The sleep position trainer: a new treatment for positional obstructive sleep apnoea

Abstract

Background

Positional obstructive sleep apnoea (POSA), defined as a supine apnoea–hypopnoea index (AHI) twice or more as compared to the AHI in the other positions, occurs in 56 % of obstructive sleep apnoea patients. Positional therapy (PT) is one of several available treatment options for these patients. So far, PT has been hampered by compliance problems, mainly because of the usage of bulky masses placed in the back. In this article, we present a novel device for treating POSA patients.

Methods

Patients older than 18 years with mild to moderate POSA slept with the Sleep Position Trainer (SPT), strapped to the chest, for a period of 29 ± 2 nights. SPT measures the body position and vibrates when the patient lies in supine position.

Results

Thirty-six patients were included; 31 patients (mean age, 48.1 ± 11.0 years; mean body mass index, 27.0 ± 3.7 kg/m2) completed the study protocol. The median percentage of supine sleeping time decreased from 49.9 % [20.4–77.3 %] to 0.0 % [range, 0.0–48.7 %] (p < 0.001). The median AHI decreased from 16.4 [6.6–29.9] to 5.2 [0.5–46.5] (p < 0.001). Fifteen patients developed an overall AHI below five. Sleep efficiency did not change significantly. Epworth Sleepiness Scale decreased significantly. Functional Outcomes of Sleep Questionnaire increased significantly. Compliance was found to be 92.7 % [62.0–100.0 %].

Conclusions

The Sleep Position Trainer applied for 1 month is a highly successful and well-tolerated treatment for POSA patients, which diminishes subjective sleepiness and improves sleep-related quality of life without negatively affecting sleep efficiency. Further research, especially on long-term effectiveness, is ongoing.

Abbreviations

AHI: Apnoea–hypopnoea index
CPAP: Continuous positive airway pressure
ESS: Epworth Sleepiness Scale
FOSQ: Functional Outcomes of Sleep Questionnaire
OSA: Obstructive sleep apnoea
POSA: Positional obstructive sleep apnoea
PSG: Polysomnography
PT: Positional therapy
SD: Standard deviation
SPT: Sleep Position Trainer
TIB: Time in bed
TST: Total sleep time

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Conflict of interest

None of the authors have financial or other relationships that might lead to a conflict of interest.

Author information

Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, St. Lucas Andreas Hospital, Amsterdam, The Netherlands
    • J. Peter van Maanen
    • , Lideke N. Dun
    • , Ioannis Koutsourelakis
    •  & Nico de Vries
  2. Department of Clinical Neurophysiology, St. Lucas Andreas Hospital, Amsterdam, The Netherlands
    • Kristel A. W. Meester
    • , D. Martin Laman
    •  & Antonius A. J. Hilgevoord
  3. Department of Otorhinolaryngology, Head and Neck Surgery, Academic Medical Center, Amsterdam, The Netherlands
    • J. Peter van Maanen
  4. Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
    • Birgit I. Witte
  5. Department of Otolaryngology/Head Neck Surgery, Sint Lucas Andreas Ziekenhuis, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
    • J. Peter van Maanen

Corresponding author

Correspondence to J. Peter van Maanen.

Additional information

This study was performed at the St. Lucas Andreas Hospital, Amsterdam, the Netherlands.

Upper airway collapse during drug induced sleep endoscopy: head rotation in supine position compared with lateral head and trunk position

Abstract

Drug induced sedated sleep endoscopy (DISE) is often employed to determine the site, severity and pattern of obstruction in patients with sleep apnea. DISE is usually performed in supine position. We recently showed that the obstruction pattern is different when DISE is performed in lateral position. In this study, we compared the outcomes of DISE performed in supine position with head rotated, with the outcomes of DISE performed with head and trunk in lateral position. The Prospective study design was used in the present study. Sixty patients with OSA (44 male; mean apnea hypopnea index (AHI) 20.8 ± 17.5 events/h) underwent DISE under propofol sedation. Patients were placed in lateral position, and the upper airway collapse was evaluated. The patients were then placed in supine position with the head rotated to the right side. DISE outcomes were scored using the VOTE classification system. In lateral position, nine patients (15.0 %) had a complete antero-posterior (A-P) collapse at the level of the velum, nine had a partial A-P collapse. During head rotation and trunk in supine position, at the level of the velum, four patients (6.7 %) had a complete A-P collapse, while two patients (3.3 %) had a partial A-P collapse. For all other sites, the patterns of collapse were not significantly different between head rotation and lateral position. During DISE, rotation of the head in supine position, and lateral head and trunk position present similar sites, severity and patterns of upper airway collapse, with the exception of collapse at the level of the velum. Here the severity of A-P collapse is less severe during head rotation than in lateral head and trunk position.

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Conflict of interest

None of the authors has any financial support or conflict of interest to disclose.

Author information

Affiliations

  1. Department of Otolaryngology/Head Neck Surgery, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
    • Faiza Safiruddin
    •  & Nico de Vries
  2. Department of Critical Care and Pulmonary Services, Evangelismos Hospital, Center of Sleep Disorders, Medical School of Athens University, Athens, Greece
    • Ioannis Koutsourelakis

Severe obstructive sleep apnoea syndrome in a 5-year-old girl

Summary

The obstructive sleep apnoea syndrome (OSAS) is a common cause of morbidity during childhood. Although pediatric OSAS usually stems from adenotonsillar hypertrophy, it is also related to craniofacial anomalies. We report a case of extremely severe OSAS in a 5-year-old girl who has undergone adenoidectomy and partial tonsillectomy 1.5 year previously. A second adenotonsillectomy was elected to resolve abnormal respiration during sleep. Polysomnography was repeated 8 weeks after surgery and revealed an outstanding improvement but not complete resolution. The residual number of apnoeas is attributed to the retrognathia of the patient.

Analysis of the influence of head rotation during drug‐induced sleep endoscopy in obstructive sleep apnea

Abstract

Objectives/Hypothesis

Currently, drug‐induced sleep endoscopy (DISE) in obstructive sleep apnea (OSA) is predominantly performed in supine position. When positional therapy (avoidance of supine sleeping position in positional OSA (POSA) is implemented as (part of the) treatment, one should assess levels of obstruction in the other sleeping positions. Therefore, the current study examined the influence of difference head positions during DISE in patients with OSA and POSA.

Study Design

Consecutive prospective study.

Methods

DISE was performed in patients with an apnea hypopnea index at baseline polysomnography greater than 5 events/h. The upper airway was assessed at velum, oropharynx, tongue base, and epiglottis level in supine position. The patients head were then tilted to the left and the right side and the DISE findings were recorded.

Results

One hundred consecutive patients were included. In positional apneics (n = 67), lateral position was associated with decreased frequency of complete anteroposterior collapse at velum (P < 0.01), tongue base (P < 0.01), and epiglottis (P < 0.01) level—and increased frequency of partial anteroposterior collapse at velum (P < 0.01), tongue base (P < 0.01), and epiglottis (P <0.05) level in comparison with supine position. DISE findings showed no difference between the right and left position, whereas findings after head rotation were significantly different in comparison with the supine position.

Conclusions

Head rotation improves upper airway collapse during DISE in supine position. This improvement of upper airway patency is more predominant in POSA patients.

Level of Evidence

4. Laryngoscope, 124:2195–2199, 2014