User Compliance and Behavioral Adaptation Associated With Supine Avoidance Therapy

Levendowski, Daniel J.; Cunnington, David; Swieca, John; Westbrook, Philip R.

doi:10.1080/15402002.2016.1163704

Cited by 16 publications

(12 citation statements)

References 32 publications

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“…52,53 However, the longterm adherence to PT has improved in the recent past with the use of newer generation devices that appear to be much more comfortable and acceptable/applicable. [54][55][56][57][58][59][60] Our study has shown that POSA is prevalent in this regional and remote Australian population studied and the simulated PT model demonstrates that PT may be beneficial among not only in patients with milder OSA but also among those with moderate to severe OSA and PT could be a potential alternate modality in treating OSA, especially among patients who may have difficulty in the affordability/accessibility or intolerant to CPAP therapy. Further prospective research using novel PT devices is however warranted in this population.…”

Section: Discussionmentioning

confidence: 64%

<p>Positional Sleep Apnea Among Regional and Remote Australian Population and Simulated Positional Treatment Effects</p>

Garg¹,

Er²,

Howarth³

et al. 2020

NSS

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Purpose: To assess the prevalence of positional sleep apnea (POSA) and its predictors in patients diagnosed to have obstructive sleep apnea (OSA) in the regional and remote population of the Northern Territory of Australia over a two-year study period (2018 and 2019). Patients and Methods: Of the total 1463 adult patients who underwent a diagnostic polysomnography (PSG), 946 patients were eligible to be included in the study, of them, 810 consecutive patients with OSA (Apnea-Hypopnea Index (AHI) ≥ 5) who slept >4 h and had ≥30 min sleep in both supine and lateral positions were assessed. Patients were considered to have POSA if supine AHI to lateral AHI ratio ≥2. The likely comparative impact of use of continuous positive airway therapy (CPAP) or positional therapy (PT) on disease severity was evaluated using model simulation. Results: A total of 495/810 (61%) patients had POSA, the majority were males (68% vs 60%, p=0.013) and non-Indigenous Australians (93% vs 87%, p=0.004). POSA patients were younger (mean difference 2.23 years (95% CI 0.27, 4.19)), less obese (BMI mean difference 3.06 (95% CI 2.11, 4.01)), demonstrated less severe OSA (p < 0.001) and a greater proportion reported alcohol consumption (72% vs 62%, p=0.001) as compared to those with non-POSA. Using the simulation model, if patients with POSA use PT two-thirds (323/495, 65%) would obtain significant improvement of their OSA severity, with one in five (92/495, 19%) displaying complete resolution. Comparing this to simulated CPAP therapy, where the majority (444/495, 90%) will show significant improvement, and onethird (162/495, 33%) will display complete resolution. Conclusion: POSA needs to be routinely recognised and positional therapy integrated in practice especially in the remote regions and in the developing world when effective methods are in place to monitor positional therapy.

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Section: Discussionmentioning

confidence: 64%

<p>Positional Sleep Apnea Among Regional and Remote Australian Population and Simulated Positional Treatment Effects</p>

Garg¹,

Er²,

Howarth³

et al. 2020

NSS

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“…This is also supported by a study that followed 135 users of a neck‐placed vibration SPT over 15–52 weeks. The number of turns to supine position as well as the response rate to the vibrations remained unchanged during the period of SPT use (Levendowski et al ., ).…”

Section: Discussionmentioning

confidence: 97%

A Sleep Position Trainer for positional sleep apnea: a randomized, controlled trial

