Effect of below-the-knee compression stockings on severity of obstructive sleep apnea

Overnight fluid shift from the legs to the neck may narrow the upper airway and contribute to obstructive sleep apnea (OSA) pathogenesis. We hypothesized that below-the-knee compression stockings will decrease OSA severity in a general OSA population by decreasing daytime leg fluid accumulation and overnight fluid shift and increasing upper-airway size.

Patients with OSA (apnea-hypopnea index ≥ 10) were randomized to wear compression stockings during the daytime or to a control group for 2 weeks. Overnight polysomnography with measurement of leg and neck fluid volumes and upper-airway cross-sectional area before and after sleep was performed at baseline and follow-up. The primary outcome was change in the apnea-hypopnea index.

Twenty-two patients randomized to compression stockings and 23 to control completed the study. The apnea-hypopnea index decreased significantly more in the compression stockings than in the control group (from 32.4 ± 20.0 to 23.8 ± 15.5 vs. from 31.2 ± 25.0 to 30.3 ± 23.8, p = 0.042), in association with a significantly greater reduction in the overnight decrease in leg fluid volume (p = 0.028), and a significantly greater increase in morning upper-airway cross-sectional area (p = 0.006). Overnight change in neck fluid volume was unchanged.

These observations suggest that in, a general OSA population, below-the-knee compression stockings decrease OSA severity modestly via attenuation of overnight fluid shift and consequent upper-airway dilatation.