A Comparative Study of Treatments for Positional Sleep Apnea

Cartwright, Rosalind D.; Ristanovic, Ruzica; Diaz, Frank; Caldarelli, David D.; Alder, Gary

doi:10.1093/sleep/14.6.546

Cited by 165 publications

(110 citation statements)

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“…Nevertheless, the consistency of the results is strikbeing an OSA positional patient correlates with the RDI, BMI and age in a general reverse relationship, of positional devices have also shown that many patients can successfully learn to avoid the supine ie, an OSA patient with a severe RDI and who is obese (BMI Ͼ30) and older than age 60 is signifiposition during sleep. 33,38,62 However, long term compliance data using these different techniques are cantly less likely to be positional than an OSA patient with a moderate RDI who is not obese and not yet available and studies investigating this issue are clearly needed. This is particularly the case who is less than 60 years of age.…”

Section: Bp Variabilitymentioning

confidence: 99%

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Avoiding the supine position during sleep lowers 24 h blood pressure in obstructive sleep apnea (OSA) patients

Berger

Oksenberg

Silverberg³

et al. 1997

J Hum Hypertens

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Obstructive sleep apnea (OSA), is a common clinical inexpensive method for avoiding the supine posture during sleep, namely the tennis ball technique. condition affecting at least 2-4% of the adult population. Hypertension is found in about half of all OSA Of the 13 patients, all had a reduction in 24-h mean BP (MBP). The mean 24-h systolic/diastolic (SBP/DBP) fell by patients, and about one-third of all patients with essential hypertension have OSA. There is growing 6.4/2.9 mm Hg, the mean awake SBP/DBP fell by 6.6/3.3 mm Hg and the mean sleeping SBP/DBP fell by 6.5/2.7 evidence that successful treatment of OSA can reduce systemic blood pressure (BP). Body position appears mm Hg, respectively. All these reductions were significant (at least P Ͻ 0.05) except for the sleeping DBP. The to have an important influence on the incidence and severity of these sleep-related breathing disturbmagnitude of the fall in SBP was significantly greater in the hypertensive than in the normotensive group for the ances.We have investigated the effect of avoiding the supine 24 h period and for the awake hours. In addition, a significant reduction in BP variability and load were found. position during sleep for a 1 month period on systemic BP in 13 OSA patients (six hypertensives and seven Since the majority of OSA patients have supine-related breathing abnormalities, and since about a third of all normotensives) who by polysomnography (PSG) were found to have their sleep-related breathing disturbances hypertensive patients have OSA, avoiding the supine position during sleep, if confirmed by future studies, could mainly in the supine position. BP monitoring was performed by 24-h ambulatory BP measurements before and become a new non-pharmacological form of treatment for many hypertensive patients. after a 1 month intervention period. We used a simple, Keywords: obstructive sleep apnea; ambulatory blood pressure monitoring; sleep position; body posture ous positive airway pressure (nCPAP). [1][2][3] However, Introductionthe long term compliance with nCPAP is often disObstructive sleep apnea (OSA) is a clinical entity appointing. 28 Other methods of treatment of OSA characterised by intermittent partial or complete include weight reduction, 29 use of oral devices that collapse of the upper airway during sleep. [1][2][3] Studies advance the mandible and/or the tongue 30 and difover the last few years have shown that the prevaferent surgical interventions of which the most lence of essential hypertension is much higher in popular is uvulopalatopharyngoplasty (UPPP). 31 patients with OSA (50%) 4-7 than it is in the general Although weight reduction, when achieved, is effecpopulation (20%). 8 Conversely, the prevalence of tive in improving or even curing many overweight OSA is much higher in patients with essential OSA patients, 29 the long term compliance with this hypertension (30%) 9-12 than it is in the general form of therapy is often poor. 32 There is insufficient population (2-4%). 13 As summarised by ourselves long term data avai...

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Section: Bp Variabilitymentioning

confidence: 99%

“…The patients arrived at the sleep unit around turbances to a great extent and in some cases even 20.00 and the PSG recordings usually began entirely. 33,38 between 22.00 and midnight. The aim of this study is to assess the effect of avo-…”

Section: Introductionmentioning

confidence: 99%

Avoiding the supine position during sleep lowers 24 h blood pressure in obstructive sleep apnea (OSA) patients

Berger

Oksenberg

Silverberg³

et al. 1997

J Hum Hypertens

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“…Arrhythmias need proper ECG monitoring, and a separate 24h Holter monitor may be more appropriate. Posture needs to be measured owing to the exquisite sensitivity of OSA to the supine posture, and the response of OSA to posture training when this is the case (Cartwright 1984;Cartwright et al 1991). 'Moderate' sleep apnoea is usually due to individuals with supine-only obstructions who spend variable proportions of their sleep time on the back.…”

