Can Simple Postural Assessment Help Identify Obstructive Sleep Apnea in Primary Care ?

Context
Obstructive sleep apnea (OSA) is frequent but remains underdiagnosed in primary care.
Screening strategies mainly rely on questionnaires and anthropometric measurements, while clinical observation is often underused.
General practitioners routinely observe patients’ posture during consultation. Clinical experience suggests that patients with suspected OSA frequently present common postural characteristics, such as forward head posture (FHP) and shoulder curl, which may reflect chronic upper airway constraints and altered autonomic regulation.
These postural features are easily observable and reproducible, and could represent an additional clinical approach to improve early identification of patients at risk for OSA in routine primary care practice.
Methods
A retrospective study included 523 patients referred for suspected sleep disorders. Postural parameters (FHP assessed by inion–vertical distance, shoulder curl, shoulder antepulsion) were measured in standing position and correlated with polysomnographic and autonomic parameters using regression analysis and ANOVA.
Originality
This study explores postural assessment as a novel, equipment-free clinical screening approach tailored for primary care. While posture is routinely observed by clinicians, it has rarely been formally evaluated in relation to sleep apnea severity.
The originality lies in the use of simple, standardized postural measurements and their correlation with both respiratory and autonomic markers in a large clinical cohort.
Lessons learned and future implications
Simple postural assessment can provide additional clinical clues in patients with suspected obstructive sleep apnea in primary care.
FHP and shoulder curl appear to be relevant markers, while not all postural parameters are clinically useful.
Integrating postural observation into routine consultation may help improve early identification, guide referral for sleep investigations, and support non-CPAP management strategies, including postural and rehabilitative approaches.
Future research should focus on prospective validation and on integrating postural assessment into simplified clinical screening tools for general practice.
Discussion
FHP and shoulder curl are associated with OSA severity (p < 0.01) and autonomic parameters, suggesting that posture reflects a clinically relevant respiratory phenotype.
Not all postural measures are informative, underlining the importance of targeted clinical observation.
Conclusion
Simple postural assessment, especially forward head posture and shoulder curl, may support earlier identification of obstructive sleep apnea in primary care and encourage integrated, clinically grounded management strategies for patients.