Towards a clinical classification system for position-dependent obstructive sleep apnea

In this chapter, we discuss the various definitions of position-dependent obstructive apnea. The first was introduced in 1984 by Cartwright, who suggested that physicians should differentiate between patients with either positional (POSA) or non-positional obstructive sleep apnea.

Treatment of POSA has advanced dramatically recently with the introduction of a new generation of positional therapy (PT), a small device attached to either the neck or chest which corrects the patient from adopting the supine position through a vibrating stimulus. Encouraging data have been published suggesting that this simple therapy successfully prevents patients with POSA from adopting the supine position without negatively influencing sleep efficiency, as well as allowing for good adherence. Unfortunately, evaluating the efficacy of PT and comparing results are hindered by the fact that there are no universally used POSA criteria.

In this chapter a new classification system is discussed called the Amsterdam Positional OSA Classification (APOC) aimed at identifying suitable candidates for PT: patients who will benefit from a clinically, significant improvement of their OSA with PT.

The shared use of this classification can facilitate collection of data across multiple centres and comparison of results across studies.