Sleep-Related Disorders

Risk Factors

• Nasal obstruction due to septal deviation, nasal polyps, hypertrophied turbinates, chronic rhinitis, and nasal congestion is a common cause of snoring 1
• Enlarged tonsils and adenoids, particularly in children, can contribute to snoring 2
• A BMI >95th percentile for age and gender in children is associated with an increased risk of snoring 2
• Higher prevalence of snoring is found in men (40% in adult men vs. 20% in adult women) 3
• Allergic rhinitis can cause nasal congestion, leading to increased airway resistance and snoring 1

Associated Conditions

• Snoring is often a symptom of obstructive sleep apnea (OSA) 3
• Adenotonsillar hypertrophy is the primary cause of snoring in children 2
• Children with habitual snoring may have neurocognitive impairment, behavioral problems, and failure to thrive 2

Diagnosis of Positional Obstructive Sleep Apnea (POSA)

• The European Respiratory Society defines POSA as a condition where the apnea-hypopnea index (AHI) in the supine position is at least twice as high as the AHI in the non-supine position, with no relevant non-supine AHI (<15 events/hour) 4, 5
• A minimum time spent in both supine and non-supine positions during sleep study (typically 30 minutes to 1 hour of sleep in each position) is required for accurate diagnosis 4
• Approximately 50% of OSA patients have positional OSA, as reported by the European Respiratory Society 5

Treatment of Positional OSA

• The European Respiratory Society suggests either vibratory positional therapy or CPAP for patients with mild or moderate position-dependent OSA with non-supine AHI <15 events/hour 4
• For mild positional OSA, either vibrational positional therapy or mandibular advancement devices (MAD) may be used, as recommended by the European Respiratory Review 4
• Positional therapy is not recommended for severe OSA or patients with significant non-supine AHI, as stated by the European Respiratory Review 4
• CPAP remains the gold standard for moderate to severe OSA, as reported in Pulmonology 3
• Positional therapy has fewer side effects compared to CPAP, as reported by the European Respiratory Review 4
• Positional therapy has better compliance compared to CPAP, with an additional 2.5 hours per night, as stated by the European Respiratory Review 4

Management and Follow-up

• If positional therapy is used, sleep studies should be performed to document individual success, as recommended by the European Respiratory Journal 5
• Long-term compliance should be secured by follow-up studies, as stated by the European Respiratory Journal 5
• Not all patients normalize AHI when non-supine, so correction of OSA by position should be documented with polysomnography before initiating this form of treatment, as noted by the Journal of Clinical Sleep Medicine 6
• Elevation of the head of the bed may be used as a strategy to allow down-titration of EPAP pressure in patients using non-invasive positive pressure ventilation (NPPV) who find the pressure difficult to tolerate, as stated by the American Academy of Sleep Medicine 7
• Positional therapy (avoiding the supine position) can be an effective secondary therapy for patients with positional OSA, as reported by the American Academy of Sleep Medicine 6