不同睡眠体位对阻塞性睡眠呼吸暂停严重程度的影响：一项回顾性研究

文献信息

中文摘要

引言： 阻塞性睡眠呼吸暂停是心血管疾病的危险因素。体位性睡眠呼吸暂停是阻塞性睡眠呼吸暂停的一种亚型，其严重程度受患者睡眠体位影响。既往研究比较了仰卧位与非仰卧位；右侧卧位与左侧卧位的影响仍存疑问。我们的目的是研究和比较不同睡眠体位下阻塞性睡眠呼吸暂停的严重程度。
方法： 我们开展了一项回顾性、单中心研究，纳入338例成人患者（年龄≥18岁），这些患者在2023年1月至2025年1月期间于一家门诊社区诊所通过家庭睡眠监测检查被诊断为阻塞性睡眠呼吸暂停。采用线性混合效应模型进行统计分析。
结果： 参与者的平均年龄为55.29岁，平均AHI为29.54。仰卧位与俯卧位相比，AHI更高（校正模型SE=1.06，p=0.001）。然而，不同患者之间左侧位与右侧位无显著差异（p=0.327），同一患者内也无显著差异（SE 1.31，P 0.65）。比较出现时间超过20%的睡眠体位显示，仰卧位与右侧卧位相比，AHI显著更高（CI 15.08-20.61；P<0.001），与左侧卧位相比亦显著更高（95% CI 14.49-20.23；P<0.001）。左侧卧位与右侧卧位之间未发现显著差异（95% CI -2.64至3.61；P=0.762）。
结论： 右侧卧位与左侧卧位对睡眠呼吸暂停严重程度无统计学显著差异，而仰卧位与所有睡眠体位相比AHI最高。对于仰卧位为主的OSA患者，体位治疗仍是有效选择。建议进一步开展大规模研究，以比较每种睡眠体位下睡眠呼吸暂停的真实性质和严重程度。

英文摘要

INTRODUCTION: Obstructive sleep apnea is a risk factor for cardiovascular diseases. Positional sleep apnea is a subtype of obstructive sleep apnea where severity is influenced by the patient's sleeping position. Previous studies have compared supine to non-supine positions; the effect of right lateral versus left lateral position remains in question. Our objective is to study and compare the severity of obstructive sleep apnea across different sleeping positions.
METHODS: We conducted a retrospective, single-centered study on 338 adult patients (age ≥18 years) diagnosed with Obstructive Sleep Apnea on home sleep study test in the time period between January 2023 and January 2025 in an outpatient community clinic. Linear mixed-effects models were used for statistical analyses.
RESULTS: The mean age of the participants was 55.29 years, with an average AHI of 29.54. Supine position was associated with a higher AHI than prone position (Adjusted model SE= 1.06, p=0.001). However, there were no significant differences between left and right positions across different patients (p =0.327) nor within the same patient (SE 1.31, P 0.65). Comparing sleep positions that were observed more than 20% of the time showed that supine positioning was associated with a significantly higher AHI than right-lateral positioning (CI 15.08-20.61; P<0.001) and left-lateral positioning (95% CI 14.49-20.23; P<0.001). No significant difference was identified between left- and right-lateral positioning (95% CI -2.64 to 3.61; P=0.762).
CONCLUSION: There was no statistically significant difference between right lateral and left lateral positions on sleep apnea severity, whereas supine position had the highest AHI in comparison to all sleeping positions. Positional therapy remains a valid option for patients with supine‑predominant OSA. Further large scale studies are recommended to compare the true nature and severity of sleep apnea of each sleeping position.