Sleep and Breathing

, Volume 22, Issue 2, pp 297–304 | Cite as

Positional therapy in the management of positional obstructive sleep apnea—a review of the current literature

Review
First Online:
Received:
Revised:
Accepted:

Abstract

More than 50% of obstructive sleep apnea (OSA) patients have worsening of their OSA in the supine position (positional obstructive sleep apnea [POSA], commonly defined as supine to non-supine apnea hypopnea index (AHI) ratio of ≥ 2). Positional therapy (PT) aims to prevent patients from sleeping in the supine position. One of the major limiting factors to the routine use of PT in clinical practice is the lack of validated tools to measure compliance objectively. Furthermore, there are no universal guidelines to determine if PT will be effective as standalone or as adjunctive therapy. This paper assesses recent literature on PT demonstrating its effectiveness in management of POSA. It also outlines the proposed subclassification systems for POSA. Electronic literature review was done on EMBASE. Since the last review of PT by Ravesloot et al. (2012), ten studies were identified which demonstrate effectiveness of PT in POSA. We found three publications proposing different subclassification systems for POSA. There were three studies validating different compliance monitoring tools for PT. One study showed the cost benefits of incorporating PT into OSA management. Positional therapy is an effective treatment for POSA and progress has been made in development of tools for measuring compliance. Creating a subclassification of POSA may help develop targeted therapy for patients and determine its use as standalone or adjunct therapy. The integration of PT into POSA management may be cost-effective when compared to the use of CPAP alone.

Keywords

Positional therapy Obstructive sleep apnea Continuous positive airway pressure 
This is a preview of subscription content, log in to check access.

Notes

Author contribution

This manuscript has been seen and approved by all authors.

