Elevated posture for the management of obstructive sleep apnea

This study aimed to evaluate the effectiveness of elevated posture in the management of obstructive sleep apnea (OSA). Fourteen subjects presenting with mild-moderate OSA, (apnea-hypopnea index [AHI] 10 to 60/h), were included in a randomized crossover investigation. A shoulder-head elevation pillow (SHEP) was compared with nasal continuous positive airway pressure (nCPAP) therapy. Treatment success was defined as AHI10<16/h. Four subjects achieved treatment success with the SHEP and three achieved partial success. The remaining seven subjects were treatment failures. In contrast, success was achieved with nCPAP in 12 subjects. One subject achieved partial success and one was a treatment failure. With the SHEP, the mean AHI decreased from 27+/-12/h to 21+/-17/h. With nCPAP, the mean AHI was 5+/-3/h; (p=0.008 for the difference between treatments). Although somewhat variable, these data provide evidence that elevated posture during sleep is helpful in the management of OSA in some individuals. Results support the use of elevated posture as second-line therapy in the management of OSA. However, no relationships could be identified between baseline data, including the identification of positional OSA, and objective outcomes that might predict patients who are likely to benefit from treatment in an elevated position.