PURPOSE: Previous studies demonstrated comparable efficacy of positional treatment (aimed to prevent sleeping supine) to continuous positive airway pressure (CPAP) in the management of positional obstructive sleep apnea syndrome (OSAS). Pure prone positioning (PPP) consisted of a pillow mounted on a table designed to keep the subjects sleeping prone and hence reduce the gravity effect. Efficacy of PPP treatment in improving apnea-hypopnea index (AHI) and nocturnal oxygen saturation was investigated in mild to moderate OSAS.
METHODS: 29 mild to moderate OSAS patients (17 males, 12 females) who gave informed consent were tested with polysomnography at diagnostic and PPP nights, 2 weeks apart. Mean± SD age and AHI were 48.4±10.6 and 15.5±6.2, respectively. 16 patients had positional OSAS. Patients having morbid obesity, or any condition that could interfere with sleep such as upper respiratory infection, heart failure, coronary artery disease, narcolepsy, periodic leg movement disorder, panic disorder or insomnia were excluded from the study. Paired samples t-test was used for the statistical testing of comparisons. P<0.05 was considered statistically significant.
RESULTS: AHI (diagnostic - PPP treatment, mean difference: 5.2, 95%CI: 0.1 to 10.3, p: 0.04) and percentage of sleep below oxygen saturation of 90% (mean difference: 1.80, 95%CI: 0.22 to 3.37, p: 0.02) were significantly lower in PPP than diagnostic night. Findings were not associated with positional OSAS.
CONCLUSIONS: To our knowledge this is the first prospective study demonstrating the efficacy of prone positioning in the treatment of mild to moderate OSAS. The mechanism of action of PPP could be through gravity force in the prone position, which decreases the critical pressure around the upper airway by repositioning the base of the tongue and soft palate. Application of PPP treatment with more comfortable design will be helpful to investigate its efficacy in the long term in a larger sample of patients with mild to moderate OSAS.
CLINICAL IMPLICATIONS: Our findings, if confirmed in a randomized clinical trial would provide PPP as a cost-effective treatment of mild to moderate OSAS.
DISCLOSURE: The following authors have nothing to disclose: Arman Afrashi, Zeynep Ucar
Pure prone positioning (PPP) consisted of a pillow mounted on a table designed to keep the subjects sleeping prone and hence reduce the gravity effect.