Comment diagnostiquer et prendre en charge un syndrome d'apnée/hypopnée du sommeil (SAHOS) positionnel de l'adulte ?

The positional OSAS corresponds to OSAS whose respiratory events are twice when the patient is in the supine position during sleep. The “predominant” positional SAOS exhibit an IAH > 5/h in the non-supine position and the “isolated” positional SAOS exhibit an IAH in the non-supine position < 5/h. The most recent studies include time spent on supine position to define a positional OSAS. This is an important variable to evaluate the relevance of a positional treatment according to the type of actual position in which the patient sleeps. However, to date there is no reliable and valid consensual method for assessing position and time on supine position during the sleep. The effectiveness of positional treatments depends on their ability to maintain a suitable, non-supine position without major discomfort. Under the best conditions (isolated positional OSAS and sufficient supine position time before treatment), this type of treatment could be as effective as CPAP therapy. But current data on prognostic factors and long-term efficacy are insufficient. It is therefore necessary to complete the current research to know more precisely the physiopathological mechanism of the positional OSAS, to better characterize the different subtypes and to develop adapted treatments.