Sleep and Breathing

, Volume 23, Issue 4, pp 1141–1149 | Cite as

Treatment of sleep-disordered breathing with positional therapy: long-term results

  • Jolien BeyersEmail author
  • O. M. Vanderveken
  • C. Kastoer
  • A. Boudewyns
  • I. De Volder
  • A. Van Gastel
  • J. A. Verbraecken
  • W. A. De Backer
  • M. J. Braem
  • P. H. Van de Heyning
  • M. Dieltjens
Sleep Breathing Physiology and Disorders • Original Article



The aim of the present study was to assess the efficacy of a sleep position trainer (SPT) in patients with an established diagnosis of positional obstructive sleep apnea and to evaluate the adherence after 1-year follow-up.


Polysomnography (PSG) was performed at baseline and after 1 year of SPT use. Patients received questionnaires to assess treatment satisfaction and subjective adherence. Data on objective adherence and number of vibrations initiated by the SPT were collected from the SPT device.


Nine out of 58 patients stopped using the SPT during the first year of treatment (16%). Thirty-four middle-aged and overweight patients underwent a PSG after 1 year of SPT use (male/female ratio, 28/6; overall apnea/hypopnea index (AHI), 16/h). A significant reduction in overall AHI to 6/h was observed using treatment (p < 0.001). The median percentage of supine sleep decreased significantly to 1% with SPT (p < 0.001). The mean objective SPT use in 28 patients was 7.3 ± 0.9 h/night and 69 ± 26% of the nights. Furthermore, 75% of the patients reported a better sleep quality since the start of SPT treatment.


Long-term treatment with the SPT was found to be effective in reducing overall AHI. Time spent sleeping in supine position was reduced to almost zero in the continuing users. Patient satisfaction was high when using the SPT.


Long-term therapy Obstructive sleep apnea (OSA) Supine dependent Sleep position trainer Non-invasive therapy 



apnea/hypopnea index


continuous positive airway pressure


Epworth sleepiness scale


oxygen desaturation index


obstructive sleep apnea


positional obstructive sleep apnea




positional therapy


sleep-disordered breathing


sleep position trainer


minimum oxygen saturation


total sleep time

VAS snoring

visual analogue scale for snoring



The authors would like to thank Adelheidis Hoogewijs for her assistance with this research project.

Compliance with ethical standards

Conflict of interest

Olivier Vanderveken holds a Senior Clinical Investigator Fellowship from the Research Foundation, Flanders (FWO), 2016-2021. Marijke Dieltjens holds a Postdoctoral fellowship at Research Foundation, Flanders (FWO), 12H4516N.

Dr. Vanderveken reports other from Research support from NightBalance, during the conduct of the study; grants from Philips research grant at Antwerp University Hospital, grants from Somnomed research grant at Antwerp University Hospital, other from Somnomed, other from Inspire Medical Systems, other from Galvani, other from Zephyr, outside the submitted work. Dr. Verbraecken reports grants from NightBalance, during the conduct of the study. Dr. Braem reports grants from Somnomed Research Grant, outside the submitted work.

Research involving human participants

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11325_2019_1792_MOESM1_ESM.pdf (244 kb)
ESM 1 (PDF 243 kb)