Section: Eog Onlymentioning

confidence: 99%

Sleep studies for sleep‐related breathing disorders

Stradling¹

1992

Journal of Sleep Research

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SUMMARY Our understanding of sleep-related breathing disorders is still in a period of rapid change. Considerable uncertainty exists in several major areas of patient assessment. Although early definitions of sleep apnoea enshrined the concept of rigid guidelines, such an approach is no longer helpful, and may constrain potential advances. The recognition of the basic pathophysiological events in obstructive sleep apnoea (OSA) has evolved from purely apnoeas, to include hypopnoeas, and now to increased upper airway resistance alone. Our view as to the significant consequences of such respiratory events has also evolved from alterations to the classic sleep architecture, to hypoxic events, and now to micro-arousals and cardio-vascular events. The exact nature of a significant arousal is also far from clear, with the suggestion that perhaps even EEG based approaches to their measurement may not be telling us the whole story. Finally, the frequency of such respiratory events and their consequences, that lead to significant symptoms and long-term damage, is not known either. Thus, given this situation, the best we can achieve is broad guidelines that stress the main important physiological events and their consequences that need to be assessed, and then interpreted in conjunction with the patient's symptoms. This will not necessarily be the same for all patients and this report offers some general guidance, based on the experience of several centres throughout Europe.

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“…8 Other common therapeutic options have included surgical intervention of the upper airway, weight loss, the use of oral appliances, and when indicated, positional therapy. [9][10][11][12][13] More recently, data have identified that positional OSA, where sleep-disordered breathing events occur predominantly in the supine position, is quite prevalent in patients with mild and moderate OSA.…”

mentioning

confidence: 99%

“…[9][10][11][12][13] These studies have included those utilizing training methods [9][10] or devices designed to prevent the patients from rolling on their back. positional OSA.…”

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confidence: 99%

Comparison of Positional Therapy to CPAP in Patients with Positional Obstructive Sleep Apnea

Permut

Diaz‐Abad

Chatila

et al. 2014

Positional Therapy in Obstructive Sleep Apnea

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Study Objectives: We hypothesized that positional therapy would be equivalent to continuous positive airway pressure (CPAP) at normalizing the apnea-hypopnea index (AHI) in patients with positional obstructive sleep apnea (OSA). Methods: Thirty-eight patients (25 men, 49 ± 12 years of age, body mass index 31 ± 5 kg/m 2 ) with positional OSA (nonsupine AHI < 5 events/h) identified on a baseline polysomnogram were studied. Patients were randomly assigned to a night with a positional device (PD) and a night on CPAP (10 ± 3 cm h 2 o). Results: Positional therapy was equivalent to CPAP at normalizing the AHI to less than 5 events per hour (92% and 97%, respectively [p = 0.16]). The AHI decreased from a median of 11 events per hour (interquartile range 9-15, range 6-26) to 2 (1-4, 0-8) and 0 events per hour (0-2, 0-7) with the PD and CPAP, respectively; the difference between treatments was significant (p < 0.001). The percentage of total sleep time in the supine position decreased from 40% (23%-67%, 7%-82%) to 0% (0%-0%, 0%-27%) with the PD (p < 0.001) but was unchanged with CPAP (51% [36%-69%, 0%-100%]). The lowest Sao 2 increased with the PD and CPAP therapy, from 85% (83%-89%, 76%-93%) to 89% (86%-9%1, 78%-95%) and 89% (87%-91%, 81%-95%), respectively (p < 0.001). The total sleep time was unchanged with the PD, but decreased with CPAP, from 338 (303-374, 159-449) minutes to 334 (287-366, 194-397) and 319 (266-343, 170-386) minutes, respectively (p = 0.02). Sleep efficiency, spontaneous arousal index, and sleep architecture were unchanged with both therapies. Conclusion: Positional therapy is equivalent to CPAP at normalizing the AHI in patients with positional OSA, with similar effects on sleep quality and nocturnal oxygenation. BRIEF SUMMARYCurrent Knowledge/Study Rationale: Previous studies evaluating positional therapy simply defined positional obstructive sleep apnea (OSA) as a 50% reduction in the apnea-hypopnea index (AHI) while in the nonsupine position, and as a result many patients still demonstrated mild to severe OSA with the use of positional therapy. The present study evaluates the effectiveness of positional therapy, as compared to CPAP therapy, to normalize the AHI to < 5 events/hr in patients with mild to moderate positional OSA. Study Impact: Positional therapy was found to be effective at maintaining patients in the nonsupine position during the night, and was equivalent to CPAP therapy at normalizing the AHI to < 5 events/hr, with similar effects on nocturnal oxygenation and sleep quality. As a result, positional therapy may be an appropriate primary treatment for patients with positional OSA.

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A Comparative Study of Treatments for Positional Sleep Apnea

Cited by 165 publications

References 0 publications

Avoiding the supine position during sleep lowers 24 h blood pressure in obstructive sleep apnea (OSA) patients

Avoiding the supine position during sleep lowers 24 h blood pressure in obstructive sleep apnea (OSA) patients

Sleep studies for sleep‐related breathing disorders

Comparison of Positional Therapy to CPAP in Patients with Positional Obstructive Sleep Apnea

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