title: Efficacy of sleep position modification to treat positional obstructive sleep apnea.
abstract: OBJECTIVE
  To assess the feasibility and efficacy of sleep position modification in preventing supine sleep and improving sleep-disordered breathing and relevant clinical outcomes in positional obstructive sleep apnea (OSA) patients.
  
  
  METHODS
  Eighty-six consecutive participants with moderate positional OSA on routine diagnostic polysomnography underwent a randomized controlled parallel group design trial of 4-weeks treatment using a sleep position modification device (active) or sleep hygiene advice (control). Outcomes were measured at baseline and following a 4-week treatment period.
  
  
  RESULTS
  There was a significant reduction in the amount of supine sleep in the active group (mean ± SD change from baseline, active group 99.5 ± 85.2 minutes, control group 68.6 ± 103.2 minutes, p = 0.002), and an improvement in apnea-hypopnea index (AHI) (active group reduced by 9.9 ± 11.6, control group reduced by 5.3 ± 13.9, p = 0.013). Post-hoc analyses indicated that positional therapy was most effective for patients with baseline AHI cut-off above 20 (p = 0.02). Logistic regression showed that a treatment response (AHI < 10) was more likely in the active group (OR = 5.57), and those with higher baseline nadir oxygen desaturation (OR = 1.95) and non-supine AHI (OR = 0.55). There were no significant improvements in quality of life, daytime sleepiness, mood, symptoms, neuropsychological measures or blood pressure in the active group.
  
  
  CONCLUSIONS
  The position device utilized in this study was effective in reducing supine sleep and AHI, which was significant in those with baseline AHI ≥20. Longer duration studies of physical treatments that modify sleep position are needed to explore further whether additional clinical benefits in are achievable.
authors.affiliation: Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia; The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Melinda
authors.initials: M
authors.lastname: Jackson
authors.affiliation: Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Collins
authors.affiliation: Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Berlowitz
authors.affiliation: Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia; The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Howard
authors.affiliation: Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia; The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Fergal
authors.initials: F
authors.lastname: O'Donoghue
authors.affiliation: Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia; The University of Melbourne, Melbourne, Victoria, Australia. Electronic address: maree.barnes@austin.org.au.
authors.forename: Maree
authors.initials: M
authors.lastname: Barnes
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011187:Posture / Q000502:physiology; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016683:Supine Position / Q000502:physiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Neuropsychological function; Non-CPAP treatment of sleep apnea; Obstructive sleep apnea; Positional obstructive sleep apnea