The undervalued potential of positional therapy in position-dependent snoring and obstructive sleep apnea—a review of the literature

PurposeResearch during the past 10–20 years shows that positional therapy (PT) has a significant influence on the apnea–hypopnea index. These studies are predominantly performed as case series on a comparably small number of patients. Still, results have not found their way into the daily diagnostic and treatment routine. An average of 56 % of patients with obstructive sleep apnea (OSA) have position-dependent OSA (POSA), commonly defined as a difference of 50 % or more in apnea index between supine and non-supine positions. A great deal could be gained in treating patients with POSA with PT. The aim of this paper was to perform a thorough review of the literature on positional sleep apnea and its therapy.MethodsA broad search strategy was run electronically in the MEDLINE and EMBASE databases using synonyms for position and sleep apnea.ResultsSixteen studies were found which examined the effect of PT on OSA. In this literature review, we discuss the various techniques, results, and compliance rates.ConclusionLong-term compliance for PT remains an issue, and although remarkable results have been shown using innovative treatment concepts for PT, there is room for both technical improvement of the devices and for further research.

[1]  Jeong-Whun Kim,et al.  Effect of uvulopalatopharyngoplasty on positional dependency in obstructive sleep apnea. , 2011, Archives of otolaryngology--head & neck surgery.

[2]  K Abrams,et al.  Meta-analysis and the synthesis of evidence. , 1995, IMA journal of mathematics applied in medicine and biology.

[3]  C. Guilleminault,et al.  Cervical positional effects on snoring and apneas. , 1999, Sleep research online : SRO.

[4]  R. Cartwright,et al.  Sleep position training as treatment for sleep apnea syndrome: a preliminary study. , 1985, Sleep.

[5]  R. Schwab,et al.  A quantum advance in PSG recordings: the importance of head position in mediating the AHI. , 2011, Sleep.

[6]  R. Daroff,et al.  The International Classification of Sleep Disorders , 1991, Neurology.

[7]  J. Choi,et al.  Effect of Successful Surgical Treatment on Changes of Position during Sleep in Adults with Obstructive Sleep Apnea Syndrome , 2011, The Annals of otology, rhinology, and laryngology.

[8]  A. Oksenberg,et al.  Association of body position with severity of apneic events in patients with severe nonpositional obstructive sleep apnea. , 2000, Chest.

[9]  Doo Hee Han,et al.  The implication of sleep position in the evaluation of surgical outcomes in obstructive sleep apnea , 2009, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[10]  D. Pevernagie,et al.  Relations between sleep stage, posture and effective nasal CPAP levels in OSA. , 1992, Sleep.

[11]  Daniel J Buysse,et al.  Sleep–Related Breathing Disorders in Adults: Recommendations for Syndrome Definition and Measurement Techniques in Clinical Research , 2000 .

[12]  C. Tinelli,et al.  Hyoidthyroidpexia as a treatment in multilevel surgery for obstructive sleep apnea , 2008, Acta oto-laryngologica.

[13]  J. Pépin,et al.  Mandibular advancement devices: rate of contraindications in 100 consecutive obstructive sleep apnea patients. , 2002, American journal of respiratory and critical care medicine.

[14]  R. Cartwright,et al.  Effect of sleep position on sleep apnea severity. , 1984, Sleep.

[15]  H. Tinteren,et al.  UPPP combined with radiofrequency thermotherapy of the tongue base for the treatment of obstructive sleep apnea syndrome , 2008, European Archives of Oto-Rhino-Laryngology.

[16]  H. Tinteren,et al.  One stage multilevel surgery (uvulopalatopharyngoplasty, hyoid suspension, radiofrequent ablation of the tongue base with/without genioglossus advancement), in obstructive sleep apnea syndrome , 2007, European Archives of Oto-Rhino-Laryngology.

[17]  A. Oksenberg,et al.  Positional Therapy for Obstructive Sleep Apnea Patients: A 6‐Month Follow‐Up Study , 2006, The Laryngoscope.

[18]  A. Oksenberg,et al.  Positional vs Nonpositional Obstructive Sleep Apnea Patients* Anthropomorphic, Nocturnal Polysomnographic, and Multiple Sleep Latency Test Data , 1997 .

[19]  M. Crossley,et al.  Positional treatment vs continuous positive airway pressure in patients with positional obstructive sleep apnea syndrome. , 1999, Chest.

[20]  C. Kushida,et al.  Cervical Positioning for Reduction of Sleep-Disordered Breathing in Mild-to-Moderate OSAS , 2001, Sleep and Breathing.

