Skip to main content
SpringerLink
Log in

Comparison of Positional Therapy to CPAP in Patients with Positional Obstructive Sleep Apnea

  • Chapter
  • First Online:
Positional Therapy in Obstructive Sleep Apnea

Abstract

While treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) therapy has been shown to be clinically effective, compliance is poor, and as a result, alternative therapies often need to be considered. With the recognition that many patients with OSA have positional OSA, where the majority of sleep-disordered breathing events occur in the supine position, prospective studies comparing positional therapy to CPAP therapy in these patients have been performed. The results of these short-term studies, both in regard to sleep-disordered breathing and sleep quality, suggest that positional therapy as a primary treatment can be as effective as CPAP therapy in patients with positional OSA and in those patients who are intolerant to CPAP therapy. More long-term trials that prospectively and quantitatively compare effectiveness and compliance between positional therapy and CPAP therapy appear warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230–5.

    Article  CAS  PubMed  Google Scholar 

  2. Nieto FJ, Young TB, Lind BK, et al. Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study: Sleep Heart Health Study. JAMA. 2000;283:1829–36.

    Article  CAS  PubMed  Google Scholar 

  3. Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med. 2000;342:1378–84.

    Article  CAS  PubMed  Google Scholar 

  4. Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353:2034–41.

    Article  CAS  PubMed  Google Scholar 

  5. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F, O’Connor GT, Boland LL, Schwartz JE, Samet JM. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163:19–25.

    Article  CAS  PubMed  Google Scholar 

  6. Kribbs NB, Pack AI, Kline LR, Smith PL, Schwartz AR, Schubert NM, Redline S, Henry JN, Getsy JE, Dinges DF. Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea. Am Rev Respir Dis. 1993;147:887–95.

    Article  CAS  PubMed  Google Scholar 

  7. Weaver TE, Grunstein RR. Adherence to continuous positive airway pressure therapy. The challenge to effective treatment. Proc Am Thorac Soc. 2008;5:173–8.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Sawyer AM, Gooneratne NS, Marcus CL, Ofer D, Richards KC, Weaver TE. A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev. 2011;15:343–56.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Oksenberg A, Silverberg D, Offenbach D, Arons E. Positional therapy for obstructive sleep apnea patients: a 6-month follow-up study. Laryngoscope. 2006;116:1995–2000.

    Article  PubMed  Google Scholar 

  10. Bignold JJ, Deans-Costi G, Goldworthy MR, Robertson CA, McEvoy D, Catcheside PG, Mercer JD. Poor long-term compliance with the tennis ball technique for treating positional obstructive sleep apnea. J Clin Sleep Med. 2009;5(5):428–30.

    PubMed Central  PubMed  Google Scholar 

  11. White D. Pathogenesis of obstructive and central sleep apnea. Am J Respir Crit Care Med. 2005;172:1363–70.

    Article  PubMed  Google Scholar 

  12. Olson L, Fouke J, Hokje P, Strohl K. A biomechanical view of the upper airway. In: Mathew OP, Saint’Ambroggio G, editors. The respiratory function of the upper airway. New York: Marcel Dekker; 1988. p. 359–90.

    Google Scholar 

  13. Fouke J, Strohl K. Effect of position and lung volume on upper airway geometry. J Appl Physiol. 1987;63:375–80.

    CAS  PubMed  Google Scholar 

  14. Cartwright RD. Effect of sleep position on sleep apnea severity. Sleep. 1984;7:110–4.

    CAS  PubMed  Google Scholar 

  15. Cartwright R, Ristanovic R, Diaz F, Caldarelli D, Alder G. A comparative study of treatments for positional sleep apnea. Sleep. 1991;14:546–52.

    CAS  PubMed  Google Scholar 

  16. Oksenberg A, Silverberg DS, Arons E, Radwan H. Positional vs. nonpositional obstructive sleep apnea patients: anthropomorphic, nocturnal polysomnographic, and multiple sleep latency test data. Chest. 1997;112:629–39.

    Article  CAS  PubMed  Google Scholar 

  17. Akita Y, Kawakatsu K, Hattori C, Hattori H, Suzuki K, Nishimura T. Posture of patients with sleep apnea during sleep. Acta Otolaryngol. 2003;550(Suppl):41–5.

