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New-generation positional therapy in patients with positional central sleep apnea

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Abstract

Purpose

To evaluate the effect of a sleep position trainer (SPT) in patients with positional central sleep apnea (PCSA).

Methods

A multicentre cohort study was conducted. Patients with symptomatic PCSA were included. Effectiveness, compliance and quality of life were assessed at 1- and 6-month follow-up.

Results

Sixteen patients were included. Median AHI dropped from 23.4/h [12.9–31.2] to 11.5/h [7.2–24.5] (p = 0.044) after 1-month SPT therapy and in patients who continued treatment, median AHI further decreased after 6 months to 9.7/h [3.4–27.6] (p = 0.075). Median percentage of supine sleep decreased significantly from 37.6 [17.2–51.8] to 6.7 [0.7–22.8] (p < 0.001), after 1 month, and to 6.8 [0.7–22.1] (p = 0.001), after 6 months. Mean compliance over 1 and 6 months was 78.6 ± 35.3 and 66.0 ± 33.3%, respectively. Epworth Sleepiness Scale at baseline was 9.5 [3.3–11.8] and did not significantly decrease after 1 month (11.0 [3.0–13.0]) and 6 months (4.0 [3.0–10.5]) follow-up. Functional Outcomes of Sleep Questionnaire remained stable within the first month. However, after 6 months, there was a significant improvement compared to baseline values, 15.9 [11.9–18.4] vs. 17.8 [14.3–19.2]; p = 0.030.

Conclusion

This is the first study on effects of positional therapy with a new-generation smart device in patients with PCSA after 1 and 6 months of follow-up. Results of this study show that the SPT is effective in reducing AHI and central AI, feasible in PCSA, and is associated with symptomatic improvement. While the working mechanism behind this effect remains speculative, the effect is positive and considerable.

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References

  1. Eckert DJ, Jordan AS, Merchia P, Malhotra A (2007) Central sleep apnea: pathophysiology and treatment. Chest 131(2):595–607. https://doi.org/10.1378/chest.06.2287

    Article  PubMed  Google Scholar 

  2. Randerath W, Verbraecken J, Andreas S, Arzt M, Bloch KE, Brack T, Buyse B, De Backer W, Eckert DJ, Grote L, Hagmeyer L, Hedner J, Jennum P, La Rovere MT, Miltz C, McNicholas WT, Montserrat J, Naughton M, Pepin JL, Pevernagie D, Sanner B, Testelmans D, Tonia T, Vrijsen B, Wijkstra P, Levy P (2017) Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. Eur Respir J. https://doi.org/10.1183/13993003.00959-2016

    Article  PubMed  Google Scholar 

  3. Yumino D, Bradley TD (2008) Central sleep apnea and Cheyne–Stokes respiration. Proc Am Thorac Soc 5(2):226–236. https://doi.org/10.1513/pats.200708-129MG

    Article  PubMed  Google Scholar 

  4. Xie A, Skatrud JB, Puleo DS, Morgan BJ (2001) Exposure to hypoxia produces long-lasting sympathetic activation in humans. J Appl Physiol (1985) 91(4):1555–1562. https://doi.org/10.1152/jappl.2001.91.4.1555

    Article  CAS  Google Scholar 

  5. Muza RT (2015) Central sleep apnoea-a clinical review. J Thorac Dis 7(5):930–937. https://doi.org/10.3978/j.issn.2072-1439.2015.04.45

    Article  PubMed  PubMed Central  Google Scholar 

  6. Randerath W (2017) Central sleep apnea: the problem of diagnosis. Sleep Med 34:224–225. https://doi.org/10.1016/j.sleep.2016.12.015

    Article  CAS  PubMed  Google Scholar 

  7. Cartwright RD (1984) Effect of sleep position on sleep apnea severity. Sleep 7(2):110–114

    Article  CAS  PubMed  Google Scholar 

  8. Ravesloot MJ, 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(1):39–49. https://doi.org/10.1007/s11325-012-0683-5

    Article  CAS  PubMed  Google Scholar 

  9. Sahlin C, Svanborg E, Stenlund H, Franklin KA (2005) Cheyne–Stokes respiration and supine dependency. Eur Respir J 25(5):829–833. https://doi.org/10.1183/09031936.05.00107904

    Article  CAS  PubMed  Google Scholar 

  10. Zaharna M, Rama A, Chan R, Kushida C (2013) A case of positional central sleep apnea. J Clin Sleep Med 9(3):265–268. https://doi.org/10.5664/jcsm.2496

