Melinda Jackson1, Allison Collins2, David Berlowitz2, Mark Howard1, Fergal O'Donoghue1, Maree Barnes3. 1. Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia; The University of Melbourne, Melbourne, Victoria, Australia. 2. Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia. 3. Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia; The University of Melbourne, Melbourne, Victoria, Australia. Electronic address: maree.barnes@austin.org.au.
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.
RCT Entities:
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.
Authors: Fábio José Fabrício de Barros Souza; Pedro Rodrigues Genta; Albino José de Souza Filho; Andrew Wellman; Geraldo Lorenzi-Filho Journal: Sleep Breath Date: 2017-06-24 Impact factor: 2.816