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Positional obstructive sleep apnea within a large multicenter French cohort: prevalence, characteristics, and treatment outcomes.

STUDY OBJECTIVES
To assess, in a large cohort of patients with obstructive sleep apnea (OSA), the factors that are independently associated with positional OSA (POSA) and exclusive POSA (e-POSA) and determine their prevalence. The secondary objective was to evaluate the outcome of positive airway pressure (PAP) therapy for POSA and e-POSA patients.


METHODS
This retrospective study included 6,437 typical mild-to-severe OSA patients from the Pays de la Loire sleep cohort. Patients with POSA and e-POSA were compared to those with non POSA (NPOSA) for clinical and polygraphic characteristics. In a subgroup of patients (n=3,000) included in a PAP follow-up analysis, we determined whether POSA and e-POSA phenotypes were associated with treatment outcomes at 6 months.


RESULTS
POSA and e-POSA had a prevalence of 53.5% and 20.1% respectively and were independently associated with time in supine position, male gender, younger age, lower AHI and lower BMI. After adjustment for confounding factors, patients with POSA and e-POSA had a significantly lower likelihood of treatment adherence (PAP daily use ≥4h) at 6 months and were at higher risk of PAP treatment withdrawal compared to NPOSA.


CONCLUSIONS
The prevalence and independent predictors of POSA and e-POSA were determined in this large clinical population. POSA and e-POSA patients have lower PAP therapy adherence and this choice of treatment may not be optimal. Thus, there is a need to offer these patients an alternative therapy.