[21]  J. D. Harmon,et al.  Therapeutic Effect of Posture in Sleep Apnea , 1986, Southern medical journal (Birmingham, Ala. Print).

[22]  George P. Katsantonis,et al.  Effects of uvulopalatopharyngoplasty on sleep architecture and patterns of obstructed breathing , 1990, The Laryngoscope.

[23]  K. Franklin,et al.  Treatment success with a mandibular advancement device is related to supine-dependent sleep apnea. , 1998, Chest.

[24]  B. Tucker Woodson.  Structural effectiveness of pharyngeal sleep apnea surgery. , 2008, Sleep medicine reviews.

[25]  A. Valipour,et al.  Non-CPAP therapies in obstructive sleep apnoea , 2011, European Respiratory Journal.

[26]  M. Skinner,et al.  Elevated Posture for the Management of Obstructive Sleep Apnea , 2004, Sleep and Breathing.

[27]  Cathy Goldstein,et al.  Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. , 2010, American journal of respiratory and critical care medicine.

[28]  N B Kavey,et al.  Sleeping position and sleep apnea syndrome. , 1985, American journal of otolaryngology.

[29]  A. Oksenberg,et al.  Avoiding the supine position during sleep lowers 24 h blood pressure in obstructive sleep apnea (OSA) patients , 1997, Journal of Human Hypertension.

[30]  E. Kezirian,et al.  Hypopharyngeal surgery in obstructive sleep apnea: an evidence-based medicine review. , 2006, Archives of otolaryngology--head & neck surgery.

[31]  A. Oksenberg,et al.  [The significance of body posture on breathing abnormalities during sleep: data analysis of 2077 obstructive sleep apnea patients]. , 2009, Harefuah.

[32]  Elisabeth Hultcrantz,et al.  Positioner–a method for preventing sleep apnea , 2007, Acta oto-laryngologica.

[33]  A I Pack,et al.  Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. , 1993, The American review of respiratory disease.

[34]  J. Piccirillo,et al.  The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome. , 1996, Sleep.

[35]  Braver Hm,et al.  Effect of Nasal Spray, Positional Therapy, and the Combination Thereof in the Asymptomatic Snorer , 1994 .

[36]  H. Nakano,et al.  Effects of body position on snoring in apneic and nonapneic snorers. , 2003, Sleep.

[37]  H. Yi,et al.  Z-Palatopharyngoplasty Plus Genioglossus Advancement and Hyoid Suspension for Obstructive Sleep Apnea Hypopnea Syndrome , 2011, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[38]  J. Mercer,et al.  Accurate position monitoring and improved supine-dependent obstructive sleep apnea with a new position recording and supine avoidance device. , 2011, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[39]  F. Sériès,et al.  Importance of sleep stage- and body position-dependence of sleep apnoea in determining benefits to auto-CPAP therapy. , 2001, The European respiratory journal.

[40]  Ronald R Grunstein,et al.  Adherence to continuous positive airway pressure therapy: the challenge to effective treatment. , 2008, Proceedings of the American Thoracic Society.

[41]  J. Hiller,et al.  Redefining success in airway surgery for obstructive sleep apnea: a meta analysis and synthesis of the evidence. , 2007, Sleep.

[42]  H. Tinteren,et al.  Acceptance and long-term compliance of nCPAP in obstructive sleep apnea , 2007, European Archives of Oto-Rhino-Laryngology.

[43]  David Watts.  Apnea , 1997, The Lancet.

[44]  Ian G. Robin.  Snoring , 1948, Nursing times.

[45]  T. Young,et al.  Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. , 2008, Sleep.

[46]  A. J. Block,et al.  Effect of nasal spray, positional therapy, and the combination thereof in the asymptomatic snorer. , 1994, Sleep.

[47]  M. Ohayon,et al.  Sleep disorders, medical conditions, and road accident risk. , 2011, Accident; analysis and prevention.

[48]  Y. Fischer,et al.  Effektivität und Langzeit-Compliance der Therapie mit Rückenlage-Verhinderungsweste bei obstruktiver Schlafapnoe , 2007 .

[49]  Tadao Nishimura,et al.  Posture of Patients with Sleep Apnea During Sleep , 2003, Acta oto-laryngologica.

[50]  Kh. I. Amirkhanov,et al.  The Influence of , 1957 .

[51]  L. Findley,et al.  Drivers with untreated sleep apnea. A cause of death and serious injury. , 1991, Archives of internal medicine.

