title: Positional modification techniques for supine obstructive sleep apnea: A systematic review and meta-analysis.
abstract: This review aimed to determine the effectiveness of positional modification techniques in preventing supine sleep, sleep-disordered breathing and other clinically important outcomes in patients with supine obstructive sleep apnea (OSA). Randomized controlled trials comparing positional modification techniques with any other therapy or placebo were included. Electronic searches of databases including CENTRAL, MEDLINE, CINAHL, Embase, and Web of Science up to April 2016 were performed. Meta-analysis was undertaken where possible. This comprehensive meta-analysis found benefit for positional modification techniques in those with supine OSA in terms of reduction in apnea-hypopnea index (AHI) and time spent supine. Whilst positional modification techniques were effective in terms of a reduction in AHI, continuous positive airway pressure (CPAP) was more effective than these techniques. A reliable diagnosis of supine OSA should be considered, and further research is required on patient-centred outcomes including comfort, barriers to adherence, cost-analysis, and long term outcomes including the effect on cardiovascular disease, the metabolic syndrome, and insulin resistance.
authors.affiliation: Department of Allergy, Immunology, and Respiratory Medicine, Alfred Hospital, 55 Commercial Rd, Melbourne 3004, Australia. Electronic address: hayleynbarnes@gmail.com.
authors.forename: Hayley
authors.initials: H
authors.lastname: Barnes
authors.affiliation: Sleep and Circadian Medicine Laboratory, Department of Physiology and School of Psychological Sciences, Monash Institute of Cognitive and Clinical Neurosciences, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, 264 Ferntree Gully Road, Notting Hill, VIC 3168, Australia. Electronic address: Bradley.edwards@monash.edu.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Edwards
authors.affiliation: Monash Lung and Sleep, Monash Medical Centre, Clayton, Australia; The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Australia. Electronic address: drjoosten@hotmail.com.
authors.forename: Simon A
authors.initials: SA
authors.lastname: Joosten
authors.affiliation: Department of Allergy, Immunology, and Respiratory Medicine, Alfred Hospital, 55 Commercial Rd, Melbourne 3004, Australia; Central Clinical School, Monash University, Clayton, Australia. Electronic address: M.Naughton@alfred.org.au.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Naughton
authors.affiliation: Department of Lung and Sleep Medicine at Monash Health, School of Clinical Sciences, Monash University, Victoria, Australia. Electronic address: garun.hamilton@monashhealth.org.
authors.forename: Garun S
authors.initials: GS
authors.lastname: Hamilton
authors.affiliation: Department of Allergy, Immunology, and Respiratory Medicine, Alfred Hospital, 55 Commercial Rd, Melbourne 3004, Australia; Central Clinical School, Monash University, Clayton, Australia. Electronic address: E.Dabscheck@alfred.org.au.
authors.forename: Eli
authors.initials: E
authors.lastname: Dabscheck
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data; D006801:Humans; D011187:Posture; D016032:Randomized Controlled Trials as Topic; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D016683:Supine Position
keywords: CPAP; Obstructive sleep apnea; Positional modification device