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.
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.
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 %].
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.
- 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
- Young T, Palta M, Dempsey J, Skatrud J, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235
- Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, Stubbs R, Hla KM (2008) Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 31:1071–1078
- Redline S, Yenokyan G, Gottlieb DJ, Shahar E, O’Connor GT, Resnick HE, Diener-West M, Sanders MH, Wolf PA, Geraghty EM, Ali T, Lebowitz M, Punjabi NM (2010) Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. Am J Respir Crit Care Med 182:269–277
- Oksenberg A, Silverberg DS, Arons E, Radwan H (1997) Positional vs nonpositional obstructive sleep apnea patients. Chest 112:629–639
- Oksenberg A, Khamaysi I, Silverberg DS, Tarasiuk A (2000) Association of body position with severity of apneic events in patients with severe nonpositional obstructive sleep apnea. Chest 118:1018–1024
- Oksenberg A, Arons E, Greenberg-Dotan S, Nasser K, Radwan H (2009) The significance of body posture on breathing abnormalities during sleep: data analysis of 2077 obstructive sleep apnea patients. Harefuah 148:304–309
- Richard W, Kox D, den Herder C, Laman M, van Tinteren H, de Vries N (2006) The role of sleeping position in obstructive sleep apnea. Eur Arch Otorhinolaryngol 263:946–950
- Randerath WJ, Verbraecken J, Andreas S, Bettega G, Boudewyns A, Hamans E, Jalbert F, Paoli JR, Sanner B, Smith I, Stuck BA, Lacassagne L, Marklund M, Maurer JT, Pepin JL, Valipour A, Verse T, Fietze I (2011) European Respiratory Society task force on non-CPAP therapies in sleep apnoea. Non-CPAP therapies in obstructive sleep apnoea. Eur Respir J 37:1000–1028
- Cartwright RD, Ristanovic R, Diaz F (1991) A comparative study of treatments for positional sleep apnea. Sleep 14:546–552
- Ravesloot MJL, van Maanen JP, Dun L, de Vries N (2012) The undervalued potential of positional therapy in position dependent snoring and obstructive sleep apnea—a review of the literature. Sleep Breath (epub ahead of print, PMID 22441662) (in press)
- Cartwright RD, Lloyd S, Lilie J, Kravtiz H (1985) Sleep position training as treatment for sleep apnea syndrome: a preliminary study. Sleep 8:87–94
- Choi JH, Park YH, Hong JH, Kim SJ, Park DS, Miyazaki S, Lee SH, Shin C, Lee JB (2009) Efficacy study of a vest-type device for positional therapy in position dependent snorers. Sleep Biol Rhythm 7:181–187
- Maurer JT, Stuck BA, Hein G, Verse T, Hörmann K (2003) Schlafapnoetherapie mit einer neuartigen rückenlage-verhinderungs-weste. Dtsch Med Wochenschr 128:71–75
- Zuberi NA, Rekab K, Nguyen HV (2004) Sleep apnea avoidance pillow effects on obstructive sleep apnea syndrome and snoring. Sleep Breath 8:201–207
- Wenzel S, Smith E, Leiacker R, Fischer Y (2007) Efficacy and long-term compliance of the vest preventing the supine position in patients with obstructive sleep apnea. Laryngorhinootologie 86:579–583
- Loord H, Hultcrantz E (2007) Positioner—a method for preventing sleep apnea. Acta Otolaryngol 127:861–868
- Berger M, Oksenberg A, Silverberg DS, Arons E, Radwan H, Iaina A (1997) Avoiding the supine position during sleep lowers 24 h blood pressure in obstructive sleep apnea (OSA) patients. J Hum Hypertens 11:657–664
- Jokic R, Klimaszewski A, Crossley M, Sridhar G, Fitzpatrick MF (1999) Positional treatment vs continuous positive airway pressure in patients with positional obstructive sleep apnea syndrome. Chest 115:771–781
- Oksenberg A, Silverberg D, Offenbach D, Arons E (2006) Positional therapy for obstructive sleep apnea patients: a 6-month follow-up study. Laryngoscope 116:1995–2000
- Bignold JJ, Deans-Costi G, Goldsworthy MR, Robertson CA, McEvoy D, Catcheside PG, Mercer JD (2009) Poor long-term patient compliance with the tennis ball technique for treating positional obstructive sleep apnea. J Clin Sleep Med 5:428–430
- Skinner MA, Kingshott RN, Filsell S, Taylor R (2008) Efficacy of the ‘tennis ball technique’ versus nCPAP in the management of position-dependent obstructive sleep apnoea syndrome. Respirology 13:708–715
- Svatikova A, Chervin RD, Wing JJ, Sanchez BN, Migda EM, Brown DL (2011) Positional therapy in ischemic stroke patients with obstructive sleep apnea. Sleep Med 12:262–266
- Bignold JJ, Mercer JD, Antic NA, McEvoy RD, Catcheside PG (2011) Accurate position monitoring and improved supine-dependent obstructive sleep apnea with a new position recording and supine avoidance device. J Clin Sleep Med 7:376–383
- Permut I, Diaz-Abad M, Chatila W, Crocetti J, Gaughan JP, D’Alonzo GE, Krachman SL (2010) Comparison of positional therapy to CPAP in patients with positional obstructive sleep apnea. J Clin Sleep Med 6:238–243
- Van Maanen JP, Richard W, van Kesteren ER, Ravesloot MJ, Laman DM, Hilgevoord AA, De Vries N (2012) Evaluation of a new simple treatment for positional sleep apnea patients. J Sleep Res 21:322–329
- Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545
- Weaver TE, Laizner AM, Evans LK, Maislin G, Chugh DK, Lyon K, Smith PL, Schwartz AR, Redline S, Pack AI, Dinges DF (1997) An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep 20:835–843
- Iber C, Ancoli-Israel S, Chesson A, Quan SF (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology, and technical specification. American Academy of Sleep Medicine, Westchester, IL
- Sher AE, Schechtman KB, Piccirillo JF (1996) The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. Sleep 19:156–177
- Kribbs NB, Pack AI, Kline LR, Smith PL, Schwartz AR, Schubert NM, Redline S, Henry JN, Getsy JE, Dinges DF (1993) Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis 147:887–895
- Richard W, Venker W, den Herder C, Kox D, van den Berg B, Laman M, van Tinteren H, de Vries N (2007) Acceptance and long-term compliance of nCPAP in obstructive sleep apnea. Eur Arch Otorhinolaryngol 264:1081–1086
- Ravesloot MJL, de Vries N (2011) Reliable calculation of the efficacy of non-surgical and surgical treatment of obstructive sleep apnea revisited. Sleep 34:105–110
- Petit F, Pepin J, Bettega G, Sadek H, Raphael B, Levy P (2002) Mandibular advancement devices: rate of contraindications in 100 consecutive obstructive sleep apnea patients. Am J Respir Crit Care Med 166:274–278
- Van Kesteren ER, van Maanen JP, Hilgevoord AA, Laman DM, de Vries N (2011) Quantitative effects of trunk and head position on the apnea hypopnea index in obstructive sleep apnea. Sleep 34:1075–1081
Conflict of interest
None of the authors have financial or other relationships that might lead to a conflict of interest.
This study was performed at the St. Lucas Andreas Hospital, Amsterdam, the Netherlands.
No comment yet, add your voice below!