    Article  Google Scholar 

  18. Epstein LJ, Kristo D, Strollo PJ, Friedman NF, Malhotra A, Patil AP, et al. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5:263–76.

    PubMed  Google Scholar 

  19. Mador MJ, Kufel TJ, Magalang UJ, et al. Prevalence of positional sleep apnea in patients undergoing polysomnography. Chest. 2005;128:2130–7.

    Article  PubMed  Google Scholar 

  20. Schwartz AR, O’Donnell CP, Baron J, et al. The hypotonic upper airway in obstructive sleep apnea: role of structures and neuromuscular activity. Am J Respir Crit Care Med. 1998;157:1051–7.

    Article  CAS  PubMed  Google Scholar 

  21. Gleadhill IC, Schwartz AR, Schubert N, Wise RA, Permutt S, Smith PL. Upper airway collapsibility in snorers and in patients with obstructive hypopnea and apnea. Am Rev Respir Dis. 1991;143:1300–3.

    Article  CAS  PubMed  Google Scholar 

  22. Boudewyns A, Punjabi N, Van de Heyning PH, De Backer WA, O’Donnell CP, Schneider H, Smith PL, Schwartz AR. Abbreviated method for assessing upper airway function in obstructive sleep apnea. Chest. 2000;118:1031–41.

    Article  CAS  PubMed  Google Scholar 

  23. Penzel T, Moller M, Becker HF, Knaack L, Peter JH. Effect of sleep position and sleep stage on the collapsibility of the upper airways in patients with sleep apnea. Sleep. 2001;24:90–5.

    CAS  PubMed  Google Scholar 

  24. Ong JSL, Touyz G, Tanner S, Hillman DR, Eastwood PR, Walsh JH. Variability of human upper airway collapsibility during sleep and the influence of body posture and sleep stage. J Sleep Res. 2011;20:533–7.

    Article  PubMed  Google Scholar 

  25. Gay P, Weaver T, Loube D, Iber C. Evaluation of positive airway pressure treatment for sleep related breathing disorders in adults. Sleep. 2006;29:381–401.

    PubMed  Google Scholar 

  26. Stradling JR, Davies RJ. Is more NCPAP better? Sleep. 2000;23 Suppl 4:S150–3.

    PubMed  Google Scholar 

  27. Antic NA, Catcheside P, Buchan C, Hensley M, Naughton MT, Rowland S, et al. The effect of CPAP in normalizing daytime sleepiness, quality of life and neurocognitive function in moderate-severe OSA. Sleep. 2011;34:111–9.

    PubMed Central  PubMed  Google Scholar 

  28. Engleman HM, Martin SE, Douglas NJ. Compliance with CPAP therapy in patients with sleep apnoea/hypopnoea syndrome. Thorax. 1994;49:263–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Reeves-Hoche MK, Meck R, Zwillich CW. Nasal CPAP. An objective evaluation of patient compliance. Am J Respir Crit Care Med. 1994;149:149–54.

    Article  CAS  PubMed  Google Scholar 

  30. Rosen CL, Auckley D, Benca R, Foldvary-Schaefer N, Iber C, Kapur V, Rueschman M, Zee P, Redline S. A multisite randomized trial of portable sleep studies and positive airway pressure autotitration versus laboratory-based polysomnography for the diagnosis and treatment of obstructive sleep apnea: the HomePAP study. Sleep. 2012;35(6):757–67.

    PubMed Central  PubMed  Google Scholar 

  31. Kuna ST, Gurubhagavatula I, Malslin G, Hin S, Hartwig K, McCloskey S, Hachadoorian R, Hurley S, Gupta R, Staley B, Atwood CW. Noninferiority of functional outcome in ambulatory management of obstructive sleep apnea. Am J Respir Crit Care Med. 2011;183:1238–44.

    Article  PubMed  Google Scholar 

  32. Pepin JL, Leger P, Veale D, Langevin B, Robert R, Levy P. Side effects of nasal continuous positive airway pressure in sleep apnea syndrome: study of 193 patients in two French sleep centers. Chest. 1995;107:375–81.

    Article  CAS  PubMed  Google Scholar 

  33. Platt AB, Field SH, Asch DA, Chen Z, Patel N, Gupta R, et al. Neighborhood of residence is associated with daily adherence to CPAP therapy. Sleep. 2009;32(6):799–806.

