Skip to main content

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

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.

This is a preview of subscription content, access via your institution.

References

  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 17:771–779

    Article  PubMed  Google Scholar 

  2. Jafari B, Roux F (2012) Non-positive airway pressure therapy for obstructive sleep apnea. Curr Respir Care Rep 1:111–122

    Article  Google Scholar 

  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 45:43

    Article  PubMed  PubMed Central  Google Scholar 

  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 37:1209–1215

    Article  PubMed  PubMed Central  Google Scholar 

  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 17:39–49

    CAS  Article  PubMed  Google Scholar 

  6. Cartwright RD, Diaz F, Lloyd S (1991) The effect of sleep posture and sleep stage on apnea frequency. Sleep 14:351–353

    CAS  Article  PubMed  Google Scholar 

  7. Calik W (2016) Treatments for obstructive sleep apnea. J Clin Outcomes Manag 23:181–192

    PubMed  PubMed Central  Google Scholar 

  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 6:238–243

    PubMed  PubMed Central  Google Scholar 

  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 10:863–871

    PubMed  PubMed Central  Google Scholar 

  10. Zuberi NA, Rekab K, Nguyen HV (2004) Sleep apnea avoidance pillow effects on obstructive sleep apnea syndrome and snoring. Sleep Breath 8:201–207

    Article  PubMed  Google Scholar 

  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 7:376–383

    PubMed  PubMed Central  Google Scholar 

  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 49:11–14

    PubMed  PubMed Central  Google Scholar 

  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. 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 16:545–552

    Article  PubMed  Google Scholar 

  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 135:79–84

    Article  PubMed  Google Scholar 

  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 135:271–276

    Article  PubMed  PubMed Central  Google Scholar 

  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 11:131–137

    PubMed  PubMed Central  Google Scholar 

  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 21:322–329

    Article  PubMed  Google Scholar 

  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 13:425–428

    Article  PubMed  Google Scholar 

  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 19:473–480

    CAS  Article  PubMed  Google Scholar 

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

    CAS  Article  PubMed  Google Scholar 

  22. Marklund M, Persson M, Franklin KA (1998) Treatment success with a mandibular advancement device is related to supine-dependent sleep apnea. Chest 114:1630–1635

    CAS  Article  PubMed  Google Scholar 

  23. Mador MJ, Kufel TJ, Magalang UJ, Rajesh SK, Watwe V, Grant BJ (2005) Prevalence of positional sleep apnea in patients undergoing polysomnography. Chest 128:2130–2137

    Article  PubMed  Google Scholar 

  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 20:881–888

    CAS  Article  PubMed  Google Scholar 

  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 127:565–570

    Article  PubMed  Google Scholar 

  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. 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-)

  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-)

Download references

Funding

No funding was received for this research.

Author information

Authors and Affiliations

Authors

Contributions

This manuscript has been seen and approved by all authors.

Corresponding author

Correspondence to Olabimpe Omobomi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Omobomi, O., Quan, S.F. Positional therapy in the management of positional obstructive sleep apnea—a review of the current literature. Sleep Breath 22, 297–304 (2018). https://doi.org/10.1007/s11325-017-1561-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-017-1561-y

Keywords

  • Positional therapy
  • Obstructive sleep apnea
  • Continuous positive airway pressure