    Article  PubMed  PubMed Central  Google Scholar 

  11. DelRosso L, Gonzalez-Toledo E, Chesson AL Jr, Hoque R (2012) Positional central apnea and vascular medullary compression. Neurology 79(21):2156–2157. https://doi.org/10.1212/WNL.0b013e3182752cc9

    Article  PubMed  Google Scholar 

  12. de Vries GE, Hoekema A, Doff MH, Kerstjens HA, Meijer PM, van der Hoeven JH, Wijkstra PJ (2015) Usage of positional therapy in adults with obstructive sleep apnea. J Clin Sleep Med 11(2):131–137. https://doi.org/10.5664/jcsm.4458

    Article  PubMed  PubMed Central  Google Scholar 

  13. 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):771–779. https://doi.org/10.1007/s11325-012-0764-5

    Article  PubMed  Google Scholar 

  14. 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):813–824. https://doi.org/10.5664/jcsm.6622

    Article  PubMed  PubMed Central  Google Scholar 

  15. 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):1209–1215. https://doi.org/10.5665/sleep.3840

    Article  PubMed  PubMed Central  Google Scholar 

  16. Benoist LB, 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

    Article  PubMed  Google Scholar 

  17. Dieltjens M, Vroegop AV, Verbruggen AE, Wouters K, Willemen M, De Backer WA, Verbraecken JA, Van de Heyning PH, Braem MJ, de Vries N, Vanderveken OM (2015) A promising concept of combination therapy for positional obstructive sleep apnea. Sleep Breath 19(2):637–644. https://doi.org/10.1007/s11325-014-1068-8

    Article  PubMed  Google Scholar 

  18. Pump B, Talleruphuus U, Christensen NJ, Warberg J, Norsk P (2002) Effects of supine, prone, and lateral positions on cardiovascular and renal variables in humans. Am J Physiol Regul Integr Comp Physiol 283(1):R174–180. https://doi.org/10.1152/ajpregu.00619.2001

    Article  CAS  PubMed  Google Scholar 

  19. Fujita M, Miyamoto S, Sekiguchi H, Eiho S, Sasayama S (2000) Effects of posture on sympathetic nervous modulation in patients with chronic heart failure. Lancet 356(9244):1822–1823. https://doi.org/10.1016/S0140-6736(00)03240-2

    Article  CAS  PubMed  Google Scholar 

  20. Miyamoto S, Fujita M, Sekiguchi H, Okano Y, Nagaya N, Ueda K, Tamaki S, Nohara R, Eiho S, Sasayama S (2001) Effects of posture on cardiac autonomic nervous activity in patients with congestive heart failure. J Am Coll Cardiol 37(7):1788–1793

    Article  CAS  PubMed  Google Scholar 

  21. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep M (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 8(5):597–619. https://doi.org/10.5664/jcsm.2172

    Article  PubMed  PubMed Central  Google Scholar 

  22. Vanderveken OM, Oostveen E, Boudewyns AN, Verbraecken JA, Van de Heyning PH, De Backer WA (2005) Quantification of pharyngeal patency in patients with sleep-disordered breathing. ORL J Otorhinolaryngol Relat Spec 67(3):168–179. https://doi.org/10.1159/000086572

    Article  PubMed  Google Scholar 

  23. Jobin V, Rigau J, Beauregard J, Farre R, Monserrat J, Bradley TD, Kimoff RJ (2012) Evaluation of upper airway patency during Cheyne–Stokes breathing in heart failure patients. Eur Respir J 40(6):1523–1530. https://doi.org/10.1183/09031936.00060311

    Article  PubMed  Google Scholar 

  24. Leemans G, Ides K, Van Holsbeke C, Vissers D, Vos W, De Backer W (2013) The influence of posture on airway structure and function in healthy subjects. Eur Respir Soc

  25. Brack T, Jubran A, Laghi F, Tobin MJ (2005) Fluctuations in end-expiratory lung volume during Cheyne–Stokes respiration. Am J Respir Crit Care Med 171(12):1408–1413. https://doi.org/10.1164/rccm.200503-409OC

    Article  PubMed  Google Scholar 

  26. Hazebroek EJ, Bonjer HJ (2006) Effect of patient position on cardiovascular and pulmonary function. In: Whelan RL, Fleshman JW, Fowler DL (eds) The SAGES manual of perioperative care in minimally invasive surgery, 1 edn. Springer, Berlin, pp 410–417. https://doi.org/10.1007/0-387-29050-8

