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Updated: Jun 13, 2026
07:54
Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Marked reduction in obstructive sleep apnea severity in slow wave sleep
Rajeev Ratnavadivel1, Nuy Chau, Daniel Stadler
1Adelaide Institute for Sleep Health, Repatriation General Hospital, Adelaide, Australia. rajeev.ratnavadivel@health.sa.gov.au
Summary
Obstructive sleep apnea (OSA) improves significantly during slow wave sleep (SWS) and in the lateral position. Most OSA patients experience reduced respiratory events in SWS.
Area of Science:
- Sleep Medicine
- Respiratory Physiology
- Neurology
Background:
- Obstructive sleep apnea (OSA) is thought to improve during slow wave sleep (SWS), but data on the magnitude and prevalence of this effect are limited.
- This study investigates the impact of sleep stage and posture on OSA severity.
Purpose of the Study:
- To examine the relationship between sleep stages, posture, and respiratory event rates in patients undergoing polysomnography.
- To quantify the improvement in apnea-hypopnea index (AHI) and arousal index (AI) during SWS and lateral sleep in OSA patients.
Main Methods:
- Retrospective analysis of 253 full-night polysomnography studies.
- Respiratory and arousal event rates were calculated per sleep stage and posture (supine vs. lateral).
- Patients were classified as OSA (AHI ≥ 15) or central sleep apnea (CSA, central apnea index > 5).
Main Results:
- OSA patients had delayed SWS and REM sleep onset and less stage 4 sleep compared to non-OSA patients.
- Apnea-hypopnea index (AHI) and arousal index (AI) significantly improved from NREM stage 1 to 4 (p < 0.001).
- AHI and AI were also markedly reduced in the lateral versus supine posture (p < 0.001), with an effect size comparable to SWS.
- The majority of OSA patients achieved low respiratory event rates in SWS (82% had AHI < 15, 57% had AHI < 5 during stage 4).
Conclusions:
- Despite delayed and reduced SWS, OSA patients experience significant improvements in AHI and AI once SWS is achieved.
- Lateral sleeping posture offers a comparable benefit to SWS in reducing respiratory events in OSA patients.
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