Laub

Tønnesen

Jennum

2017

Journal of Sleep Research

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We tested the effect of the Sleep Position Trainer, a vibrational device, for positional sleep apnea in an open, randomized controlled trial with 101 patients, where 52 patients were allocated to Sleep Position Trainer and 49 patients to a non-treatment control group for 2 months (Part 1). All patients were then followed as a cohort for a period of 6 months with use of the Sleep Position Trainer (Part 2). The participants were assessed with polygraphy at entry, and after 2 and 6 months. The mean apnea-hypopnea index supine was 35 per h (SD, 18) in the Sleep Position Trainer group and 38 per h (SD, 15) in the control group at entry. In a per protocol analysis, the mean total apnea-hypopnea index at entry and after 2 months in the Sleep Position Trainer group was 18 per h (SD, 10) and 10 per h (SD, 9; P < 0.001) versus 20 per h (SD, 9) and 18 per h (SD, 10; NS) in the control group. The mean supine sleep time decreased from 47% (SD, 22) to 17% (SD, 18; P < 0.001) in the Sleep Position Trainer group after 2 months. In the control group, the mean supine sleep time was 48% (SD, 20) at entry and 39% (SD, 21; NS) after 2 months. The positive effect of Sleep Position Trainer was maintained in all patients treated with Sleep Position Trainer after 6 months. Daytime sleepiness improved after 6 months. Compliance with the Sleep Position Trainer device during the first 2 months, defined as use of Sleep Position Trainer >4 h per night for all weekdays, was 75.5% (SD 21.2). The discontinuation rate was 28.8 and 49.4% after 2 and 6 months, respectively.

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“…As many as 50% of patients with OSA are not adherent to positive airway pressure therapy, and 20-30% of patients do not accept therapy after initial diagnosis [40]. However, although CPAP is a standard treatment for OSA, there are new FDA-approved devices, which include Night Shift (by Advanced Brain Monitoring), Winx (by ApniCure), or Provent Sleep Apnea Technology (by Theravent) [41-43]. They may be used for those who refuse or cannot tolerate CPAP and may provide an alternative to oral surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnea Screening in Patients With Atrial Fibrillation: Missed Opportunities for Early Diagnosis

et al. 2019

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Background“There is a high prevalence of obstructive sleep apnea (OSA) among patients with atrial fibrillation (AF). There is also strong evidence that proper OSA management can reduce AF recurrence.” Polysomnography is the gold standard for OSA diagnosis, but screening tests, such as STOP-BANG, have been successful in identifying patients at risk for OSA. Our study assesses screening rates for OSA in patients with persistent AF, and willingness of patients at increased risk for OSA towards further diagnostic evaluation.MethodsA total of 254 persistent AF patients were surveyed regarding prior screening for OSA, and if previously unscreened, assessed with STOP-BANG. Prior cardioversions and willingness to undergo further workup was also recorded. Patients at risk for OSA were given educational brochures. Subjects with diagnosis of OSA were asked about their compliance with positive airway pressure therapy.ResultsSixty-six percent of AF patients were never screened for OSA; 75% unscreened participants (95% CI: 68-81%) were at high risk for OSA. Patients with previous hospitalizations or electrical cardioversions were more frequently screened for OSA (P = 0.02, P = 0.03, respectively). Forty-three percent of high-risk individuals had a BMI < 30. Among patients at risk for OSA (score ≥ 3), the majority (n = 99, 79%) were interested in follow-up with a sleep study (n = 93, 74%).ConclusionsAlthough there is a strong OSA-associated risk for AF, which is amenable to intervention, most patients with persistent AF are not assessed for OSA. Simple to use screening questionnaires are sensitive and can reliably identify patients at high risk for OSA, reserving costlier and somewhat inconvenient nocturnal polysomnography to only those at risk. We hope our study will help to push the AF and OSA connection into the spotlight in the primary care of patients with AF.

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User Compliance and Behavioral Adaptation Associated With Supine Avoidance Therapy

Cited by 16 publications

References 32 publications

<p>Positional Sleep Apnea Among Regional and Remote Australian Population and Simulated Positional Treatment Effects</p>

<p>Positional Sleep Apnea Among Regional and Remote Australian Population and Simulated Positional Treatment Effects</p>

A Sleep Position Trainer for positional sleep apnea: a randomized, controlled trial

Obstructive Sleep Apnea Screening in Patients With Atrial Fibrillation: Missed Opportunities for Early Diagnosis

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