A promising concept of combination therapy for pos

Authors: Marijke Dieltjens Anneclaire V Vroegop Annelies E Verbruggen Kristien Wouters Marc Willemen Wilfried A De Backer Johan A Verbraecken Paul H Van de Heyning Marc J Braem Nico de Vries Olivier M Vanderveken

Publish Date: 2014/10/22

Volume: 19, Issue: 2, Pages: 637-644

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Abstract

The objective of this randomized controlled trial was to assess the additional effect of a chestworn sleep position trainer SPT in patients with residual supinedependent obstructive sleep apnea sdOSA under mandibular advancement device MAD therapyBaseline and followup polysomnography with MAD were performed Twenty patients with sdOSA under MAD therapy underwent two consecutive randomized polysomnographies one with SPT and one with combination of SPT + MAD Data are presented as median quartile 1 quartile 3The SPT reduced the time spent in supine sleeping position compared to baseline and MAD therapy Both MAD and SPT were individually effective in reducing the overall apnea/hypopnea index AHI significantly when compared to baseline from 208 151 336/h at baseline to 110 67 138/h and to 111 35 177/h with MAD or SPT respectively The combination of SPT + MAD further reduced the overall AHI to 57 36 74 which was significantly lower than with MAD alone p  0001 and SPT alone p  0008 respectivelyApproximately 50–60  of patients with obstructive sleep apnea OSA suffer from supinedependent OSA sdOSA defined according to Cartwright 1 as having twice as many respiratory events in the supine sleeping position compared to the nonsupine sleeping position Mador et al 2 defined sdOSA as having twice as many respiratory events in the supine position than in nonsupine positions along with an apnea/hypopnea index AHI 5 events/h in the nonsupine position and a 15min threshold for sleep in supine and nonsupine position A third definition of sdOSA was introduced by Marklund et al 3 4 defined as a supine AHI ≥10 events/h together with a nonsupine AHI of 10 events/hPositional therapy is a treatment modality aimed at preventing sleep in the supine position 5 It is recently shown during druginduced sleep endoscopy DISE that a change of body position from supine to lateral position leads to improvement of upper airway collapse in patients with sdOSA 6 In the future DISE could be performed in both the supine and lateral positions 7 The most widely used technique to avoid the supine sleeping position involves strapping a bulky object to the back of the patient thereby preventing supine positioning Several studies have shown that such therapies have a significant positive effect on snoring and OSA severity in patients with sdOSA 5 8 9 10 11 12 However the bulky object is uncomfortable for patients and results in disturbed sleep and low longterm compliance rates 8 9 Therefore positional therapy has not found its way into daily OSA treatment routine to date 13 In order to overcome such compliance problems both a new neckworn device and a chestworn device correcting the supine sleeping position by activating a vibration alarm were evaluated This novel concept of positional therapy showed promising results in reducing apnea severity together with a higher compliance 14 15Oral appliance therapy is a noninvasive treatment for patients with snoring and OSA 16 The most common type of oral appliances prescribed for the treatment of OSA is the mandibular advancement device MAD worn intraorally at night in order to reduce upper airway collapse by protruding the mandible 4 17 18 19 This treatment modality although not as effective as continuous positive airway pressure CPAP in reducing apnea severity is preferred by the majority of patients and has a relatively high objective compliance rate 20 21 22

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