    PubMed Central  PubMed  Google Scholar 

  34. Simon-Tuval T, Reuveni H, Greenberg-Dolan S, Oksenberg A, Tal A, Tarsiuk A. Low socioeconomic status is a risk factor CPAP acceptance among adult OSAS patients requiring treatment. Sleep. 2009;32(4):545–52.

    PubMed Central  PubMed  Google Scholar 

  35. Kavey NB, Blitzer A, Gidro-Frank S, Korstanje K. Sleeping position and sleep apnea syndrome. Am J Otolaryngol. 1985;6(5):373–7.

    Article  CAS  PubMed  Google Scholar 

  36. Jokic R, Klimaszewski A, Crossley M, Sridhar G, Fitzpatrick MF. Positional treatment vs continuous positive airway pressure in patients with positional obstructive sleep apnea. Chest. 1999;115:771–81.

    Article  CAS  PubMed  Google Scholar 

  37. Skinner MA, Kingshott RN, Filsell S, Taylor DR. Efficacy of the ‘tennis ball technique’ versus NCPAP in the management of position-dependent obstructive sleep apnoea syndrome. Respirology. 2008;13:708–15.

    Article  PubMed  Google Scholar 

  38. Permut I, Diaz-Abad M, Chatila W, Crocetti J, Gaughan J, D’Alonzo GE, Krachman SL. Comparison of positional therapy to CPAP in patients with positional obstructive sleep apnea. J Clin Sleep Med. 2010;6(3):238–43.

    PubMed Central  PubMed  Google Scholar 

  39. Heinzer RC, Pellaton C, Rey V, Rossetti AO, Lecciso G, Haba-Rubio J, Tafti M, Lavigne G. Positional therapy for obstructive sleep apnea: an objective measurement of patients’ usage and efficacy at home. Sleep Med. 2012;13(4):425–8.

    Article  PubMed  Google Scholar 

  40. Lattimore JL, Wilcox I, Skilton M, Langenfeld M, Celermajer DS. Treatment of obstructive sleep apnoea leads to improved microvascular endothelial function in the systemic circulation. Thorax. 2006;61(6):491–5.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Ip MS, Tse HF, Lam B, Tsang KW, Lam WK. Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med. 2004;169(3):348–53.

    Article  PubMed  Google Scholar 

  42. Imadojemu VA, Gleeson K, Quraishi SA, Kunselman AR, Sinoway LI, Leuenberger UA. Impaired vasodilator responses in obstructive sleep apnea are improved with continuous positive airway pressure therapy. Am J Respir Crit Care Med. 2002;65(7):950–3.

    Article  Google Scholar 

  43. Shamsuzzaman ASM, Winnicki M, Lanfranchi P, Wolk R, Kara T, Accurso V, Somers VK. Elevated C-reactive protein in patients with obstructive sleep apnea. Circulation. 2002;105:2462–4.

    Article  CAS  PubMed  Google Scholar 

  44. Guo Y, Pan L, Ren D, Xie X. Impact of continuous positive airway pressure on C-reactive protein in patients with obstructive sleep apnea: a meta-analysis. Sleep Breath. 2013;17(2):495–503.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pulmonary, Critical Care and Sleep Medicine, Temple University School of Medicine, 3401 North Broad St, Philadelphia, PA, 19140, USA

    Samuel Krachman D.O., Irene Swift M.D. & Maria Elena Vega M.D.

Authors
  1. Samuel Krachman D.O.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Irene Swift M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria Elena Vega M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Samuel Krachman D.O. .

Editor information

Editors and Affiliations

  1. Department of Otolaryngology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands

    Nico de Vries

  2. Department of Otorhinolaryngology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands

    Madeline Ravesloot

  3. Department of Otolaryngology, Sint Lucas Andreas Ziekenhuis, Amsterdam, The Netherlands

    J. Peter van Maanen

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Krachman, S., Swift, I., Vega, M.E. (2015). Comparison of Positional Therapy to CPAP in Patients with Positional Obstructive Sleep Apnea. In: de Vries, N., Ravesloot, M., van Maanen, J. (eds) Positional Therapy in Obstructive Sleep Apnea. Springer, Cham. https://doi.org/10.1007/978-3-319-09626-1_31

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-09626-1_31

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-09625-4

  • Online ISBN: 978-3-319-09626-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation