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Differences in Physiologic Endotypes Between Nonpositional and Positional OSA: Results From the Shanghai Sleep Health

Xiaoting Wang1, Tianjiao Zhou1, Weijun Huang1

  • 1Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.

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|January 13, 2024
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Summary

Positional obstructive sleep apnea (POSA) and nonpositional OSA (NPOSA) have distinct endotypes. Anatomic factors influence NPOSA severity, while nonanatomic traits like loop gain are key for POSA severity in Chinese individuals.

Keywords:
arousal thresholdendotypeloop gainmuscle compensationpharyngeal collapsibilitypositional OSA

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Area of Science:

  • Sleep Medicine
  • Respiratory Physiology
  • Pulmonology

Background:

  • Positional Obstructive Sleep Apnea (POSA) is a subtype of Obstructive Sleep Apnea (OSA) with unique endotypic characteristics compared to nonpositional OSA (NPOSA).
  • The underlying endotypic differences between POSA and NPOSA remain poorly understood.
  • This study investigates these endotypic disparities in a Chinese cohort.

Purpose of the Study:

  • To determine if individuals with NPOSA and POSA exhibit different underlying OSA endotypes.
  • To identify critical endotypic characteristics that determine the severity of NPOSA and POSA.

Main Methods:

  • Utilized polysomnography data from 1,036 individuals with OSA in the Shanghai Sleep Health Study cohort.
  • Classified participants into POSA and NPOSA groups.
  • Calculated and compared endotypic parameters including loop gain, arousal threshold, pharyngeal collapsibility (VpassiveAll), and muscle compensation.

Main Results:

  • Individuals with POSA showed lower loop gain, lower arousal threshold, lower pharyngeal collapsibility (VpassiveAll), and higher muscle compensation compared to NPOSA.
  • Higher VpassiveAll was associated with increased odds of POSA.
  • In NPOSA, VpassiveAll and loop gain predicted OSA severity, with VpassiveAll being most critical.
  • In POSA, nonanatomic traits (loop gain, arousal threshold, muscle compensation) were significant predictors of severity, with loop gain being most crucial.

Conclusions:

  • Significant endotypic differences exist between NPOSA and POSA in the studied Chinese population.
  • Anatomic factors are more critical for NPOSA severity, whereas nonanatomic traits are more influential for POSA severity.
  • Personalized management strategies based on endotype are recommended for NPOSA and POSA patients.