Positional Therapy for Positional Obstructive Sleep Apnea: What Is New?

Abstract

The objective of the present review is to give an update on newly available literature concerning positional therapy as a treatment in positional dependent OSA patients. A systematic review Five prospective cohort studies, six randomized controlled trials and one retrospective study were included in this review. All studies published on new-generation devices for positional therapy (PT) have shown a significant reduction in the AHI and percentage of supine sleeping time in patients with obstructive sleep apnea (OSA). The effectiveness of sleep position trainer (SPT) compared to OAT was similar and the results of additional treatment with PT in patients with residual positional obstructive sleep apnea (POSA) after upper airway surgery seemed to be effective. No evidence was found that confirms a behavioural or training effect of PT. Overall, the effectiveness and compliance are high during short-time follow-up as well as in long-term studies. PT with new-generation devices have shown to be effective in reducing total percentage of supine sleep time and total AHI. Additional treatment with PT in patients with residual POSA after upper airway surgery shows promising results and also combination therapy of SPT + MAD leads to a higher therapeutic efficacy when compared to one of the treatment modalities alone. Short-term and long-term compliance in SPT users is high, but due to high drop out during long-term follow-up, proper selection of PP to identify predictors of non-responders is important.