An emerging technology for the identification and characterization of postural-dependent obstructive sleep apnea

Study Objectives: Body posture has a significant impact on the presence and severity of obstructive sleep apnea (OSA). The majority of polysomnography (PSG) systems have the capacity to categorize body (torso) posture as supine, left-lateral, right-lateral or prone, each within a 90-degree range. However, such broad categorization may limit the identification of subtle relationships between posture and OSA severity. The aim of this study was to quantify sleeping posture as a continuous variable; and to develop an intuitive tool for visualizing the relationship between body posture and OSA severity. Methods: A customized triaxial accelerometer-based posture sensor which quantifies torso posture as a continuous variable was developed. 38 participants attending the sleep laboratory for suspected OSA were recruited. Each participant underwent a diagnostic PSG with an additional customized posture sensor securely attached to the sternum. Individual data were presented using a novel circular histogram-based visualization which displays sleeping position and position-specific OSA severity. Results: Acceptable measurements were obtained in 21 participants. The mean ± standard deviation percentage of total sleep time spent within ± 15 degrees of the center of supine, left-lateral, right-lateral and prone was 59.7 ± 26.0%. A further 40.3 ± 26.0% of sleep time was spent in intermediate positions outside these traditional categorizations. The novel visualization revealed a wide variety of positional OSA phenotypes. Conclusions: Quantification of torso posture as a continuous variable and analysis of these data using a novel visualization enables the identification of subtle relationships between body posture and OSA severity that are not apparent using standard clinical sensors and summary statistics.