title: Efficacy of the New Generation of Devices for Positional Therapy for Patients With Positional Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis.
abstract: OBJECTIVE
  In approximately 56% to 75% of patients with obstructive sleep apnea (OSA), the frequency and duration of apneas are influenced by body position. This is referred to as position-dependent OSA or POSA. Patients with POSA can be treated with a small device attached to either the neck or chest. These devices-a new generation of devices for positional therapy (PT)-provide a subtle vibrating stimulus that prevents patients adopting the supine position. The objectives of this study were to determine whether PT is effective in improving sleep study variables and sleepiness, and to assess compliance.
  
  
  METHODS
  A systematic review and meta-analysis.
  
  
  RESULTS
  Three prospective cohort studies and four randomized controlled trials were included in this review. Combined data for studies reporting on the effect of PT show that there was a mean difference of 11.3 events/h (54% reduction) in apnea-hypopnea index and 33.6% (84% reduction) in percentage total sleeping time in the supine position. The standardized mean difference for both parameters demonstrated a large magnitude of effect (> 0.8 in both cases).
  
  
  CONCLUSIONS
  There is strong evidence that the new generation of devices for PT are effective in reducing the apnea-hypopnea index during short-term follow-up. These devices are simple-to-use for patients and clinicians and are reversible. Under study conditions with short-term follow-up, compliance is high; however, long-term compliance cannot be assessed because of lack of reliable data. Additional long-term, high-quality studies are needed to confirm the role of PT as a single or as a combination treatment modality for OSA patients and to assess long-term compliance.
authors.affiliation: Department of Otorhinolaryngology, OLVG West, Amsterdam, The Netherlands.
authors.forename: Madeline J L
authors.initials: MJL
authors.lastname: Ravesloot
authors.affiliation: Department of Sleep Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: White
authors.affiliation: Center for Investigation and Research in Sleep (CIRS), University Hospital of Lausanne, Switzerland.
authors.forename: Raphael
authors.initials: R
authors.lastname: Heinzer
authors.affiliation: Sleep Disorders Unit, Loewenstein Hospital -Rehabilitation Center, Raanana, Israel.
authors.forename: Arie
authors.initials: A
authors.lastname: Oksenberg
authors.affiliation: Department of Physiology and Sleep, Albert Michallon Hospital, Grenoble, France.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Pépin
mesh_terms: D056902:Clinical Alarms; D004867:Equipment Design; D011187:Posture; D020181:Sleep Apnea, Obstructive / Q000517:prevention & control*; D016896:Treatment Outcome; D014732:Vibration
keywords: compliance; meta-analysis; obstructive sleep apnea; positional; positional therapy; systematic review