Efficacy of the New Generation of Devices for Positional Therapy for Patients With Positional Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis

Abstract

Study Objectives:In approximately 56% to 75% of patients with obstructive sleep apnea (OSA), the frequency and duration of apneas are influenced by body position. This is referred to as position-dependent OSA or POSA. Patients with POSA can be treated with a small device attached to either the neck or chest. These devices-a new generation of devices for positional therapy (PT)-provide a subtle vibrating stimulus that prevents patients adopting the supine position. The objectives of this study were to determine whether PT is effective in improving sleep study variables and sleepiness, and to assess compliance. Methods: A systematic review and meta-analysis. Results: Three prospective cohort studies and four randomized controlled trials were included in this review. Combined data for studies reporting on the effect of PT show that there was a mean difference of 11.3 events/h (54% reduction) in apnea-hypopnea index and 33.6% (84% reduction) in percentage total sleeping time in the supine position. The standardized mean difference for both parameters demonstrated a large magnitude of effect (> 0.8 in both cases). Conclusions: There is strong evidence that the new generation of devices for PT are effective in reducing the apnea-hypopnea index during short-term follow-up. These devices are simple-to-use for patients and clinicians and are reversible. Under study conditions with short-term follow-up, compliance is high; however, long-term compliance cannot be assessed because of lack of reliable data. Additional long-term, high-quality studies are needed to confirm the role of PT as a single or as a combination treatment modality for OSA patients and to assess long-term compliance. Keywords: compliance, meta-analysis, obstructive sleep apnea, positional, positional therapy, systematic review Citation: Ravesloot MJ, White D, Heinzer R, Oksenberg A, Pépin JL. Efficacy of the new generation of devices for positional therapy for patients with positional obstructive sleep apnea: a systematic review of the literature and meta-analysis. J Clin Sleep Med. 2017;13(6):813-824. I NTRO DUCTI O NIn approximately 56% to 75% of patients with obstructive sleep apnea (OSA), the frequency and duration of apneas are influenced by body position.1-5 Various definitions of positiondependent obstructive sleep apnea (POSA) have been applied in literature, but the most common classification system and definition marks a distinction between two groups of patients: positional patients (PP) 6 and nonpositional patients (NPP). 3,4,7In PP, desaturations, cyclic variations in heart rate, loud snoring, and apneas and hypopneas appear almost exclusively in the supine position. 8 Cartwright first described the arbitrary cutoff point of a difference of 50% or more in apnea index between supine and nonsupine positions. In the medical literature many have applied modified versions of Cartwright's criteria. In 1998, Marklund et al. defined supine-dependent sleep apnea as a supine apnea-hypopnea index (AHI) ≥ 10 events/h, together with a lateral AHI < 10 ev...

Evaluation of a Trial Period With a Sleep Position Trainer in Patients With Positional Sleep Apnea

“…P values compare data between responders and non-responders. by Ravesloot et al 34 In addition, Barnes et al 35 reviewed the positional modification techniques. In this study, the SPT was used in the routine clinical practice for the treatment of POSA, meaning that any patient in whom POSA was diagnosed was offered to try treatment with the SPT.…”

<p>A comparison between auto-scored apnea-hypopnea index and oxygen desaturation index in the characterization of positional obstructive sleep apnea</p>

“…22 POSA is increasingly important to recognize as advances in the delivery of position therapy using vibrotactile feedback have contributed to improved outcomes, and long-term compliance compared to traditional techniques (eg, tennis ball t-shirts, restrictive pillows, or padding). 19,[23][24][25] The characterization of POSA has also evolved, improving the likelihood that clinically important reductions in overall OSA severity will be achieved if supine sleep is avoided. 20 Unfortunately, if split night PSG or Type III studies without sleep position monitoring capability are used in the assessment of OSA, clinicians cannot routinely identify which patients might benefit from position therapy alone or in combination with oral appliance therapy.…”

Intrapharyngeal surgery with integrated treatment for obstructive sleep apnea

“…Accordingly positional therapy (lateral sleep) is helpful in these patients to resist the collapse and improve apnea [57] . Study revealed that positional therapy in positional OSA patients reshape the velopharyngeal airway, decreased its collapsibility during Muller maneuver, reduction of snoring intensity, and increase of oxygen saturation [58] . Further, the majority of non-positional OSA patients after palatal surgery turn out to be positional OSA patients [59] .…”