    Chapter  Google Scholar 

  27. Martin-Du Pan RC, Benoit R, Girardier L (2004) The role of body position and gravity in the symptoms and treatment of various medical diseases. Swiss Med Wkly 134(37–38):543–551. https://doi.org/10.4414/smw.2004/37/smw-09765

    Article  PubMed  Google Scholar 

  28. Solin P, Jackson D, Roebuck T, Naughton M (2002) Cardiac diastolic function and hypercapnic ventilatory responses in central sleep apnoea. Eur Respir J 20(3):717–723

    Article  CAS  PubMed  Google Scholar 

  29. Hanly PJ (2009) Impact of sleeping angle on the upper airway and pathogenesis of Cheyne Stokes respiration. Sleep 32(11):1412–1413

    Article  PubMed  PubMed Central  Google Scholar 

  30. Joosten SA, Sands SA, Edwards BA, Hamza K, Turton A, Lau KK, Crossett M, Berger PJ, Hamilton GS (2015) Evaluation of the role of lung volume and airway size and shape in supine-predominant obstructive sleep apnoea patients. Respirology 20(5):819–827

    Article  PubMed  Google Scholar 

  31. Joosten SA, Landry SA, Sands SA, Terrill PI, Mann D, Andara C, Skuza E, Turton A, Berger P, Hamilton GS (2017) Dynamic loop gain increases upon adopting the supine body position during sleep in patients with obstructive sleep apnoea. Respirology 22(8):1662–1669

    Article  PubMed  PubMed Central  Google Scholar 

  32. Galetke W, Ghassemi BM, Priegnitz C, Stieglitz S, Anduleit N, Richter K, Randerath WJ (2014) Anticyclic modulated ventilation versus continuous positive airway pressure in patients with coexisting obstructive sleep apnea and Cheyne–Stokes respiration: a randomized crossover trial. Sleep Med 15(8):874–879. https://doi.org/10.1016/j.sleep.2014.02.012

    Article  PubMed  Google Scholar 

  33. Boudewyns A, Willemen M, Wagemans M, De Cock W, Van de Heyning P, De Backer W (1997) Assessment of respiratory effort by means of strain gauges and esophageal pressure swings: a comparative study. Sleep 20(2):168–170

    Article  CAS  PubMed  Google Scholar 

  34. Rotenberg BW, Murariu D, Pang KP (2016) Trends in CPAP adherence over twenty years of data collection: a flattened curve. J Otolaryngol Head Neck Surg 45(1):43

    Article  PubMed  PubMed Central  Google Scholar 

  35. Verbraecken J, Willemen M, Wittesaele W, Van de Heyning P, De Backer W (2002) Short-term CPAP does not influence the increased CO. Monaldi Arch Chest Dis 57(1):10–18

    CAS  PubMed  Google Scholar 

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Funding

NightBalance provided the 16 SPT devices.

Author information

Authors and Affiliations

  1. Department of Otolaryngology and Head and Neck Surgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands

    L. B. L. Benoist, P. E. Vonk & N. de Vries

  2. Department of Otolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands

    L. B. L. Benoist

  3. Department of Otolaryngology and Head and Neck Surgery, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium

    N. de Vries

  4. Department of Oral Kinesiology, ACTA, Amsterdam, The Netherlands

    N. de Vries

  5. Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands

    H. C. J. P. Janssen

  6. Department of Pulmonary Medicine and Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem, Antwerp, Belgium

    J. Verbraecken

Authors
  1. L. B. L. Benoist
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Corresponding author

Correspondence to P. E. Vonk.

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Conflict of interest

Prof. Dr. N. de Vries is a member of the Medical Advisory Board of NightBalance. He is also an investigator of Inspire and Jazz Pharmaceutics, consultant of Philips, Olympus and the AE Mann Foundation. Prof. Dr. J. Verbraecken is a member of the Medical Advisory Boards of ResMed Narval and Bioprojet. He is also a consultant of Philips and Jazz Pharmaceutics, and an investigator of ResMed. All the other authors declare that they have no conflicts of interest or financial ties to disclose. Dr. L.B.L. Benoist, Dr. P.E. Vonk, and Dr. H.C.J.P. Janssen declare that they have no conflict of interest.

Research involving human participants

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national 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.

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Benoist, L.B.L., Vonk, P.E., de Vries, N. et al. New-generation positional therapy in patients with positional central sleep apnea. Eur Arch Otorhinolaryngol 276, 2611–2619 (2019). https://doi.org/10.1007/s00405-019-05545-y

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  • DOI: https://doi.org/10.1007/s00405-019-05545-y

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