title: Positional therapy for obstructive sleep apnea: an objective measurement of patients' usage and efficacy at home.
abstract: BACKGROUND
  Positional therapy that prevents patients from sleeping supine has been used for many years to manage positional obstructive sleep apnea (OSA). However, patients' usage at home and the long term efficacy of this therapy have never been objectively assessed.
  
  
  METHODS
  Sixteen patients with positional OSA who refused or could not tolerate continuous positive airway pressure (CPAP) were enrolled after a test night study (T0) to test the efficacy of the positional therapy device. The patients who had a successful test night were instructed to use the device every night for three months. Nightly usage was monitored by an actigraphic recorder placed inside the positional device. A follow-up night study (T3) was performed after three months of positional therapy.
  
  
  RESULTS
  Patients used the device on average 73.7 ± 29.3% (mean ± SD) of the nights for 8.0 ± 2.0 h/night. 10/16 patients used the device more than 80% of the nights. Compared to the baseline (diagnostic) night, mean apnea-hypopnea index (AHI) decreased from 26.7 ± 17.5 to 6.0 ± 3.4 with the positional device (p<0.0001) during T0 night. Oxygen desaturation (3%) index also fell from 18.4 ± 11.1 to 7.1 ± 5.7 (p = 0.001). Time spent supine fell from 42.8 ± 26.2% to 5.8 ± 7.2% (p < 0.0001). At three months (T3), the benefits persisted with no difference in AHI (p = 0.58) or in time spent supine (p = 0.98) compared to T0 night. The Epworth sleepiness scale showed a significant decrease from 9.4 ± 4.5 to 6.6 ± 4.7 (p = 0.02) after three months.
  
  
  CONCLUSIONS
  Selected patients with positional OSA can be effectively treated by a positional therapy with an objective compliance of 73.7% of the nights and a persistent efficacy after three months.
authors.affiliation: Centre for Investigation and Research in Sleep, Lausanne University Hospital, CHUV, 1011 Lausanne, Switzerland. raphael.heinzer@chuv.ch
authors.forename: Raphael C
authors.initials: RC
authors.lastname: Heinzer
authors.forename: Cyril
authors.initials: C
authors.lastname: Pellaton
authors.forename: Vincianne
authors.initials: V
authors.lastname: Rey
authors.forename: Andrea O
authors.initials: AO
authors.lastname: Rossetti
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Lecciso
authors.forename: José
authors.initials: J
authors.lastname: Haba-Rubio
authors.forename: Mehdi
authors.initials: M
authors.lastname: Tafti
authors.forename: Gilles
authors.initials: G
authors.lastname: Lavigne
mesh_terms: D056044:Actigraphy; D000328:Adult; D000368:Aged; D004864:Equipment and Supplies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017060:Patient Satisfaction; D011187:Posture; D016684:Prone Position; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D012894:Sleep Stages; D016683:Supine Position; D016896:Treatment Outcome