The impact of semi-upright position on severity of sleep disordered breathing in patients with obstructive sleep apnea: a two-arm, prospective, randomized controlled trial
Abstract Background The severity of sleep-disordered breathing is known to worsen postoperatively and is associated with increased cardio-pulmonary complications and increased resource implications. In the general population, the semi-upright position has been used in the management of OSA. We hypot...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-023-02193-y |
| _version_ | 1797778702545715200 |
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| author | Gincy A. Lukachan Azadeh Yadollahi Dennis Auckley Bojan Gavrilovic John Matelski Frances Chung Mandeep Singh |
| author_facet | Gincy A. Lukachan Azadeh Yadollahi Dennis Auckley Bojan Gavrilovic John Matelski Frances Chung Mandeep Singh |
| author_sort | Gincy A. Lukachan |
| collection | DOAJ |
| description | Abstract Background The severity of sleep-disordered breathing is known to worsen postoperatively and is associated with increased cardio-pulmonary complications and increased resource implications. In the general population, the semi-upright position has been used in the management of OSA. We hypothesized that the use of a semi-upright position versus a non-elevated position will reduce postoperative worsening of OSA in patients undergoing non-cardiac surgeries. Methods This study was conducted as a prospective randomized controlled trial of perioperative patients, undergoing elective non-cardiac inpatient surgeries. Patients underwent a preoperative sleep study using a portable polysomnography device. Patients with OSA (apnea hypopnea index (AHI) > 5 events/hr), underwent a sleep study on postoperative night 2 (N2) after being randomized into an intervention group (Group I): semi-upright position (30 to 45 degrees incline), or a control group (Group C) (zero degrees from horizontal). The primary outcome was postoperative AHI on N2. The secondary outcomes were obstructive apnea index (OAI), central apnea index (CAI), hypopnea index (HI), obstructive apnea hypopnea index (OAHI) and oxygenation parameters. Results Thirty-five patients were included. Twenty-one patients were assigned to the Group 1 (females-14 (67%); mean age 65 ± 12) while there were fourteen patients in the Group C (females-5 (36%); mean age 63 ± 10). The semi-upright position resulted in a significant reduction in OAI in the intervention arm (Group C vs Group I postop AHI: 16.6 ± 19.0 vs 8.6 ± 11.2 events/hr; overall p = 0.01), but there were no significant differences in the overall AHI or other parameters between the two groups. Subgroup analysis of patients with “supine related OSA” revealed a decreasing trend in postoperative AHI with semi-upright position, but the sample size was too small to evaluate statistical significance. Conclusion In patients with newly diagnosed OSA, the semi-upright position resulted in improvement in obstructive apneas, but not the overall AHI. Trial registration This trial was retrospectively registered in clinicaltrials.gov NCT02152202 on 02/06/2014. |
| first_indexed | 2024-03-12T23:21:19Z |
| format | Article |
| id | doaj.art-62a155a6f669486da8a54b5cee408798 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-03-12T23:21:19Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-62a155a6f669486da8a54b5cee4087982023-07-16T11:26:17ZengBMCBMC Anesthesiology1471-22532023-07-0123111010.1186/s12871-023-02193-yThe impact of semi-upright position on severity of sleep disordered breathing in patients with obstructive sleep apnea: a two-arm, prospective, randomized controlled trialGincy A. Lukachan0Azadeh Yadollahi1Dennis Auckley2Bojan Gavrilovic3John Matelski4Frances Chung5Mandeep Singh6Department of Anesthesia, Believers Church Medical College HospitalKITE - Toronto Rehabilitation Institute, University Health Network, University of TorontoDivision of Pulmonary, Critical Care and Sleep Medicine, MetroHealth Medical Center, Case Western Reserve UniversityKITE - Toronto Rehabilitation Institute, University Health Network, University of TorontoBiostatistics Research Unit, University Health NetworkDepartment of Anesthesia, Toronto Western Hospital, University Health Network, University of TorontoDepartment of Anesthesia, Toronto Western Hospital, University Health Network, University of TorontoAbstract Background The severity of sleep-disordered breathing is known to worsen postoperatively and is associated with increased cardio-pulmonary complications and increased resource implications. In the general population, the semi-upright position has been used in the management of OSA. We hypothesized that the use of a semi-upright position versus a non-elevated position will reduce postoperative worsening of OSA in patients undergoing non-cardiac surgeries. Methods This study was conducted as a prospective randomized controlled trial of perioperative patients, undergoing elective non-cardiac inpatient surgeries. Patients underwent a preoperative sleep study using a portable polysomnography device. Patients with OSA (apnea hypopnea index (AHI) > 5 events/hr), underwent a sleep study on postoperative night 2 (N2) after being randomized into an intervention group (Group I): semi-upright position (30 to 45 degrees incline), or a control group (Group C) (zero degrees from horizontal). The primary outcome was postoperative AHI on N2. The secondary outcomes were obstructive apnea index (OAI), central apnea index (CAI), hypopnea index (HI), obstructive apnea hypopnea index (OAHI) and oxygenation parameters. Results Thirty-five patients were included. Twenty-one patients were assigned to the Group 1 (females-14 (67%); mean age 65 ± 12) while there were fourteen patients in the Group C (females-5 (36%); mean age 63 ± 10). The semi-upright position resulted in a significant reduction in OAI in the intervention arm (Group C vs Group I postop AHI: 16.6 ± 19.0 vs 8.6 ± 11.2 events/hr; overall p = 0.01), but there were no significant differences in the overall AHI or other parameters between the two groups. Subgroup analysis of patients with “supine related OSA” revealed a decreasing trend in postoperative AHI with semi-upright position, but the sample size was too small to evaluate statistical significance. Conclusion In patients with newly diagnosed OSA, the semi-upright position resulted in improvement in obstructive apneas, but not the overall AHI. Trial registration This trial was retrospectively registered in clinicaltrials.gov NCT02152202 on 02/06/2014.https://doi.org/10.1186/s12871-023-02193-yObstructive sleep apneaSupine-related OSASurgeryElevated positionPositional therapy |
| spellingShingle | Gincy A. Lukachan Azadeh Yadollahi Dennis Auckley Bojan Gavrilovic John Matelski Frances Chung Mandeep Singh The impact of semi-upright position on severity of sleep disordered breathing in patients with obstructive sleep apnea: a two-arm, prospective, randomized controlled trial BMC Anesthesiology Obstructive sleep apnea Supine-related OSA Surgery Elevated position Positional therapy |
| title | The impact of semi-upright position on severity of sleep disordered breathing in patients with obstructive sleep apnea: a two-arm, prospective, randomized controlled trial |
| title_full | The impact of semi-upright position on severity of sleep disordered breathing in patients with obstructive sleep apnea: a two-arm, prospective, randomized controlled trial |
| title_fullStr | The impact of semi-upright position on severity of sleep disordered breathing in patients with obstructive sleep apnea: a two-arm, prospective, randomized controlled trial |
| title_full_unstemmed | The impact of semi-upright position on severity of sleep disordered breathing in patients with obstructive sleep apnea: a two-arm, prospective, randomized controlled trial |
| title_short | The impact of semi-upright position on severity of sleep disordered breathing in patients with obstructive sleep apnea: a two-arm, prospective, randomized controlled trial |
| title_sort | impact of semi upright position on severity of sleep disordered breathing in patients with obstructive sleep apnea a two arm prospective randomized controlled trial |
| topic | Obstructive sleep apnea Supine-related OSA Surgery Elevated position Positional therapy |
| url | https://doi.org/10.1186/s12871-023-02193-y |
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