Funding

No funding was received for this research.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Van Maanen JP, Meester KAW, Dun LN, Koutsourelakis I, Witte BI, Laman DM, Hilgevoord AAJ, de Vries N (2013) The sleep position trainer: a new treatment for positional obstructive sleep apnea. Sleep Breath 17:771–779CrossRefPubMedGoogle Scholar
  2. 2.
    Jafari B, Roux F (2012) Non-positive airway pressure therapy for obstructive sleep apnea. Curr Respir Care Rep 1:111–122CrossRefGoogle Scholar
  3. 3.
    Rotenberg BW, Muriariu D, Pang KP (2016) Trends in CPAP adherence over twenty years of data collection: a flattened curve. J Otolaryngol Head Neck Surg 45:43CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Van Maanen JP, De Vries N (2014) Long-term effectiveness and compliance of positional therapy with the sleep position trainer in the treatment of positional obstructive sleep apnea syndrome. Sleep 37:1209–1215CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Ravesloot MJL, Van Maanen JP, Dun L, De Vries N (2013) The undervalued potential of positional therapy in position-dependent snoring and obstructive sleep apnea – a review of the literature. Sleep Breath 17:39–49CrossRefPubMedGoogle Scholar
  6. 6.
    Cartwright RD, Diaz F, Lloyd S (1991) The effect of sleep posture and sleep stage on apnea frequency. Sleep 14:351–353CrossRefPubMedGoogle Scholar
  7. 7.
    Calik W (2016) Treatments for obstructive sleep apnea. J Clin Outcomes Manag 23:181–192PubMedPubMedCentralGoogle Scholar
  8. 8.
    Permut I, Diaz-Abad M, Chatila W, Crocetti J, Gaughan JP, D’Alonzo GE, Krachman SL (2010) Comparison of positional therapy to CPAP in patients with positional obstructive sleep apnea. J Clin Sleep Med 6:238–243PubMedPubMedCentralGoogle Scholar
  9. 9.
    Levendowski DJ, Seagraves S, Popovic D, Westbrook PR (2014) Assessment of a neck-based treatment and monitoring device for positional obstructive sleep apnea. J Clin Sleep Med 10:863–871PubMedPubMedCentralGoogle Scholar
  10. 10.
    Zuberi NA, Rekab K, Nguyen HV (2004) Sleep apnea avoidance pillow effects on obstructive sleep apnea syndrome and snoring. Sleep Breath 8:201–207CrossRefPubMedGoogle Scholar
  11. 11.
    Bignold JJ, Mercer JD, Antic NA, McEvoy RD, Catcheside PG (2011) Accurate position monitoring and improved supine-dependent obstructive sleep apnea with a new position recording and supine avoidance device. J Clin Sleep Med 7:376–383PubMedPubMedCentralGoogle Scholar
  12. 12.
    Matthews L, Fortier N (2013) The Rematee Bumper Belt® positional therapy device for snoring and obstructive sleep apnea: positional effectiveness in healthy subjects. Can J Respir Ther 49:11–14PubMedPubMedCentralGoogle Scholar
  13. 13.
    Benoist LBL, Verhagen M, Torensma B, van Maanen JP, de Vries N (2016) Positional therapy in patients with residual positional obstructive sleep apnea after upper airway surgery. Sleep Breath.  https://doi.org/10.1007/s11325-016-1397-x
  14. 14.
    Jackson M, Collins A, Berlowitz D, Howard M, O’Donoghue F, Barnes M (2015) Efficacy of sleep position modification to treat positional obstructive sleep apnea. Sleep Med 16:545–552CrossRefPubMedGoogle Scholar
  15. 15.
    Bidarian-Moniri A, Nilsson M, Rasmusson L, Attia J, Ejnell H (2015) The effect of the prone sleeping position on obstructive sleep apnea. Acta Otolaryngol 135:79–84CrossRefPubMedGoogle Scholar
  16. 16.
    Bidarian-Moniri A, Nilsson M, Attia J, Ejnell H (2015) Mattress and pillow for prone positioning for treatment of obstructive sleep apnea. Acta Otolaryngol 135:271–276CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    De Vries GE, Hoekema A, Doff MHJ, Kerstjens HAM, Meijer PM, Van Der Hoeven JH, Wijkstra PJ (2015) Usage of positional therapy in adults with obstructive sleep apnea. J Clin Sleep Med 11:131–137PubMedPubMedCentralGoogle Scholar
  18. 18.
    Van Maanen JP, Richard W, Van Kesteren ER, Ravesloot MJL, Laman DM, Hilgevoord AAJ, De Vries N (2012) Evaluation of a new simple treatment for positional sleep apnea patients. J Sleep Res 21:322–329CrossRefPubMedGoogle Scholar
  19. 19.
    Heinzer RC, Pellaton C, Rey V, Rossetti AO, Lecciso G, Haba-Rubio J, Tafti M, Lavigne G (2012) Positional therapy for obstructive sleep apnea: an objective measurement of patient’s usage and efficacy at home. Sleep Med 13:425–428CrossRefPubMedGoogle Scholar
  20. 20.
    Frank MH, Ravesloot MJL, van Maanen JP, Verhagen E, de Lange J, de Vries N (2015) Positional OSA part 1: towards a clinical classification system for position dependent sleep apnea. Sleep Breath 19:473–480CrossRefPubMedGoogle Scholar
  21. 21.
    Cartwright RD (1984) Effect of sleep position on sleep apnea severity. Sleep 7:110–114CrossRefPubMedGoogle Scholar
  22. 22.
    Marklund M, Persson M, Franklin KA (1998) Treatment success with a mandibular advancement device is related to supine-dependent sleep apnea. Chest 114:1630–1635CrossRefPubMedGoogle Scholar
  23. 23.
    Mador MJ, Kufel TJ, Magalang UJ, Rajesh SK, Watwe V, Grant BJ (2005) Prevalence of positional sleep apnea in patients undergoing polysomnography. Chest 128:2130–2137CrossRefPubMedGoogle Scholar
  24. 24.
    Ravesloot MJL, Frank MH, van Maanen JP, Verhagen EA, de Lange J, de Vries N (2016) Positional OSA part 2: retrospective cohort analysis with a new classification system (APOC). Sleep Breath 20:881–888CrossRefPubMedGoogle Scholar
  25. 25.
    Kim KT, Cho YW, Kim DE, Hwang SH, Song ML, Motamedi GK (2016) Two subtypes of positional obstructive sleep apnea: supine-predominant and supine-isolated. Clin Neurophysiol 127:565–570CrossRefPubMedGoogle Scholar
  26. 26.
    Lee S-A, Paek J-H, Chung Y-S, Kim WS (2016) Clinical features in patients with positional obstructive sleep apnea according to its subtypes. Sleep Breath.  https://doi.org/10.1007/s11325-016-1379-z
  27. 27.
    Omobomi O, Krahnke JS, Ramos FL, Chatila W, Shariff T, D'Alonzo GE, Jaffe F, Vega M, Krachman SL (2015) Accuracy of a new wireless portable monitoring chip to determine body position and time of use during sleep. Sleep 38 (Suppl. 1) (A424-)Google Scholar
  28. 28.
    Ramos FL, Chatila W, Shariff T, Jaffe F, D’Alonzo GE, Vega ME, Krachman SL (2015) Cost effectiveness of incorporating positional therapy into a treatment algorithm for obstructive sleep apnea. Sleep 38 (Suppl. 1) (A442-)Google Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Division of Sleep and Circadian DisordersBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA

Personalised recommendations