Supine or Not? - Hidden Severity of Obstructive Sleep Apnea Depending on Position During Home Sleep Apnea Test

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

Sleep

Abstract

Introduction: Severity of obstructive sleep apnea (OSA) varies significantly in some patients based on position. Here we present a case of positional OSA (POSA) which was masked in a home sleep apnea test (HSAT) due to lack of considerable time in supine position. This led to multiple tests along with second opinion with us prior to the correct diagnosis and management. Report of case: A 74-year-old female presented to our sleep clinic for a second opinion on her OSA management. Initially, she was referred to outside sleep clinic by her cardiologist for suspected OSA, given snoring and new-onset Atrial Fibrillation. She underwent flow-based HSAT which revealed mild OSA with apnea hypopnea index (AHI) of 7.6/hour. She was given oral appliance with plan to repeat HSAT to determine efficacy. 6 months later, another flow-based HSAT with oral appliance revealed AHI of 17.8/hour. Given unexpected increase in AHI with oral appliance, outside sleep clinic performed another HSAT without oral appliance to confirm severity of OSA. Testing showed 90.5% supine sleep and AHI of 28/hour. After that test, patient sought second opinion with us. We reviewed earlier studies thoroughly and explained that she has POSA. She had a delay of proper care as supine AHI was not reviewed in HSAT interpretation. Patient wanted to avoid using continuous positive airway pressure (CPAP) device, so we recommended a repeat HSAT with oral appliance and positional therapy (PT). Flow-based HSAT with combined oral appliance and positional therapy showed AHI of 1.6/hour. Recently, a classification system called Amsterdam positional OSA classification (APOC) is proposed for POSA. According to that, polysomnograms must have minimum 10% of total sleep time in their best and worst sleeping position. Our patient met criteria for APOC II which requires that AHI in their best sleeping position to be in a lower severity category compared to worst sleeping position. Conclusion: Our case demonstrates the importance of reviewing sleeping position during sleep study interpretation as POSA may be masked by low supine sleep time. PT can be an effective first-line treatment in selective patients with POSA and supplemental treatment with oral appliance or CPAP in remaining patients with POSA.

Volume

48

Issue

Suppl 1

First Page

A646

Last Page

A647

Comments

39th Annual Meeting of the Associated Professional Sleep Societies, June 8-11, 2025, Seattle, WA

DOI

10.1093/sleep/zsaf090.1512

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