A considerable portion of patients has residual positional obstructive sleep apnea (POSA) after upper airway surgery. Those patients could benefit from additional treatment with positional therapy (PT). The objective of this prospective study was to assess the additional effect of PT in patients with residual POSA after upper airway surgery for sleep apnea.
A polysomnography (PSG) was used to diagnose a patient with residual POSA after surgery. After informed consent, patients were treated with PT for 3 months and underwent a follow-up PSG while using the sleep position trainer (SPT). Changes in apnea-hypopnea index (AHI) and sleep position parameters were analyzed. Compliance rates and mean disease alleviation (MDA) were determined.
Thirty-three patients with a median postoperative AHI of 18.3/h sleep were included. With the SPT median AHI dropped to 12.5/h sleep and the Epworth Sleepiness Scale (ESS) improved from 10.0 to 7.0. After 3 months, 37.5 % patients were considered responders of whom 31.3 % had treatment success. The compliance rate with SPT was 89.0 %. MDA was 44.7 % for SPT alone. With the combination of both surgery and SPT, MDA was 65.6 %.
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).
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We would like to thank our colleagues from the Clinical Neurophysiology department of the OLVG West Hospital Amsterdam for their assistance with this research project. Special thanks also to Kristel Meesters for her additional support.
No funding was received for this research.
Conflict of interest
Drs. L.B.L. Benoist, M. Verhagen, B. Torensma and J.P. van Maanen certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria, educational grants, participation in speakers’ bureaus, membership, employment, consultancies, stock ownership or other equity interest, and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript. Prof. dr. N. de Vries is a member of the Medical Advisory Board of NightBalance, consultant of Philips Healthcare and Olympus, researcher for Inspire Medical Systems, member of ReVent’s Medical Advisory Board, and has shares in NightBalance and ReVent.
All 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 was obtained from all individual participants included in the study.
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Benoist, L., Verhagen, M., Torensma, B. et al. Positional therapy in patients with residual positional obstructive sleep apnea after upper airway surgery. Sleep Breath 21, 279–288 (2017). https://doi.org/10.1007/s11325-016-1397-x
- Residual positional obstructive sleep apnea
- Positional therapy
- Upper airway surgery
- Obstructive sleep apnea