title: Positional therapy in patients with residual positional obstructive sleep apnea after upper airway surgery.
abstract: OBJECTIVE
  A considerable portion of patients has residual positional obstructive sleep apnea (POSA) after upper airway surgery. Those patients could benefit from additional treatment with positional therapy (PT). The objective of this prospective study was to assess the additional effect of PT in patients with residual POSA after upper airway surgery for sleep apnea.
  
  
  METHODS
  A polysomnography (PSG) was used to diagnose a patient with residual POSA after surgery. After informed consent, patients were treated with PT for 3 months and underwent a follow-up PSG while using the sleep position trainer (SPT). Changes in apnea-hypopnea index (AHI) and sleep position parameters were analyzed. Compliance rates and mean disease alleviation (MDA) were determined.
  
  
  RESULTS
  Thirty-three patients with a median postoperative AHI of 18.3/h sleep were included. With the SPT median AHI dropped to 12.5/h sleep and the Epworth Sleepiness Scale (ESS) improved from 10.0 to 7.0. After 3 months, 37.5 % patients were considered responders of whom 31.3 % had treatment success. The compliance rate with SPT was 89.0 %. MDA was 44.7 % for SPT alone. With the combination of both surgery and SPT, MDA was 65.6 %.
  
  
  CONCLUSIONS
  The results of this study indicate that additional PT in a complex OSA patient population with residual POSA after surgery can increase overall therapeutic effectiveness by improving the median MDA from 39.5 % (effect of surgery alone) to 65.6 % (effect of combining surgery and PT).
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, OLVG west, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. l.benoist@erasmusmc.nl.|Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. l.benoist@erasmusmc.nl.
authors.forename: L B L
authors.initials: LBL
authors.lastname: Benoist
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, OLVG west, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Verhagen
authors.affiliation: Department of Epidemiology and Biostatistics, OLVG west, Amsterdam, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Torensma
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, OLVG west, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: van Maanen
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, OLVG west, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.|Department of Epidemiology and Biostatistics, OLVG west, Amsterdam, The Netherlands.|Department of Oral Kinesiology ACTA, Amsterdam, The Netherlands.|Department of Otolaryngology Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium.
authors.forename: N
authors.initials: N
authors.lastname: de Vries
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D026741:Physical Therapy Modalities / Q000295:instrumentation*; D017286:Polysomnography; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy*; D011187:Posture; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000628:therapy*; D016683:Supine Position; D014059:Tongue / Q000601:surgery*
keywords: Obstructive sleep apnea; Positional therapy; Residual positional obstructive sleep apnea; Upper airway surgery