ナガサカ　ヤスコ   NAGASAKA Yasuko   長坂　安子    所属   医学部 医学科（東京女子医科大学病院）    職種   教授・基幹分野長
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Elevated upper body position improves pregnancy-related OSA without impairing sleep quality or sleep architecture early after delivery.
掲載誌名	正式名：Chest 略　 称：Chest ISSNコード：19313543/00123692
掲載区分	国外
巻・号・頁	148(4),pp.936-944
国際共著	国際共著
著者・共著者	Zaremba Sebastian, Mueller Noomi, Heisig Anne M, Shin Christina H, Jung Stefanie, Leffert Lisa R, Bateman Brian T, Pugsley Lori J, Nagasaka Yasuko, Duarte Ingrid Moreno, Ecker Jeffrey L, Eikermann Matthias
発行年月	2015/10
概要	BACKGROUND:During pregnancy, upper airway resistance is increased, predisposing vulnerable women to pregnancy-related OSA. Elevation of the upper body increases upper airway cross-sectional area (CSA) and improves severity of OSA in a subgroup of nonpregnant patients (positional-dependent sleep apnea). We tested the hypothesis that elevated position of the upper body improves OSA early after delivery.METHODS:Following institutional review board approval, we conducted a randomized, crossover study on two postpartum units of Massachusetts General Hospital. Women during the first 48 h after delivery were included. Polysomnography was performed in nonelevated and 45° elevated upper body position. Upper airway CSA was measured by acoustic pharyngometry in nonelevated, 45° elevated, and sitting body position.RESULTS:Fifty-five patients were enrolled, and measurements of airway CSA obtained. Thirty patients completed polysomnography in both body positions. Elevation of the upper body significantly reduced apnea-hypopnea index (AHI) from 7.7 ± 2.2/h in nonelevated to 4.5 ± 1.4/h in 45° elevated upper body position (P = .031) during sleep. Moderate to severe OSA (AHI > 15/h) was diagnosed in 20% of postpartum patients and successfully treated by elevated body position in one-half of them. Total sleep time and sleep architecture were not affected by upper body elevation. Change from nonelevated to sitting position increased inspiratory upper airway CSA from 1.35 ± 0.1 cm2 to 1.54 ± 0.1 cm2 during wakefulness. Position-dependent increase in CSA and decrease in AHI were correlated (r = 0.42, P = .022).CONCLUSIONS:Among early postpartum women, 45° upper body elevation increased upper airway CSA and mitigated sleep apnea. Elevated body position might improve respiratory safety in women early after delivery.TRIAL REGISTRY:ClinicalTrials.gov; No.: NCT01719224; URL: www.clinicaltrials.gov.
DOI	10.1378/chest.14-2973
PMID	25905714