Use of positional therapy when incorporated into a diagnosis-treatment algorithm for obstructive sleep apnea

Area of Science:

• Sleep Medicine
• Respiratory Medicine

Background:

• Obstructive sleep apnea (OSA) is a prevalent condition affecting many individuals.
• Positional OSA, where apnea events are linked to sleeping position, is a significant subtype.
• Current treatment algorithms may not optimally integrate positional therapy.

Purpose of the Study:

• To evaluate the hypothesis that incorporating positional therapy into an OSA diagnosis-treatment algorithm increases its prescription as a first-line therapy.
• To assess the cost-effectiveness of positional therapy compared to continuous positive airway pressure (CPAP) for OSA treatment.

Main Methods:

• Fifty-nine individuals with suspected OSA underwent Epworth Sleepiness Scale (ESS) questionnaires and home sleep tests (HST).
• Patients diagnosed with positional OSA (apnea-hypopnea index [AHI] < 5 events/hr when non-supine) were offered positional therapy.
• A cost comparison between positional therapy and CPAP was conducted.

Main Results:

• Of 59 participants, 54 (92%) were diagnosed with OSA (AHI 24.2±20.1 events/hr), with 16 (30%) having positional OSA.
• Patients with positional OSA were less heavy, less sleepy (lower ESS), and had less severe OSA compared to non-positional OSA patients.
• Positional therapy ($189.95/device) was significantly cheaper than CPAP ($962.49/device), resulting in a 24% cost saving when integrated into the algorithm.

Conclusions:

• The high prevalence of positional OSA supports its consideration as a first-line therapy.
• Integrating positional therapy into diagnosis-treatment algorithms increases its use as a cost-effective initial treatment for OSA.
• This approach offers significant cost savings compared to universal CPAP initiation.