1151 Lateral Head Position Improves Supine Predominant Obstructive Sleep Apnea

Abstract

Introduction: Head positioning is increasingly being demonstrated to influence OSA independently of trunk position. Prior studies have shown that lateral head positions can influence collapsibility of the passive pharynx in patients with sleep disordered breathing. Lateral head rotation was associated with a significantly decreased frequency of complete (as compared to partial) anteroposterior collapse at velum, tongue base and epiglottis level in comparison with the supine position. Report of Case: A 31 year old male with PTSD and obesity presented with complaints of snoring, apneic episodes and excessive day time sleepiness. His Epworth Sleepiness Scale(ESS) score was 22 and a STOP BANG score of 4. The patient underwent an in-lab cardiopulmonary study including video recording. The patient was recorded in the supine position for the duration of the study and revealed a respiratory event index (REI) of 30 events per recording time. A review of the hypnogram noted that the patient experienced clustering of respiratory events without a change in trunk position. A further review of the video and matching with the cardiorespiratory tracing showed that the majority of respiratory events took place with the position in the head supine-trunk supine position (REI 55/hour) and improved with a change to the head lateral-trunk supine position (REI 7/hour). Conclusion(s): This case adds to a growing body of evidence that has demonstrated that patients with supine obstructive sleep apnea can have decreased obstructive respiratory events with lateral head positioning. This is particularly important as a form of positional therapy directed at ameliorating patient's symptoms by lateral positioning of the head when patients prefer to sleep in the supine position predominantly.