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Clinical Investigations: SLEEP AND BREATHING |

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

Ruzica Jokic, MD; Artur Klimaszewski, MD; Margaret Crossley, PhD; Guruswamy Sridhar, MD; Michael F. Fitzpatrick, MD
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*From the Division of Respiratory Medicine (Drs. Jokie, Klimaszewski, and Fitzpatrick) and Department of Psychology Dr. Crossley), University of Saskatchewan, Saskatoon, and Regina Health District (Dr. Sridhar), Regina, Saskatchewan, Canada.



Chest. 1999;115(3):771-781. doi:10.1378/chest.115.3.771
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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.

Abbreviations: AHI = apnea-hypopnea index; ANOVA = analysis of variance; CI = confidence interval; CPAP = continuous positive airway pressure; EMG = electromyogram; MWT = Maintenance of Wakefulness Test; NREM = non-REM; OSA = obstructive sleep apnea; REM = rapid eye movement

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