Characteristics of patients with positional OSA according to ethnicity and the identification of a novel phenotype – Lateral Positional Patients (Lateral PP): A MESA study

Study Objectives To investigate the characteristics of Obstructive Sleep Apnea (OSA) positional patients’ (PP) phenotypes among different ethnic groups in the Multi-Ethnic Study of Atherosclerosis (MESA) dataset. Moreover, we hypothesized the existence of a new OSA PP phenotype we coined “Lateral PP”, for whom the lateral apneas hypopnea index (AHI) is at least double the supine AHI. Methods From 2,273 adults with sleep information, we analyzed data of 1,323 subjects that slept more than 4 hours and had at least 30 minutes of sleep in both the supine and the non-supine positions. Demographics and clinical information were compared for the different PP, and ethnic groups. Results 861 (65.1%) patients had OSA and 35 (4.1%) were Lateral PP. Lateral PP patients were mainly females (62.9%), obese (31.4 median body mass index), had mild to moderate OSA (94.3%), and mostly were non-Chinese American (97.1%). Among all OSA patients, 550 (63.9%) were Supine PP, and 17.7% were supine-isolated OSA (siOSA). Supine PP and Lateral PP were present in 73.1% and 1.0% of Chinese Americans, 61.0% and 3.4% of Hispanics, 68.3% and 4.7% of White-Caucasian, and 56.2% and 5.2% of Black-African American OSA patients. Conclusion Chinese-American have the highest prevalence of Supine PP, whereas Black-African American patients lean towards less Supine PP and higher Lateral PP. Lateral PP appears as a novel OSA phenotype. However, it was found for a small group of OSA patients and thus its presence should be further validated. Brief Summary We studied prevalence of obstructive sleep apnea (OSA) positional phenotypes among Black African-American, Caucasian, Hispanic, and Chinese American patients and described their demographic and polysomnographic characteristics. Despite similar levels of OSA severity in the four ethnic groups, Chinese American had a higher prevalence of Supine PP, whereas Black-African American patients were significantly less Supine PP, as compared to other ethnic groups. In addition, we identify a novel OSA PP phenotype we named “Lateral positional patients (Lateral-PP)”. These OSA patients had apnea and hypopnea events mainly in the lateral position. This was a small group of OSA patients (4.1%) that were mainly obese, female, with mild-moderate OSA, and more prevalent in Black-African American. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement YBS and JB acknowledge the financial support of the Technion Machine Learning and Intelligent Systems center (MLIS). JS was partially supported by The Milner Foundation, founded by Yuri Milner and his wife Julia. JS acknowledges the Placide Nicod Foundation for their financial support. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Permission to use retrospective medical databases was granted following the Technion Israel Institute of Technology Rappaport Faculty of Medicine institutional review board approval 62-2019. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced are available online at National Sleep Research Resource (NSRR) * AHI : Apnea-hypopnea index IQR : Interquartile range IRB : Institutional review board KS : Kolmogorov-Smirnov KW : Kruskal-Wallis MESA : Multi-ethnic study of Atherosclerosis NHLBI : National Heart, Lung and Blood Institute NSRR : National Sleep Research Resources ODI : Oxygen desaturation index OSA : Obstructive sleep apnea POSA : Positional obstructive sleep apnea PSG : Polysomnography PT : Positional Therapy RDI : Respiratory distribution index TBT : Tennis ball technique TST : Total sleep time liOSA : Lateral-isolated obstructive sleep apnea lpOSA : Lateral-predominant obstructive sleep apnea siOSA : Supine-isolated obstructive sleep apnea spOSA : Supine-predominant obstructive sleep apnea