J. Peter van Maanen

Evaluation of a new simple treatment for positional sleep apnoea patients

Obstructive sleep apnoea syndrome is a common clinical problem. Positional sleep apnoea syndrome, defined as having a supine apnoea–hypopnoea index of twice or more compared to the apnoea–hypopnoea index in the other positions, occurs in 56% of obstructive sleep apnoea patients. A limited number of studies focus on decreasing the severity of sleep apnoea by influencing sleep position. In these studies an object was strapped to the back (tennis balls, squash balls, special vests), preventing patients from sleeping in the supine position. Frequently, this was not successful due to arousals while turning from one lateral position to the other, thereby disturbing sleep architecture and sleep quality. We developed a new neck‐worn device which influences sleep position by offering a vibration when in supine position, without significantly reducing total sleep time. Thirty patients with positional sleep apnoea were included in this study. No side effects were reported. The mean apnoea–hypopnoea index dropped from 27.7 ± 2.4 to 12.8 ± 2.2. Seven patients developed an overall apnoea–hypopnoea index below 5 when using the device in ON modus. We expect that positional therapy with such a device can be applied as a single treatment in many patients with mild to moderate position‐dependent obstructive sleep apnoea, while in patients with a more severe obstructive sleep apnoea such a device could be used in combination with other treatment modalities.

Long-Term Effectiveness and Compliance of Positional Therapy with the Sleep Position Trainer in the Treatment of Positional Obstructive Sleep Apnea Syndrome

STUDY OBJECTIVES To investigate effectiveness, long-term compliance, and effects on subjective sleep of the Sleep Position Trainer (SPT) in patients with position-dependent obstructive sleep apnea syndrome (POSAS). DESIGN Prospective, multicenter cohort study. PATIENTS OR PARTICIPANTS Adult patients with mild and moderate POSAS were included. INTERVENTIONS Patients were [corrected] asked to use the SPT for 6 mo. At baseline and after 1, 3, and 6 mo, questionnaires would be completed: Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Functional Outcomes of Sleep Questionnaire (FOSQ), and questions related to SPT use. MEASUREMENTS AND RESULTS One hundred forty-five patients were included. SPT use and SPT data could not be retrieved in 39 patients. In the remaining 106 patients, median percentage of supine sleep decreased rapidly during SPTs training phase (day 3 to 9) to near-total avoidance of supine sleep. This decrease was maintained during the following months of treatment (21% at baseline versus 3% at 6 mo). SPT compliance, defined as more than 4 h of nightly use, was 64.4%. Regular use, defined as more than 4 h of usage over 5 nights/w, was 71.2%. Subjective compliance and regular use were 59.8% and 74.4%, respectively. Median ESS (11 to 8), PSQI (8 to 6), and FOSQ (87 to 103) values significantly improved compared with baseline. CONCLUSIONS Positional therapy using the Sleep Position Trainer (SPT) effectively diminished the percentage of supine sleep and subjective sleepiness and improved sleep related quality of life in patients with mild to moderate position-dependent obstructive sleep apnea syndrome. SPT treatment appeared to have sustained effects over 6 months. SPT compliance and regular use rate were relatively good. Subjective and objective compliance data corresponded well. The lack of a placebo-controlled group limited the efficacy of conclusions. CITATION van Maamen JP, de Vries N. Long-term effectiveness and compliance of positional therapy with the Sleep Position Trainer in the treatment of positional obstructive sleep apnea syndrome.

Positional Therapy in Obstructive Sleep Apnea

The best ebooks about Positional Therapy In Obstructive Sleep Apnea that you can get for free here by download this Positional Therapy In Obstructive Sleep Apnea and save to your desktop. This ebooks is under topic such as how reliable is the diagnosis of positional obstructive positional therapy in patients with residual positional positional therapy for the reduction of obstructive sleep medical therapy for obstructive sleep apnea: a review by the undervalued potential of positional therapy in nasal expiratory positive airway pressure (epap) device to positional therapy for obstructive sleep apnea: an effects of body position on snoring in apneic and sleep non-cpap therapies in obstructive sleep apnoea cost effectiveness of incorporating positional therapy treatment of osa sleep education sleep disorder and other therapies for sleep apnea non-cpap, non surgical therapies in obstructive sleep apnoea positional vs nonpositional obstructive sleep apnea patients* treatment of snoring with positional therapy in patients assessment of a neck-based treatment and monitoring device positional therapy for sleep apnea 150 monument rd positional therapy in obstructive sleep apnea case study provent therapy the sleep position trainer: a new treatment for positional positional therapy versus oral appliance therapy for sleep apnea diagnosis and treatment in adults measure #278: sleep apnea: positive airway pressure 1 adherence and effectiveness of positional therapy for comparison of a new positional device to cpap therapy in treatment of obstructive sleep apnea syndrome 526 management of obstructive sleep apnea apa and cpap devices positional modification techniques for supine obstructive 9 alternative therapies for obstructive sleep apnea alternative therapies for obstructive sleep apnea comparative effectiveness of diagnosis and treatment of journal of sleep disorders & therapy recent advances in management of obstructive sleep apnea treating obstructive sleep apnea with positive pressure positional therapy in obstructive sleep apnea patient powered device for the treatment of obstructive obstructive sleep apnea sleep medicine centers obstructive sleep apnea syndrome use of sleep endoscopy to assess positional obstructive hypoglossal nerve pacing for treatment of obstructive obstructive sleep apnea home | geha diagnosis and treatment of obstructive sleep apnea in adults obstructive sleep apnea handout subject: obstructive sleep apnea (osa): surgical management*

The Utility of Sleep Endoscopy in Adults with Obstructive Sleep Apnea: A Review of the Literature

Since history and physical examination alone cannot reliably diagnose obstructive sleep apnea (OSA), the gold standard for the diagnosis of OSA is polysomnography. When an oral device or surgery is considered, it is of utmost importance to examine an individual’s pattern, degree and site(s) of upper airway obstruction. This article tries to evaluate recent literature published on the use of (drug-induced) sleep endoscopy in evaluating the individually tailored treatment. Different techniques, interrater reliability, test–retest reliability and currently available data on the relationship with treatment outcome are reviewed.

