Poor Long-Term Patient Compliance with the Tennis Ball Technique for Treating Positional Obstructive Sleep Apnea

Bignold, James J; Deans-Costi, Georgina; Goldsworthy, Mitchell R.; Robertson, Claire A.; McEvoy, D.; Catcheside, Peter; Mercer, Jeremy

doi:10.5664/jcsm.27597

Cited by 142 publications

(73 citation statements)

References 8 publications

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“…The latter was achieved by fastening a tennis ball to the back of their nightshirt (Fig. 1) as previously reported in the context of positional therapy for posture-dependent obstructive sleep apnoea patients (Bignold et al 2009). Patients with anatomical failure (non-closure of the MH) received 4 days FDP on the ward following the second surgery.…”

Section: Methodsmentioning

confidence: 80%

Short-term postoperative non-supine positioning versus strict face-down positioning in macular hole surgery

Forsaa

Ræder

Hashemi

et al. 2012

Acta Ophthalmologica

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. Purpose: The purpose of this study was to compare the efficacy of short‐term non‐supine positioning (NSP) and strict face‐down positioning (FDP) in the repair of macular hole (MH). Methods: We retrospectively reviewed all MH repairs over a 27‐month period (2008–2010). Inclusion criteria were idiopathic full thickness stage 2–4 MH treated by a single surgeon with 23‐gauge pars plana vitrectomy, internal limiting membrane peeling and gas tamponade, followed by postoperative short‐term NSP (for 5 days) or strict FDP (for 3–4 days). NSP was achieved by fastening a tennis ball to the back of the nightshirt. Outcome measures were anatomical MH closure verified by optical coherence tomography and postoperative visual acuity. Results: A total of 67 eyes (64 patients) met the inclusion criteria. The median follow‐up period was 6.6 months (range, 4.7–19.8 months). The closure rates following a single operation were 30/33 (90.9%) in the FDP group, and 31/34 (91.2%) in the NSP group, respectively (p = 0.97). The FDP group improved 2.9 ETDRS lines, and 23 eyes (69.7%) gained two or more ETDRS lines. The NSP group improved 2.7 ETDRS lines (p = 1.00), and 25 eyes (73.5%) gained two or more ETDRS lines. The closure rates in the MH subgroup with diameters larger than 400 μm were 20/23 (87.0%) and 15/17 (88.2%) in the FDP group and the NSP group, respectively (p = 0.96). Conclusion: The study indicates that short‐term NSP is equally effective as strict FDP in the repair of MH. Contrary to previous reports, even large MH did not seem to benefit from FDP.

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Section: Methodsmentioning

confidence: 80%

Short-term postoperative non-supine positioning versus strict face-down positioning in macular hole surgery

Forsaa

Ræder

Hashemi

et al. 2012

Acta Ophthalmologica

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“…An Australian long‐term (2.5 years) follow‐up study (Bignold et al ., ) of compliance with TBT provided disappointing results. The investigators used the same questionnaire as the previous study (Oksenberg et al ., ) in 108 patients who were prescribed TBT.…”

Section: The Tennis Ball Technique (Tbt)mentioning

confidence: 99%

Are we missing a simple treatment for most adult sleep apnea patients? The avoidance of the supine sleep position

Oksenberg

Gadoth

2013

Journal of Sleep Research

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Summary Obstructive sleep apnea (OSA) is a sleep disorder which has been gradually accepted as an important cause of increased morbidity and mortality. The treatment of moderate–severe OSA has improved dramatically since the introduction of continuous positive airway pressure (CPAP) devices; however, the adherence of patients to CPAP treatment is relatively low. Adherence appears to be even worse in patients with mild or asymptomatic OSA. The failure to identify and treat mildly symptomatic or asymptomatic OSA patients may be costly, as such patients comprise about 20% of the general adult population. OSA patients could be divided into positional and non‐positional patients. Positional patients show most of their breathing abnormalities while sleeping in the supine position. Simply, by sleeping in the lateral postures, they eliminate or reduce significantly the number of apneas and hypopneas. On the contrary, non‐positional patients suffer from breathing abnormalities in the supine and lateral postures, and as a consequence those are the most severe OSA patients for whom CPAP is the treatment of choice. In this paper we intend to argue that positional therapy, i.e. avoidance of the supine posture during sleep, could represent a valuable therapy mainly for mild–moderate OSA. Considering the fact that the vast majority of mild–moderate OSA patients are positional patients (between 65 and 87%), positional therapy may be a simple, cheap and effective solution for them. High‐quality research regarding this issue is needed to evaluate the real effectiveness of this mode of therapy.

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“…The worst sleeping position is usually, but not always, the supine position. Previous attempts by strapping an object on the back (tennis balls, squash balls, special vests (Bignold et al, 2009;Maurer et al, 2003;Oksenberg et al, 2006;Wenzel et al, 2007), Ôshark finsÕ, etc.) were unsuccessful due to arousals while turning from one lateral position to the other, thereby disturbing sleep architecture and sleep quality.…”

Section: Discussionmentioning

confidence: 99%

“…An additional 30% of patients have a higher AHI in the supine position than in other positions, but not twice as high. Attempts to decrease the severity of sleep apnoea by influencing sleep position have been reported, but with limited success (Bignold et al, 2009;Maurer et al, 2003;Oksenberg et al, 2006;Wenzel et al, 2007). The discomfort and disruption of sleep architecture have been responsible for poor compliance and subsequent disappointing results of these interventions.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a new simple treatment for positional sleep apnoea patients

Maanen

Richard

Kesteren

et al. 2011

Journal of Sleep Research

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Summary Obstructive sleep apnoea syndrome is a common clinical problem. Positional sleep apnoea syndrome, defined as having a supine apnoea–hypopnoea index of twice or more compared to the apnoea–hypopnoea index in the other positions, occurs in 56% of obstructive sleep apnoea patients. A limited number of studies focus on decreasing the severity of sleep apnoea by influencing sleep position. In these studies an object was strapped to the back (tennis balls, squash balls, special vests), preventing patients from sleeping in the supine position. Frequently, this was not successful due to arousals while turning from one lateral position to the other, thereby disturbing sleep architecture and sleep quality. We developed a new neck‐worn device which influences sleep position by offering a vibration when in supine position, without significantly reducing total sleep time. Thirty patients with positional sleep apnoea were included in this study. No side effects were reported. The mean apnoea–hypopnoea index dropped from 27.7 ± 2.4 to 12.8 ± 2.2. Seven patients developed an overall apnoea–hypopnoea index below 5 when using the device in ON modus. We expect that positional therapy with such a device can be applied as a single treatment in many patients with mild to moderate position‐dependent obstructive sleep apnoea, while in patients with a more severe obstructive sleep apnoea such a device could be used in combination with other treatment modalities.

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Poor Long-Term Patient Compliance with the Tennis Ball Technique for Treating Positional Obstructive Sleep Apnea

Cited by 142 publications

References 8 publications

Short-term postoperative non-supine positioning versus strict face-down positioning in macular hole surgery

Short-term postoperative non-supine positioning versus strict face-down positioning in macular hole surgery

Are we missing a simple treatment for most adult sleep apnea patients? The avoidance of the supine sleep position

Evaluation of a new simple treatment for positional sleep apnoea patients

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