Positional therapy in patients with residual positional obstructive sleep apnea after upper airway surgery

Benoist, Linda; Verhagen, Merel; Torensma, Bart; Maanen, J. Peter van; Vries, Nico de

doi:10.1007/s11325-016-1397-x

Cited by 45 publications

(22 citation statements)

References 37 publications

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“…In a prospective single arm study from Netherlands of 36 patients with mild to moderate POSA by van Maanen et al , a very high treatment adherence rate (defined by >4 hours device use/day) of 92.7% with the Nightbalance SPT was observed 16. In another two studies using the Nightbalance SPT by Benoist et al , treatment adherence (defined as >4 hours device use/day at least 5 days in a week) was found to be 89.3%22 and 89.0%,23 respectively at 3 months. The much lower PT adherence rate seen in our Asian study population reinforces the importance of replicating positive results from Caucasian studies in other ethnic populations.…”

Section: Discussionmentioning

confidence: 94%

Comparing treatment effects of a convenient vibratory positional device to CPAP in positional OSA: a crossover randomised controlled trial

Mok

Tan

Hsu

et al. 2020

Thorax

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ObjectivesUp to 77% of patients with obstructive sleep apnoea (OSA) have positional OSA (POSA) but traditional positional therapy (PT) methods have failed as they were poorly tolerated. New convenient vibratory PT devices have been invented but while recent studies suggest high treatment efficacy and adherence, there are no published data comparing these devices directly with continuous positive airway pressure (CPAP). Our objective is to evaluate if a convenient vibratory PT device is non-inferior to CPAP in POSA treatment.MethodsIn this crossover randomised controlled trial, we enrolled patients with POSA with significant daytime sleepiness (Epworth Sleepiness Scale (ESS)≥10). POSA diagnosis was based on: (1) total Apnoea/Hypopnoea Index (AHI)>10/hour and non-supine AHI<10/hour (2) supine AHI≥2 × non-supine AHI. Patients used their initial allocated devices (PT or CPAP) for 8 weeks before crossing to the alternative intervention after a 1 week washout. The primary aim is to measure changes in ESS between the two treatments. Secondary outcomes include sleep study parameters and patient treatment preference (ClinicalTrials.gov: NCT03125512).Results40 patients completed the trial between April 2017 and December 2018. Difference in ESS after 8 weeks of device use (PT minus CPAP) was 2.0 (95% CI 0.68 to 3.32), exceeding our predetermined non-inferiority margin of 1.5. AHI on CPAP was lower than with PT (4.0±3.2 vs 13.0±13.8 events/hour, respectively, p=0.001), although both were lower than at baseline. Time spent supine was significantly lower with PT than CPAP (p<0.001). 60% of patients preferred CPAP, 20% preferred PT, while 20% preferred neither device.ConclusionsThe non-inferiority ESS endpoint for PT compared with CPAP was not met and the results were inconclusive. Future trials with larger sample sizes or in less symptomatic patients are warranted to provide further insight into the role of these new vibratory PT devices.

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Section: Discussionmentioning

confidence: 94%

Comparing treatment effects of a convenient vibratory positional device to CPAP in positional OSA: a crossover randomised controlled trial

Mok

Tan

Hsu

et al. 2020

Thorax

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“…Furthermore, patients suffering from residual POSA under a given therapy can be good candidates for combination therapy. Dieltjens et al 26 studied the effect of the combination of OA therapy with SPT, whereas Benoist et al 27 investigated the effect of additional SPT therapy after upper airway surgery. Both studies showed promising results.…”

Section: Discussionmentioning

confidence: 99%

“…[20][21][22][23][24][25] Furthermore, the use of the chest-worn sleep position trainer (SPT) was studied as part of combination therapy in patients who have residual POSA after treatment with oral appliances (OA) or after upper airway surgery. 26,27 The authors of both studies concluded that additional positional training in a group of patients with residual POSA after standard treatment can increase the overall therapeutic effectiveness.…”

Section: Evaluation Of a Trial Period With A Sleep Position Trainer Imentioning

confidence: 99%

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

Beyers

Dieltjens

Kastoer

et al. 2018

Journal of Clinical Sleep Medicine

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“…In positional patients, in particular, performing DISE in both the lateral and supine position can be of added value, especially since the role of positional therapy is gaining momentum, both as a single treatment option, or as combination therapy, for example, with OAT or upper airway surgery . Various studies have shown that DISE findings in these patients differ when performed in the supine or lateral position .…”

Section: Patient Positioning Basic and Special Diagnostic Manoeuvrementioning

confidence: 99%

European position paper on drug‐induced sleep endoscopy: 2017 Update

Vito

Carrasco-Llatas

Ravesloot

et al. 2018

Clinical Otolaryngology

169

155

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After the first European Position Consensus Meeting on DISE and its update, consensus was confirmed for indications, required preliminary examinations, where to perform DISE, technical equipment required, staffing, local anaesthesia, nasal decongestion, other medications, patient positioning, basics and special diagnostic manoeuvres, drugs and observation windows. So far, no consensus could be reached on a scoring and classification system. However, regarding this aim, the idea of an essential classification, such as VOTE with the possibility of its graded implementation of information and descriptions, seems to be the best way to reach a universal consensus on DISE classification at this stage. A common DISE language is mandatory, and attempts to come to a generally accepted system should be pursued.

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Positional therapy in patients with residual positional obstructive sleep apnea after upper airway surgery

Abstract: The results of this study indicate that additional PT in a complex OSA patient population with residual POSA after surgery can increase overall therapeutic effectiveness by improving the median MDA from 39.5 % (effect of surgery alone) to 65.6 % (effect of combining surgery and PT).

Cited by 45 publications

References 37 publications

Comparing treatment effects of a convenient vibratory positional device to CPAP in positional OSA: a crossover randomised controlled trial

Comparing treatment effects of a convenient vibratory positional device to CPAP in positional OSA: a crossover randomised controlled trial

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

European position paper on drug‐induced sleep endoscopy: 2017 Update

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