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Original Research: Sleep Disorders |

Elevated Upper Body Position Improves Pregnancy-Related OSA Without Impairing Sleep Quality or Sleep Architecture Early After DeliveryEffect of Body Elevation on Postpartum Sleep Apnea

Sebastian Zaremba, MD; Noomi Mueller, Cand Med; Anne M. Heisig, MD; Christina H. Shin, BA; Stefanie Jung, MD; Lisa R. Leffert, MD; Brian T. Bateman, MD; Lori J. Pugsley, RN, BSN; Yasuko Nagasaka, MD, PhD; Ingrid Moreno Duarte, MD; Jeffrey L. Ecker, MD; Matthias Eikermann, MD, PhD
Author and Funding Information

From the Department of Anesthesia, Critical Care, and Pain Medicine (Drs Zaremba, Heisig, Jung, Leffert, Bateman, Nagasaka, Moreno Duarte, and Eikermann and Mss Mueller and Shin) and the Department of Obstetrics and Gynecology (Ms Pugsley and Dr Ecker), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Sleep Medicine (Dr Zaremba), Department of Neurology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-University, Bonn, Germany; the Department of Pediatric Surgery (Dr Jung) and the Department of Pediatric Urology (Dr Jung), DRK-Kinderklinik Siegen, Teaching Hospital of Philipps University, Marburg, Germany; the Division of Pharmacoepidemiology and Pharmacoeconomics (Dr Bateman), Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA; and the Department of Anesthesia and Critical Care Medicine (Dr Eikermann), University Hospital Essen, University Duisburg-Essen, Essen, Germany.

CORRESPONDENCE TO: Matthias Eikermann, MD, PhD, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114; e-mail: meikermann@partners.org


Drs Zaremba and Heisig and Ms Mueller participated equally in preparing the manuscript.

FUNDING/SUPPORT: This study was funded by the Department of Anesthesia, Critical Care, and Pain Medicine at Massachusetts General Hospital, Boston and by an unrestricted research grant to Dr Eikermann from the Buzen fund, established by Jeffrey Buzen and Judith Buzen of Boston, Massachusetts.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(4):936-944. doi:10.1378/chest.14-2973
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BACKGROUND:  During pregnancy, upper airway resistance is increased, predisposing vulnerable women to pregnancy-related OSA. Elevation of the upper body increases upper airway cross-sectional area (CSA) and improves severity of OSA in a subgroup of nonpregnant patients (positional-dependent sleep apnea). We tested the hypothesis that elevated position of the upper body improves OSA early after delivery.

METHODS:  Following institutional review board approval, we conducted a randomized, crossover study on two postpartum units of Massachusetts General Hospital. Women during the first 48 h after delivery were included. Polysomnography was performed in nonelevated and 45° elevated upper body position. Upper airway CSA was measured by acoustic pharyngometry in nonelevated, 45° elevated, and sitting body position.

RESULTS:  Fifty-five patients were enrolled, and measurements of airway CSA obtained. Thirty patients completed polysomnography in both body positions. Elevation of the upper body significantly reduced apnea-hypopnea index (AHI) from 7.7 ± 2.2/h in nonelevated to 4.5 ± 1.4/h in 45° elevated upper body position (P = .031) during sleep. Moderate to severe OSA (AHI > 15/h) was diagnosed in 20% of postpartum patients and successfully treated by elevated body position in one-half of them. Total sleep time and sleep architecture were not affected by upper body elevation. Change from nonelevated to sitting position increased inspiratory upper airway CSA from 1.35 ± 0.1 cm2 to 1.54 ± 0.1 cm2 during wakefulness. Position-dependent increase in CSA and decrease in AHI were correlated (r = 0.42, P = .022).

CONCLUSIONS:  Among early postpartum women, 45° upper body elevation increased upper airway CSA and mitigated sleep apnea. Elevated body position might improve respiratory safety in women early after delivery.

TRIAL REGISTRY:  ClinicalTrials.gov; No.: NCT01719224; URL: www.clinicaltrials.gov

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