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

Abstract

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.

Clinical and polysomnographic determinants of snoring

“…This finding might be explained by the fact that in the supine position upper airway dimensions present increased propensity of collapse (Walsh et al, 2008). In this regard, it is not surprising that positional therapy has proven to be equivalent to continuous positive airway pressure at normalizing AHI in patients with positional OSA (Permut et al, 2010). However, even in patients with non-positional OSA, as were the apnoeic patients of the current study, positional dependence of snoring appears to persist.…”

“…The positional dependence of OSA is explained by the fact that turning from the lateral to supine position can lead to a decrease and an eventual collapse of the upper airway (positional OSA patients; Pevernagie et al, 1995). In these patients positional therapy has proven to be an effective alternative to continuous positive airway pressure therapy (Permut et al, 2010).…”

Redefining the timing of surgery for obstructive sleep apnea in anatomically favorable patients

“…Most of these more recent studies fall into many of the traps of prior research, generally being short term, 36,39,40,46,[49][50][51][52] failing to compare different treatment approaches, or using sample sizes inadequate to detect clinically meaningful differences. [52][53][54][55] In one larger and longer randomized trial, in which 723 nonsomnolent patients with OSA were randomized either to CPAP (N 5 357) or no active treatment (N 5 366) over a median of 4 years of follow-up, no intergroup difference was detected in the incidence of hypertension or other cardiovascular events. 56 And in another randomized trial comparing nasal CPAP and an oral appliance over 12 months, though AHI scores improved from baseline in both treatment groups, there was no difference between them, except that more subjects withdrew from the nasal CPAP treatment arm due to side effects.…”

Evaluation of a new simple treatment for positional sleep apnoea patients

“…The present device circumvents this problem, as this small, light and comfortable-to-wear device does not cause any discomfort during position change. Permut et al (2010) showed recently that positional therapy with a bulky mass strapped to the back was equal to CPAP in normalizing the AHI in patients with a mild to moderate POSAS. However, patient selection criteria and thus definition of POSAS were not the same as in our study.…”