title: Head-up sleeping improves orthostatic tolerance in patients with syncope.
abstract: OBJECTIVE
  This study was designed to examine the effect of head-up sleeping as a treatment for vasovagal syncope in otherwise healthy patients. Treatment for syncope is difficult. Pharmacological treatments have potential side effects and, although other non-pharmacological treatments such as salt and fluid loading often help, in some cases they may be ineffective or unsuitable. Head-up sleeping may provide an alternative treatment.
  
  
  METHODS
  Twelve patients had a diagnosis of vasovagal syncope based both on the history and on early pre-syncope during a test of head-up tilting and graded lower body suction. They then underwent a period of 3-4 months of sleeping with the head-end of their bed raised by 10 degrees , after which orthostatic tolerance (time to pre-syncope during tilt test) was reassessed.
  
  
  RESULTS
  Eleven patients (92%) showed a significant improvement in orthostatic tolerance (time to pre-syncope increased by 2 minutes or more). Plasma volume was assessed in eight patients and was found to show a significant increase (P < 0.05, Wilcoxon signed-rank test). There was no significant change in either resting or tilted heart rate or blood pressure after head-up sleeping.
  
  
  CONCLUSIONS
  Head-up sleeping is a simple, non-pharmacological treatment which is effective in the majority of patients. However, it may not be tolerated by patients or bed-partners long term and whether the effects continue after cessation of treatment remains to be determined.
authors.affiliation: Cardiorespiratory Unit, St James's University Hospital, Leeds, UK.
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Cooper
authors.forename: Roger
authors.initials: R
authors.lastname: Hainsworth
mesh_terms: D000293:Adolescent; D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D001810:Blood Volume / Q000502:physiology; D005260:Female; D006257:Head; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology*; D012890:Sleep / Q000502:physiology*; D019462:Syncope, Vasovagal / Q000503:physiopathology / Q000628:therapy*; D018667:Tilt-Table Test; D055815:Young Adult