPAP: Relationship With REM-NREM Sleep, BMI, RDI, and Age*
* 

Values are mean (± SD). The op-nCPAP values are in centimeters of H2O. The total group includes 60 moderate to severe OSA patients. The comparison of op-nCPAP data for REM and NREM sleep, BMI, RDI, and age was obtained from 46 OSA patients who had data in both positions during REM and NREM sleep.

 

p < 0.0001.

 

p < 0.0047.

§ 

p < 0.013.

 

Not significant.

 

p < 0.010.

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