[52]  S. Miyazaki,et al.  Efficacy study of a vest-type device for positional therapy in position dependent snorers , 2009 .

[53]  B. Grant,et al.  Prevalence of positional sleep apnea in patients undergoing polysomnography. , 2005, Chest.

[54]  Kazuya Yoshida,et al.  Influence of sleep posture on response to oral appliance therapy for sleep apnea syndrome. , 2001, Sleep.

[55]  N. de Vries,et al.  One hundred consecutive patients undergoing drug‐induced sleep endoscopy: Results and evaluation , 2011, The Laryngoscope.

[56]  M. Kryger.  Diagnosis and management of sleep apnea syndrome. , 2000, Clinical cornerstone.

[57]  T. Young,et al.  The gender bias in sleep apnea diagnosis : Are women missed because they have different symptoms ? , 1996 .

[58]  R. Chervin,et al.  Positional therapy in ischemic stroke patients with obstructive sleep apnea. , 2011, Sleep medicine.

[59]  M. Kryger,et al.  Sleep apnea and body position during sleep. , 1988, Sleep.

[60]  A T Thornton,et al.  The effects of posture on obstructive sleep apnea. , 2015, The American review of respiratory disease.

[61]  D. Rapoport,et al.  Predictors of response to a nasal expiratory resistor device and its potential mechanisms of action for treatment of obstructive sleep apnea. , 2011, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[62]  D. Greenburg,et al.  Effects of surgical weight loss on measures of obstructive sleep apnea: a meta-analysis. , 2009, The American journal of medicine.

[63]  T. Young,et al.  The gender bias in sleep apnea diagnosis. Are women missed because they have different symptoms? , 1996, Archives of internal medicine.

[64]  R. Cartwright,et al.  The effects of sleep posture and sleep stage on apnea frequency. , 1991, Sleep.

[65]  N. de Vries,et al.  Reliable calculation of the efficacy of non-surgical and surgical treatment of obstructive sleep apnea revisited. , 2011, Sleep.

[66]  M. Skinner,et al.  Lack of efficacy for a cervicomandibular support collar in the management of obstructive sleep apnea. , 2004, Chest.

[67]  W C Dement,et al.  The sleep apnea syndromes. , 1976, Annual review of medicine.

[68]  J. Gaughan,et al.  Comparison of positional therapy to CPAP in patients with positional obstructive sleep apnea. , 2010, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[69]  R. Cartwright.  Predicting response to the tongue retaining device for sleep apnea syndrome. , 1985, Archives of otolaryngology.

[70]  C. D. Proctor,et al.  Continuous Positive Airway Pressure (CPAP) Changes in Bariatric Surgery Patients Undergoing Rapid Weight Loss , 2005, Obesity surgery.

[71]  H. Tinteren,et al.  The role of sleep position in obstructive sleep apnea syndrome , 2006, European Archives of Oto-Rhino-Laryngology and Head & Neck.

[72]  G. Clark,et al.  Treatment outcomes of mandibular advancement devices in positional and nonpositional OSA patients. , 2010, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[73]  M. Goldsworthy,et al.  Poor long-term patient compliance with the tennis ball technique for treating positional obstructive sleep apnea. , 2009, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[74]  D. Caldarelli,et al.  A comparative study of treatments for positional sleep apnea. , 1991, Sleep.

[75]  N. de Vries,et al.  Evaluation of a new simple treatment for positional sleep apnoea patients , 2012, Journal of sleep research.

[76]  M. Skinner,et al.  Efficacy of the ‘tennis ball technique’ versus nCPAP in the management of position‐dependent obstructive sleep apnoea syndrome , 2008, Respirology.

[77]  Y. Itasaka,et al.  The influence of sleep position and obesity on sleep apnea , 2000, Psychiatry and clinical neurosciences.

[78]  A. Oksenberg,et al.  The sleep supine position has a major effect on optimal nasal continuous positive airway pressure : relationship with rapid eye movements and non-rapid eye movements sleep, body mass index, respiratory disturbance index, and age. , 1999, Chest.

[79]  Terry Young,et al.  Increasing sleep duration for a healthier (and less obese?) population tomorrow. , 2008, Sleep.

[80]  Kamel Rekab,et al.  Sleep Apnea Avoidance Pillow Effects on Obstructive Sleep Apnea Syndrome and Snoring , 2004, Sleep and Breathing.

[81]  N. de Vries,et al.  Quantitative effects of trunk and head position on the apnea hypopnea index in obstructive sleep apnea. , 2011, Sleep.