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.
A prospective, randomized, single blind crossover comparison of CPAP
and positional treatment for 2 weeks each.
university teaching hospital.
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
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.
Positional treatment and CPAP have similar efficacy in the treatment of
patients with positional OSA.
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