Sleep Breath 2004; 8(4): 193-200
DOI: 10.1055/s-2004-860896
ORIGINAL ARTICLE

Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Elevated Posture for the Management of Obstructive Sleep Apnea

Margot A. Skinner1 , Ruth N. Kingshott1 , David R. Jones2 , Sean D. R Homan2 , D. Robin Taylor1
  • 1Respiratory Research Unit, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  • 2Tom McKendrick Sleep Laboratory, Dunedin Hospital, Dunedin, New Zealand
Further Information

Publication History

Publication Date:
20 December 2004 (online)

ABSTRACT

This study aimed to evaluate the effectiveness of elevated posture in the management of obstructive sleep apnea (OSA). Fourteen subjects presenting with mild-moderate OSA, (apnea-hypopnea index [AHI] 10 to 60/h), were included in a randomized crossover investigation. A shoulder-head elevation pillow (SHEP) was compared with nasal continuous positive airway pressure (nCPAP) therapy. Treatment success was defined as AHI ≤ 10/h and partial success as AHI > 10 < 16/h. Four subjects achieved treatment success with the SHEP and three achieved partial success. The remaining seven subjects were treatment failures. In contrast, success was achieved with nCPAP in 12 subjects. One subject achieved partial success and one was a treatment failure. With the SHEP, the mean AHI decreased from 27 ± 12/h to 21 ± 17/h. With nCPAP, the mean AHI was 5 ± 3/h; (p = 0.008 for the difference between treatments). Although somewhat variable, these data provide evidence that elevated posture during sleep is helpful in the management of OSA in some individuals. Results support the use of elevated posture as second-line therapy in the management of OSA. However, no relationships could be identified between baseline data, including the identification of positional OSA, and objective outcomes that might predict patients who are likely to benefit from treatment in an elevated position.

REFERENCES

  • 1 Haponik E F, Smith P L, Bohlman M E et al.. Computerized tomography in obstructive sleep apnea. Correlation of airway size with physiology during sleep and wakefulness.  Am Rev Respir Dis. 1983;  127 221-226
  • 2 Suratt P M, Dee P, Atkinson R L, Armstrong P, Wilhoit S C. Fluoroscopic and computed tomographic features of the pharyngeal airway in obstructive sleep apnea.  Am Rev Respir Dis. 1983;  127 487-492
  • 3 Anch A M, Remmers J E, Bunce 3rd H D. Supraglottic airway resistance in normal subjects and patients with occlusive sleep apnea.  J Appl Physiol. 1982;  53 1158-1163
  • 4 Remmers J E, deGroot W J, Sauerland E K, Anch A M. Pathogenesis of upper airway occlusion during sleep.  J Appl Physiol. 1978;  44 931-938
  • 5 Sforza E, Bacon W, Weiss T et al.. Upper airway collapsibility and cephalometric variables in patients with obstructive sleep apnea.  Am J Respir Crit Care Med. 2000;  161 347-352
  • 6 Brown I B, McClean P A, Boucher R, Zamel N, Hoffstein V. Changes in pharyngeal cross-sectional area with posture and application of continuous positive airway pressure in patients with obstructive sleep apnea.  Am Rev Respir Dis. 1987;  136 628-632
  • 7 Yildirim N, Fitzpatrick M F, Whyte K F et al.. The effect of posture on upper airway dimensions in normal subjects and in patients with the sleep apnea/hypopnea syndrome.  Am Rev Respir Dis. 1991;  144 845-847
  • 8 Jan M A, Marshall I, Douglas N J. Effect of posture on upper airway dimensions in normal human.  Am J Respir Crit Care Med. 1994;  149 145-148
  • 9 Martin S E, Marshall I, Douglas N J. The effect of posture on airway caliber with the sleep-apnea/hypopnea syndrome.  Am J Respir Crit Care Med. 1995;  152 721-724
  • 10 Battagel J M, Johal A, Smith A M, Kotecha B. Postural variation in oropharyngeal dimensions in subjects with sleep disordered breathing: a cephalometric study.  Eur J Orthod. 2002;  24 263-276
  • 11 Tsuiki S, Almeida F R, Bhalla P S, Lowe A A, Fleetham J A. Supine-dependent changes in upper airway size in awake obstructive sleep apnea patients.  Sleep Breath. 2003;  7 43-50
  • 12 McEvoy R D, Sharp D J, Thornton A T. The effects of posture on obstructive sleep apnea.  Am Rev Respir Dis. 1986;  133 662-666
  • 13 Neill A M, Angus S M, Sajkov D, McEvoy R D. Effects of sleep posture on upper airway stability in patients with obstructive sleep apnea.  Am J Respir Crit Care Med. 1997;  155 199-204
  • 14 Kribbs N B, Pack A I, Kline L R et al.. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea.  Am Rev Respir Dis. 1993;  147 887-895
  • 15 American Sleep Disorders Association . Practice parameters for the use of portable recording in the assessment of obstructive sleep apnea. Standards of Practice Committee of the American Sleep Disorders Association.  Sleep. 1994;  17 372-377
  • 16 Dingli K, Coleman E L, Vennelle M et al.. Evaluation of a portable device for diagnosing the sleep apnoea/hypopnoea syndrome.  Eur Respir J. 2003;  21 253-259
  • 17 American Academy of Sleep Medicine. . Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force.  Sleep. 1999;  22 667-668
  • 18 Cartwright R D. Effect of sleep position on sleep apnea severity.  Sleep. 1984;  7 110-114
  • 19 Johns M W. A new method for measuring daytime sleepiness: the Epworth sleepiness scale.  Sleep. 1991;  14 540-545
  • 20 Weaver T E, Laizner A M, Evans L K et al.. An instrument to measure functional status outcomes for disorders of excessive sleepiness.  Sleep. 1997;  20 835-843
  • 21 Ware Jr J E, Sherbourne C D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.  Med Care. 1992;  30 473-483
  • 22 Engleman H M, Kingshott R N, Wraith P K, Mackay T W, Deary I J, Douglas N J. Randomized placebo-controlled crossover trial of continuous positive airway pressure for mild sleep Apnea/Hypopnea syndrome.  Am J Respir Crit Care Med. 1999;  159 461-467
  • 23 Skinner M A, Kingshott R N, Jones D R, Taylor D R. Lack of efficacy for a cervicomandibular support collar in the management of obstructive sleep apnea.  Chest. 2004;  125 118-126
  • 24 Cheshire K, Engleman H, Deary I, Shapiro C, Douglas N J. Factors impairing daytime performance in patients with sleep apnea/hypopnea syndrome.  Arch Intern Med. 1992;  152 538-541
  • 25 Kingshott R N, Engleman H M, Deary I J, Douglas N J. Does arousal frequency predict daytime function?.  Eur Respir J. 1998;  12 1264-1270

Margot A SkinnerPh.D. 

School of Physiotherapy, University of Otago

P.O. Box 56, Dunedin, New Zealand

Email: margot.skinner@otago.ac.nz

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