Towards a Clinical Classification System for Position-Dependent Obstructive Sleep Apnea

In this chapter, we discuss the various definitions of position-dependent obstructive apnea. The first was introduced in 1984 by Cartwright, who suggested that physicians should differentiate between patients with either positional (POSA) or non-positional obstructive sleep apnea.

Long-Term (6 Months) Effectiveness, Compliance, and Subjective Sleep Outcomes of Treatment with the Sleep Position Trainer in a Large Cohort of Position-Dependent OSA Patients

This chapter evaluates the long-term effects of using the Sleep Position Trainer (SPT) in position-dependent OSA (POSA) patients over a period of 6 months, in terms of effectiveness, compliance, and subjective sleep parameters. In a large cohort of 106 adult POSA patients, the percentage of supine sleep time decreased rapidly during the training phase of SPT use (day 3–9) to near total avoidance of supine sleep time. This decrease was maintained during the following months of treatment. SPT compliance, defined as more than 4 h of usage per night as an average over seven nights per week, was 64.4 %. Epworth Sleepiness Scale (11–8), Pittsburgh Sleep Quality Index (8–6), and Functional Outcomes of Sleep Questionnaire (87–103) values showed a significant improvement compared to baseline.

Positional Therapy and Palatal Surgery

This chapter describes a retrospective evaluation of the effect of palatal surgery (uvulopalatopharyngoplasty/Z-palatoplasty) with or without (+/−) concomitant radiofrequent ablation of the base of the tongue (RFTB) on body position-specific apnea–hypopnea index (AHI) values in patients with obstructive sleep apnea (OSA). Treatment outcome is compared to the theoretical effect of (addition of) positional therapy (PT).

Positional Therapy and Tongue Base Surgery

This chapter aims to elucidate the role of sleep position as a confounding factor on apnea–hypopnea index (AHI) and surgical success in isolated tongue base or multilevel surgery. In a retrospective analysis, sleep positions and corresponding AHIs before and after surgery were compared. A total of 130 patients were included. Ninety-four patients underwent surgery of base of tongue and palate (either uvulopalatopharyngoplasty or Z-palatoplasty), of whom 72 underwent concurrent radiofrequent thermotherapy of the base of the tongue. Thirty-six patients underwent isolated base of tongue surgery. Sixty-five patients had a successful reduction either in AHI or in AI. Isolated tongue base or multilevel surgery was as successful on the supine AHI as it was on the AHI in the other sleeping positions. Surgery was not more successful in the group with position-dependent patients when compared to the non-position-dependent patients (P = 0.615). Successful and non-successful surgical results could not be explained by variations in percentages of supine sleep position. Sleep position is not a confounding factor on surgical outcomes in tongue base surgery. The results of isolated base of tongue or multilevel surgery in position-dependent OSA patients leave room for improvement, possibly through positional therapy.

Summary and Future Perspectives

The Wagnerian leitmotif in this book on OSA is sleep position. OSA is a serious, highly prevalent disease with major health implications (chapters “Introduction” and “OSAS: The Magnitude of the Problem”). In the beginning of the book, the finding is highlighted that mild OSA in the majority of cases is positional (chapters “The Contribution of Head Position to the Apnea/Hypopnea Index in Patients with Position-Dependent Obstructive Sleep Apnea”, “Influence of Sleep Position on the Transition of Mild to Moderate and Severe OSA” and “Positional Therapy: Left Lateral Decubitus Position Versus Right Lateral Decubitus Position”). With progression of the disease from mild via moderate to eventually severe OSA, positional OSA progresses into non-positional severe OSA. In later chapters the observation is made that patients with insufficient response to therapy, such as can happen in palatal surgery, maxillomandibular advancement or bariatric surgery, severe non-positional OSA can reverse to less severe positional OSA (chapters “Positional OSA in the Morbidly Obese and the Effect of Weight Loss on OSA Severity”, “Positional Therapy and Tongue Base Surgery”, “Residual POSA After Maxillomandibular Advancement in Patients with Severe OSA”, “Impact of Upper Airway Surgery on Positional Change During Sleep” and “Comparison of Positional Therapy to CPAP in Patients with Positional Obstructive Sleep Apnea”). The circle is complete.

Influence of Sleep Position on Snoring

Snoring is an acoustic phenomenon that affects approximately 20–40 % of the general population [1]. It is caused by vibration of tissue structures in the upper airway during sleep [2, 3]. Non-apneic snoring has been shown to be associated with clinical conditions such as depression and excessive daytime sleepiness in adults and may also have clinical implications in the development of hypertension, ischemic heart disease, and cerebrovascular diseases [1, 4]. In this chapter, the prevalence of position dependency in non-apneic snorers and the influence of various factors such as BMI, neck circumference, age, gender, and sleep efficiency on sleeping position will be discussed.