a Clinical Classification System for Position-Dependent Obstructive Sleep Apnea

Fig. 1

Flowchart for the APOC. The red boxes show the best possible outcome for these patients with successful positional therapy (PT). AHI apnea-hypopnea index, APOC Amsterdam positional OSA Classification, BSP best sleeping position, OSA obstructive sleep apnea, WSP worst sleeping position

Diagnosed with OSA according to the American Academy of Sleep Medicine (AASM) criteria [12]

<10 % of the TST in both BSP and WSP

Have a BSP AHI of less than 5

Have a BSP AHI in a lower OSA severity category

Have an overall AHI of at least 40 and at least a 25 % lower BSP AHI

In Table 1, we describe the best possible outcome per category of the APOC. The APOC criteria were found to be more effective in identifying patients, shown by an increase in sensitivity, specificty and predictive value, that will (not) benefit from PT, thus resulting in a more cost-efficient treatment.

Table 1

Best possible outcome per category of the APOC

APOC I: Patients who theoretically can be cured with PT only (resulting in an AHI < 5)

• Patients are diagnosed APOC 1 if the BSP AHI < 5

APOC II: Patients who theoretically can decrease an OSA severity category through treatment with PT, rendering other treatment options available

• Patients are diagnosed APOC II if the AHI in the BSP falls into a lower OSA severity category than the overall AHI

APOC III:

• Patients with an overall AHI ≥ 40, who can theoretically achieve a >25 % reduction of their AHI with PT only, thereby improving compliance of existing therapies

AHI apnea-hypopnea index, APOC Amsterdam positional OSA Classification, OSA obstructive sleep apnea, BSP best sleeping position, PT positional therapy, WSP worst sleeping position

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