  1. 1.
    Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328(17):1230–1235CrossRefGoogle Scholar
  2. 2.
    Kryger MH (2000) Diagnosis and management of sleep apnea syndrome. Clin Cornerstone 2(5):39–47CrossRefGoogle Scholar
  3. 3.
    Malhotra A, White DP (2002) Obstructive sleep apnoea. Lancet 360(9328):237–245CrossRefGoogle Scholar
  4. 4.
    Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP (2010) Pathophysiology of sleep apnea. Physiol Rev 90(1):47–112CrossRefGoogle Scholar
  5. 5.
    Jennum P, Kjellberg J (2011) Health, social and economical consequences of sleep-disordered breathing: a controlled national study. Thorax 66(7):560–566CrossRefGoogle Scholar
  6. 6.
    (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 22(5): 667–89Google Scholar
  7. 7.
    Sullivan CE, Issa FG, Berthon-Jones M, Eves L (1981) Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1(8225):862–865CrossRefGoogle Scholar
  8. 8.
    Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD, Adult Obstructive M, Sleep Apnea Task Force of the American Academy of Sleep (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5(3):263–276PubMedGoogle Scholar
  9. 9.
    Robinson GV, Stradling JR, Davies RJ (2004) Sleep . 6: obstructive sleep apnoea/hypopnoea syndrome and hypertension. Thorax 59(12):1089–1094CrossRefGoogle Scholar
  10. 10.
    Grote L, Hedner J, Grunstein R, Kraiczi H (2000) Therapy with nCPAP: incomplete elimination of Sleep Related Breathing Disorder. Eur Respir J 16(5):921–927CrossRefGoogle Scholar
  11. 11.
    Kribbs NB, Pack AI, Kline LR, Smith PL, Schwartz AR, Schubert NM, Redline S, Henry JN, Getsy JE, Dinges DF (1993) Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis 147(4):887–895CrossRefGoogle Scholar
  12. 12.
    Marklund M, Verbraecken J, Randerath W (2012) Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy. Eur Respir J 39(5):1241–1247CrossRefGoogle Scholar
  13. 13.
    Cartwright RD (1984) Effect of sleep position on sleep apnea severity. Sleep 7(2):110–114CrossRefGoogle Scholar
  14. 14.
    Marklund M, Persson M, Franklin KA (1998) Treatment success with a mandibular advancement device is related to supine-dependent sleep apnea. Chest 114(6):1630–1635CrossRefGoogle Scholar
  15. 15.
    Mador MJ, Kufel TJ, Magalang UJ, Rajesh SK, Watwe V, Grant BJ (2005) Prevalence of positional sleep apnea in patients undergoing polysomnography. Chest 128(4):2130–2137CrossRefGoogle Scholar
  16. 16.
    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(4):376–383PubMedPubMedCentralGoogle Scholar
  17. 17.
    Oksenberg A, Silverberg DS, Arons E, Radwan H (1997) Positional vs nonpositional obstructive sleep apnea patients: anthropomorphic, nocturnal polysomnographic, and multiple sleep latency test data. Chest 112(3):629–639CrossRefGoogle Scholar
  18. 18.
    Richard W, Kox D, den Herder C, Laman M, van Tinteren H, de Vries N (2006) The role of sleep position in obstructive sleep apnea syndrome. Eur Arch Otorhinolaryngol 263(10):946–950CrossRefGoogle Scholar
  19. 19.
    Eiseman NA, Westover MB, Ellenbogen JM, Bianchi MT (2012) The impact of body posture and sleep stages on sleep apnea severity in adults. J Clin Sleep Med 8(6):655–66APubMedPubMedCentralGoogle Scholar
  20. 20.
    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(3):238–243PubMedPubMedCentralGoogle Scholar
  21. 21.
    Oksenberg A, Silverberg D, Offenbach D, Arons E (2006) Positional therapy for obstructive sleep apnea patients: a 6-month follow-up study. Laryngoscope 116(11):1995–2000CrossRefGoogle Scholar
  22. 22.
    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 patients' usage and efficacy at home. Sleep Med 13(4):425–428CrossRefGoogle Scholar
  23. 23.
    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(8):863–871PubMedPubMedCentralGoogle Scholar
  24. 24.
    van Maanen JP, Meester KA, Dun LN, Koutsourelakis I, Witte BI, Laman DM, Hilgevoord AA, de Vries N (2013) The sleep position trainer: a new treatment for positional obstructive sleep apnoea. Sleep Breath 17(2):771–779CrossRefGoogle Scholar
  25. 25.
    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(7):1209–1215CrossRefGoogle Scholar
  26. 26.
    Bignold JJ, Deans-Costi G, Goldsworthy MR, Robertson CA, McEvoy D, Catcheside PG, Mercer JD (2009) Poor long-term patient compliance with the tennis ball technique for treating positional obstructive sleep apnea. J Clin Sleep Med 5(5):428–430PubMedPubMedCentralGoogle Scholar
  27. 27.
    Ravesloot MJL, White D, Heinzer R, Oksenberg A, Pepin JL (2017) 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 13(6):813–824CrossRefGoogle Scholar
  28. 28.
    Beyers J, Dieltjens M, Kastoer C, Opdebeeck L, Boudewyns AN, De Volder I, Van Gastel A, Verbraecken JA, De Backer WA, Braem MJ, Van de Heyning PH, Vanderveken OM (2018) Evaluation of a trial period with a sleep position trainer in patients with positional sleep apnea. J Clin Sleep Med 14:575–583CrossRefGoogle Scholar
  29. 29.
    Iber C, Ancoli-Israel S, Chesson A, Quan S, f.t.A.A.o.S. Medicine (2007) The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. American Academy of Sleep Medicine, WestchesterGoogle Scholar
  30. 30.
    de Ruiter MHT, Benoist LBL, de Vries N, de Lange J (2017) Durability of treatment effects of the Sleep Position Trainer versus oral appliance therapy in positional OSA: 12-month follow-up of a randomized controlled trial. Sleep BreathGoogle Scholar
  31. 31.
    Dieltjens M, Braem MJ, Vroegop A, Wouters K, Verbraecken JA, De Backer WA, Van de Heyning PH, Vanderveken OM (2013) Objectively measured vs self-reported compliance during oral appliance therapy for sleep-disordered breathing. Chest 144(5):1495–1502CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Jolien Beyers
    • 1
    • 2
    • 3
    Email author
  • O. M. Vanderveken
    • 1
    • 2
    • 3
  • C. Kastoer
    • 1
    • 2
  • A. Boudewyns
    • 1
    • 2
  • I. De Volder
    • 3
    • 4
  • A. Van Gastel
    • 3
    • 4
  • J. A. Verbraecken
    • 2
    • 3
    • 5
  • W. A. De Backer
    • 2
  • M. J. Braem
    • 2
    • 6
  • P. H. Van de Heyning
    • 1
    • 2
  • M. Dieltjens
    • 1
    • 2
  1. 1.Department of Otorhinolaryngology, Head and Neck SurgeryAntwerp University HospitalEdegemBelgium
  2. 2.Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
  3. 3.Multidisciplinary Sleep Disorders CentreAntwerp University HospitalEdegemBelgium
  4. 4.Department of PsychiatryAntwerp University HospitalEdegemBelgium
  5. 5.Department of Pulmonary MedicineAntwerp University HospitalEdegemBelgium
  6. 6.Department of Special Care DentistryAntwerp University HospitalEdegemBelgium

Personalised recommendations