Positional Treatment vs Continuous Positive Airway Pressure in Patients With Positional Obstructive Sleep Apnea Syndrome

Jokic, Ruzica; Klimaszewski, Artur; Crossley, Margaret; Sridhar, Guruswamy; Fitzpatrick, Michael F.

doi:10.1378/chest.115.3.771

Cited by 250Obstructive Sleep Apnea ResearchSleep and related disordersRespiratory Support and Mechanisms

Positional Treatment vs Continuous Positive Airway Pressure in Patients With Positional Obstructive Sleep Apnea Syndrome

Jokic, Ruzica, Klimaszewski, Artur, Crossley, Margaret, Sridhar, Guruswamy, Fitzpatrick, Michael F.·1999·Chest

DOI 10.1378/chest.115.3.771

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Abstract

Objectives The aim of this study was to compare the relative efficacy of continuous positive airway pressure (CPAP) and positional treatment in the management of positional obstructive sleep apnea (OSA), using objective outcome measures. Design A prospective, randomized, single blind crossover comparison of CPAP and positional treatment for 2 weeks each. Setting A university teaching hospital. Patients Thirteen patients with positional OSA, aged (mean+/-SD) 51+/-9 years, with an apnea-hypopnea index (AHI) of 17+/-8. Measurements (1) Daily Epworth Sleepiness Scale scores; (2) overnight polysomnography, an objective assessment of sleep quality and AHI; (3) maintenance of wakefulness testing; (4) psychometric test battery; (5) mood scales; (6) quality-of-life questionnaires; and (7) individual patient's treatment preference. Results Positional treatment was highly effective in reducing time spent supine (median, 0; range, 0 to 32 min). The AHI was lower (mean difference, 6.1; 95% confidence interval [CI], 2 to 10.2; p = 0.007), and the minimum oxygen saturation was higher (4%; 95% CI, 1% to 8%; p = 0.02) on CPAP as compared with positional treatment. There was no significant difference, however, in sleep architecture, Epworth Sleepiness Scale scores, maintenance of wakefulness testing sleep latency, psychometric test performance, mood scales, or quality-of-life measures. Conclusion Positional treatment and CPAP have similar efficacy in the treatment of patients with positional OSA.

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PAP provided greater improvements in AHI and minimum oxyhemoglobin saturation compared to positional therapy.
“PAP provided greater improvements in AHI and minimum oxyhemoglobin saturation compared to positional therapy.”
From Medical Therapy for Obstructive Sleep Apnea: A Review by the Medical Therapy for Obstructive Sleep Apnea Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine (2006) · cites this paper as [82]
The mean difference in the decline in AHI was 6 between positional therapy and CPAP; positional therapy itself decreased the AHI by 8 events/hr (from 17.9 to 9.5).
“(The mean difference in the decline in AHI was 6 between positional therapy and CPAP; but positional therapy itself decreased the AHI by 8 events/hr (from 17.9 to 9.5).”
From Medical Therapy for Obstructive Sleep Apnea: A Review by the Medical Therapy for Obstructive Sleep Apnea Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine (2006) · cites this paper as [82]
Positional therapy, relative to baseline, improved the AHI by 8 events/hour (p<0.01) in male subjects with mild-moderate OSA.
“Positional therapy, relative to baseline, improved the AHI by 8 events/hour, p<0.01.”
From Medical Therapy for Obstructive Sleep Apnea: A Review by the Medical Therapy for Obstructive Sleep Apnea Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine (2006) · cites this paper as [82]

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Authors: Jokic, R., Klimaszewski, A., Crossley, M., Sridhar, G., & Fitzpatrick, M. F.
Affiliations: University of Saskatchewan (CA)
University of Regina (CA)
Corresponding author: Fitzpatrick, Michael F.
ORCID: Klimaszewski, Artur
Fitzpatrick, Michael F.
Venue: Chest
Publisher: Elsevier BV
Published: 1999-03
Volume: 115
Issue: 3
Pages: 771-781
ISSN: 0012-3692 (ISSN-L)
DOI: 10.1378/chest.115.3.771
OpenAlex: W2079982868
Cited by: 250
References: 49
Citations by year: 2026: 2 · 2025: 4 · 2024: 2 · 2023: 5 · 2022: 6 · 2021: 4 · 2020: 7 · 2019: 12 · 2018: 9 · 2017: 15 · 2016: 10 · 2015: 11 · 2014: 22 · 2013: 9 · 2012: 8
FWCI: 2.42
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: CHEST Journal (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Keywords: positional obstructive sleep apnea, continuous positive airway pressure, supine sleeping, apnea-hypopnea index, oxygen saturation, daytime sleepiness, sleep quality, quality of life, treatment preferences
MeSH terms: Female, Humans, Male, Middle Aged, Positive-Pressure Respiration, Posture, Prospective Studies, Psychometrics, Quality of Life, Sleep Apnea Syndromes, Trail Making Test, Single-Blind Method, Supine Position, Prone Position, Cross-Over Studies

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Positional Treatment vs Continuous Positive Airway Pressure in Patients With Positional Obstructive Sleep Apnea Syndrome

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