The influence of head-of-bed elevation in patients with obstructive sleep apnea

Souza, Fábio José Fabrício de Barros; Genta, Pedro Rodrigues; Filho, Albino José de Souza; Wellman, Andrew; Lorenzi‐Filho, Geraldo

doi:10.1007/s11325-017-1524-3

Cited by 20 publications

(15 citation statements)

References 30 publications

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“…In the current clinical practice in Finland, acute stroke patients are positioned with the head of the bed elevated at 30 degrees to ensure the venous return. This may have exerted a slight impact on the observed OSA severity as it has been shown that even a mild elevation of 7.5° reduces OSA severity in both supine and non-supine position [ 30 ], and a seated position increases the upper airway area [ 31 ] and decreases the upper airway collapsibility [ 32 ]. However, as stated above, semi-recumbent position in acute stroke patients is a standard procedure.…”

Section: Discussionmentioning

confidence: 99%

Acute stroke and TIA patients have specific polygraphic features of obstructive sleep apnea

et al. 2020

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Purpose Obstructive sleep apnea (OSA) is associated with increased risk for stroke, which is known to further impair respiratory functions. However, it is unknown whether the type and severity of respiratory events are linked to stroke or transient ischemic attack (TIA). Thus, we investigate whether the characteristics of individual respiratory events differ between patients experiencing TIA or acute ischemic stroke and matched patients with clinically suspected sleep-disordered breathing. Methods Polygraphic data of 77 in-patients with acute ischemic stroke (n = 49) or TIA (n = 28) were compared to age, gender, and BMI-matched patients with suspected sleep-disordered breathing and no cerebrovascular disease. Along with conventional diagnostic parameters (e.g., apnea-hypopnea index), durations and severities of individual apneas, hypopneas and desaturations were compared between the groups separately for ischemic stroke and TIA patients. Results Stroke and TIA patients had significantly shorter apneas and hypopneas (p < 0.001) compared to matched reference patients. Furthermore, stroke patients had more central apnea events (p = 0.007) and a trend for higher apnea/hypopnea number ratios (p = 0.091). The prevalence of OSA (apnea-hypopnea index ≥ 5) was 90% in acute stroke patients and 79% in transient ischemic attack patients. Conclusion Stroke patients had different characteristics of respiratory events, i.e., their polygraphic phenotype of OSA differs compared to matched reference patients. The observed differences in polygraphic features might indicate that stroke and TIA patients suffer from OSA phenotype recently associated with increased cardiovascular mortality. Therefore, optimal diagnostics and treatment require routine OSA screening in patients with acute cerebrovascular disease, even without previous suspicion of OSA.

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Section: Discussionmentioning

confidence: 99%

Acute stroke and TIA patients have specific polygraphic features of obstructive sleep apnea

et al. 2020

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“…Surgery and oral appliances are not usually realistic options in the setting of recent stroke, but positional therapy, including the use of body positioners to prevent supine sleep, as well as elevating the head of the bed, may be of some benefit. 69,70 A nasopharyngeal airway stenting device (nasal trumpet) may also be tolerated by some patients. Avoiding or minimizing sedating medications that may worsen OSA, such as benzodiazepines and opioids, should be considered.…”

Section: Consider Alternativesmentioning

confidence: 99%

A sleeping beast: Obstructive sleep apnea and stroke

McKee

Auckley

2019

CCJM

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Up to two-thirds of patients who have had a stroke have obstructive sleep apnea (OSA) afterward. These patients have worse outcomes than those without OSA in terms of short-term morbidity, functional and cognitive recovery, and mortality rates over the long term. Following a stroke, identifying OSA and treating it with positive airway pressure, if possible, are important clinical goals. KEY POINTS A low threshold for evaluating for OSA after a stroke is warranted: the prevalence is high in this population, and risk factors for OSA and its typical clinical picture may not be present. Questionnaires can help screen for the likelihood of OSA and the need for more definitive assessment with polysomnography or home sleep apnea testing, tests that pose additional challenges after stroke. Positive airway pressure (PAP) therapy remains the firstline treatment for OSA after stroke; it may improve recovery and reduce long-term sequelae of untreated OSA. Acceptance of and adherence to PAP therapy can be especially problematic in this population, and alternatives should be considered if needed.

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“…For example, Skinner et al [ 4 ] reported mixed results after testing a shoulder-head elevation pillow for the management of obstructive sleep apnea (OSA). More recently, Souza et al [ 5 ] showed that head-of-bed elevation using a laboratory bed reduced the severity of OSA without interfering with sleep architecture. Similarly, a study of a bed that automatically lifted the trunk of the user upon detection of snoring found that it was able to reduce episodes of snoring in the laboratory [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

“…The 12-degree angle is sufficient to elevate the head while still being comfortable for sleep. A mild degree of head-of-bed elevation, compared to larger angles, is most likely to be well tolerated while still being effective according to laboratory studies [ 5 , 6 ]. The inclined position was hypothesized to reduce snoring and improve sleep.…”

Section: Introductionmentioning

confidence: 99%

Sleeping in an Inclined Position to Reduce Snoring and Improve Sleep: In-home Product Intervention Study

Danoff–Burg¹,

Rus²,

Weaver³

et al. 2022

JMIR Form Res

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Background Accurately and unobtrusively testing the effects of snoring and sleep interventions at home has become possible with recent advances in digital measurement technologies. Objective The aim of this study was to examine the effectiveness of using an adjustable bed base to sleep with the upper body in an inclined position to reduce snoring and improve sleep, measured at home using commercially available trackers. Methods Self-reported snorers (N=25) monitored their snoring and sleep nightly and completed questionnaires daily for 8 weeks. They slept flat for the first 4 weeks, then used an adjustable bed base to sleep with the upper body at a 12-degree incline for the next 4 weeks. Results Over 1000 nights of data were analyzed. Objective snoring data showed a 7% relative reduction in snoring duration (P=.001) in the inclined position. Objective sleep data showed 4% fewer awakenings (P=.04) and a 5% increase in the proportion of time spent in deep sleep (P=.02) in the inclined position. Consistent with these objective findings, snoring and sleep measured by self-report improved. Conclusions New measurement technologies allow intervention studies to be conducted in the comfort of research participants’ own bedrooms. This study showed that sleeping at an incline has potential as a nonobtrusive means of reducing snoring and improving sleep in a nonclinical snoring population.

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The influence of head-of-bed elevation in patients with obstructive sleep apnea

Cited by 20 publications

References 30 publications

Acute stroke and TIA patients have specific polygraphic features of obstructive sleep apnea

Acute stroke and TIA patients have specific polygraphic features of obstructive sleep apnea

A sleeping beast: Obstructive sleep apnea and stroke

Sleeping in an Inclined Position to Reduce Snoring and Improve Sleep: In-home Product Intervention Study

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