Efficacy of sleep position modification to treat positional obstructive sleep apnea

Abstract

Objective/background: To assess the feasibility and efficacy of sleep position modification in preventing supine sleep and improving sleep-disordered breathing and relevant clinical outcomes in positional obstructive sleep apnea (OSA) patients.

Patients/methods: Eighty-six consecutive participants with moderate positional OSA on routine diagnostic polysomnography underwent a randomized controlled parallel group design trial of 4-weeks treatment using a sleep position modification device (active) or sleep hygiene advice (control). Outcomes were measured at baseline and following a 4-week treatment period.

Results: There was a significant reduction in the amount of supine sleep in the active group (mean ± SD change from baseline, active group 99.5 ± 85.2 minutes, control group 68.6 ± 103.2 minutes, p = 0.002), and an improvement in apnea-hypopnea index (AHI) (active group reduced by 9.9 ± 11.6, control group reduced by 5.3 ± 13.9, p = 0.013). Post-hoc analyses indicated that positional therapy was most effective for patients with baseline AHI cut-off above 20 (p = 0.02). Logistic regression showed that a treatment response (AHI < 10) was more likely in the active group (OR = 5.57), and those with higher baseline nadir oxygen desaturation (OR = 1.95) and non-supine AHI (OR = 0.55). There were no significant improvements in quality of life, daytime sleepiness, mood, symptoms, neuropsychological measures or blood pressure in the active group.

Conclusions: The position device utilized in this study was effective in reducing supine sleep and AHI, which was significant in those with baseline AHI ≥20. Longer duration studies of physical treatments that modify sleep position are needed to explore further whether additional clinical benefits in are achievable.

Keywords: Neuropsychological function; Non-CPAP treatment of sleep apnea; Obstructive sleep apnea; Positional obstructive sleep apnea.