New-generation positional therapy in patients with positional central sleep apnea

  • L. B. L. Benoist
  • P. E. VonkEmail author
  • N. de Vries
  • H. C. J. P. Janssen
  • J. Verbraecken



To evaluate the effect of a sleep position trainer (SPT) in patients with positional central sleep apnea (PCSA).


A multicentre cohort study was conducted. Patients with symptomatic PCSA were included. Effectiveness, compliance and quality of life were assessed at 1- and 6-month follow-up.


Sixteen patients were included. Median AHI dropped from 23.4/h [12.9–31.2] to 11.5/h [7.2–24.5] (p = 0.044) after 1-month SPT therapy and in patients who continued treatment, median AHI further decreased after 6 months to 9.7/h [3.4–27.6] (p = 0.075). Median percentage of supine sleep decreased significantly from 37.6 [17.2–51.8] to 6.7 [0.7–22.8] (p < 0.001), after 1 month, and to 6.8 [0.7–22.1] (p = 0.001), after 6 months. Mean compliance over 1 and 6 months was 78.6 ± 35.3 and 66.0 ± 33.3%, respectively. Epworth Sleepiness Scale at baseline was 9.5 [3.3–11.8] and did not significantly decrease after 1 month (11.0 [3.0–13.0]) and 6 months (4.0 [3.0–10.5]) follow-up. Functional Outcomes of Sleep Questionnaire remained stable within the first month. However, after 6 months, there was a significant improvement compared to baseline values, 15.9 [11.9–18.4] vs. 17.8 [14.3–19.2]; p = 0.030.


This is the first study on effects of positional therapy with a new-generation smart device in patients with PCSA after 1 and 6 months of follow-up. Results of this study show that the SPT is effective in reducing AHI and central AI, feasible in PCSA, and is associated with symptomatic improvement. While the working mechanism behind this effect remains speculative, the effect is positive and considerable.


Sleep-disordered breathing Sleep apnea Positional central sleep apnea Positional therapy Sleep position trainer 



NightBalance provided the 16 SPT devices.

Compliance with ethical standards

Conflict of interest

Prof. Dr. N. de Vries is a member of the Medical Advisory Board of NightBalance. He is also an investigator of Inspire and Jazz Pharmaceutics, consultant of Philips, Olympus and the AE Mann Foundation. Prof. Dr. J. Verbraecken is a member of the Medical Advisory Boards of ResMed Narval and Bioprojet. He is also a consultant of Philips and Jazz Pharmaceutics, and an investigator of ResMed. All the other authors declare that they have no conflicts of interest or financial ties to disclose. Dr. L.B.L. Benoist, Dr. P.E. Vonk, and Dr. H.C.J.P. Janssen declare that they have no conflict of interest.

Research involving human participants

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Otolaryngology and Head and Neck SurgeryOLVGAmsterdamThe Netherlands
  2. 2.Department of Otolaryngology and Head and Neck SurgeryErasmus University Medical CenterRotterdamThe Netherlands
  3. 3.Department of Otolaryngology and Head and Neck SurgeryAntwerp University Hospital and University of AntwerpAntwerpBelgium
  4. 4.Department of Oral KinesiologyACTAAmsterdamThe Netherlands
  5. 5.Sleep Medicine Center KempenhaegheHeezeThe Netherlands
  6. 6.Department of Pulmonary Medicine and Multidisciplinary Sleep Disorders CentreAntwerp University Hospital and University of AntwerpAntwerpBelgium

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