Sleep Position and Obstructive Sleep Apnoea

Konstantin Buteyko discovered that the best position to sleep was on the left-hand side or on the tummy. Ventilation is reduced while sleeping on the left-hand side given the position of the heart and on the tummy given the weight of the body restricting breathing.

Many studies show that sleeping on the back (supine position) is most contributory to snoring and sleep apnoea for both children and adults. Here, we examine available research.

Pereira et al. conducted research to determine the effect of body position on sleep apnea in children younger than three years. Polysomnographies of 60 children were analysed for data on respiratory disturbance index, time spent in each position, number of apneic episodes in each position, oxygen saturation, and time spent in each stage of sleep. Researchers concluded that “there is an increase in the RDI (respiratory disturbance index) with increased time spent in supine sleep in very young children with obstructive sleep apnea.1

A study of fifty children, 31 with habitual snoring and 19 with obstructive sleep annoea, found that there were more apnoea hypopnea events when patients slept on their backs as opposed to on their sides.2

Davvat et al. assessed 430 children with obstructive sleep apnoea. The effect of different sleeping positions was examined in obstructive sleep apnoea, and in relation to obesity and tonsillar size. Children with OSAS were found to spend more time than controls sleeping on their backs, and that apnea index was significantly greater in the supine position than in the side position.3

During a study of 574 patients with OSAS that was published in the medical journal Chest, researchers found that there were at least double the amount of apneas/hypopneas when patients slept on their back rather than their sides. The paper concluded that “body position during sleep has a profound effect on the frequency and severity of breathing abnormalities in OSA patients.”4

During an assessment of 2077 OSA patients over a period of ten years, it was found that 53.8% had at least twice as many breathing abnormalities while sleeping in the supine (back) position compared with sleeping on their side. The paper concluded that “since avoiding the supine posture (back) during sleep may significantly improve the sleep quality and daytime alertness of many positional patients, it is imperative to carry out a high-quality study to evaluate if this is a real therapeutic alternative for many positional patients.”5

A Japanese study of 72 patients and published in the journal Sleep found that most subjects in the snoring group decreased snoring both in time and intensity while sleeping on their side versus sleeping on their back.6

Another paper entitled “Association of body position with severity of apneic events in patients with severe nonpositional obstructive sleep apnea” and published in the medical journal Chest evaluated the apneic events of 30 sleep apnea patients when sleeping in either the supine position (back) or the lateral position (side). The researchers found that “even in patients with severe OSA who have a high number of apneic events in the supine and lateral posture, the apneic events occurring in the supine position are more severe than those occurring while sleeping in the lateral position. Thus, it is not only the number of apneic events that worsen in the supine sleep position but, probably no less important, the nature of the apneic events themselves.”7

Szollosi et al. found that sleeping on the side reduces the severity of central sleep apnoea with cheyne-stokes respiration. The researchers found that “compared with supine position, lateral position reduced the apnea-hypopnea index in all sleep stages” and that the “lateral position decreased desaturation independent of apnea type.”8

• Pereira KD, Roebuck JC, Howell L. The effect of body position on sleep apnea in children younger than 3 years. Arch Otolaryngol Head Neck Surg. 2005 Nov;131(11):1014-6.
• Kim HY, Dhong HJ, Lee JK, Chung SK, Jung SC. Sleep quality and effects of position on sleep apnea in East Asian children. Auris Nasus Larynx. 2011 Apr;38(2):228-32.
• Dayyat E, Maarafeya MM, Capdevila OS, Kheirandish-Gozal L, Montgomery-Downs HE, Gozal D. Nocturnal body position in sleeping children with and without obstructive sleep apnea. Pediatr Pulmonol. 2007 Apr;42(4):374-9.
• Oksenberg A, Silverberg DS, Arons E, Radwan H. Positional vs nonpositional obstructive sleep apnea patients: anthropomorphic, nocturnal polysomnographic, and multiple sleep latency test data. Chest. 1997 Sep;112(3):629-39.
• Oksenberg A, Arons E, Greenberg-Dotan S, Nasser K, Radwan H. [The significance of body posture on breathing abnormalities during sleep: data analysis of 2077 obstructive sleep apnea patients]. [Article in Hebrew] Harefuah. 2009 May;148(5):304-9, 351, 350.
• Nakano H, Ikeda T, Hayashi M, Ohshima E, Onizuka A. Effects of body position on snoring in apneic and nonapneic snorers. Sleep. 2003 Mar 15;26(2):169-72.
• Oksenberg A, Khamaysi I, Silverberg DS, Tarasiuk A. Association of body position with severity of apneic events in patients with severe nonpositional obstructive sleep apnea. Chest. 2000 Oct;118(4):1018-24.
• Szollosi I, Roebuck T, Thompson B, Naughton MT. Lateral sleeping position reduces severity of central sleep apnea / Cheyne-Stokes respiration. Sleep. 2006 Aug 1;29(8):1045-51