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Updated: Aug 25, 2025

Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
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Head-Of-Bed Elevation (HOBE) for Improving Positional Obstructive Sleep Apnea (POSA): An Experimental Study.

Giannicola Iannella1, Giovanni Cammaroto2, Giuseppe Meccariello2

  • 1Department of 'Organi di Senso', University "Sapienza", Viale dell'Università, 33, 00185 Rome, Italy.

Journal of Clinical Medicine
|October 14, 2022
PubMed
Summary

Elevating the head of the bed (HOBE) by 30° significantly reduces upper airway obstructions in obstructive sleep apnea (OSA) patients. This simple intervention improves apnea/hypopnea events and overall respiratory outcomes during sleep.

Keywords:
obstructive sleep apneapositional obstructive sleep apneasnoring

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Area of Science:

  • Sleep Medicine
  • Respiratory Physiology
  • Otolaryngology

Background:

  • Obstructive sleep apnea (OSA) is a common sleep disorder characterized by recurrent upper airway collapse.
  • Current treatments for OSA often involve continuous positive airway pressure (CPAP) or oral appliances.
  • Positional therapy, including head-of-bed elevation, is an emerging strategy to manage OSA.

Purpose of the Study:

  • To evaluate the effectiveness of a 30° head-of-bed elevation (HOBE) position in mitigating upper airway obstructions in patients with obstructive sleep apnea (OSA).
  • To assess the impact of HOBE on polysomnography (PSG) parameters and patient-reported outcomes.

Main Methods:

  • A prospective trial involving 45 OSA patients who underwent simultaneous drug-induced sleep endoscopy (DISE) and polysomnography (PSG).
  • DISE and PSG were performed at 0° (supine) and 30° HOBE positions to evaluate airway collapse and respiratory events.
  • Patient feedback on sleeping in the HOBE position was collected via a questionnaire.

Main Results:

  • A significant reduction in velum and oropharynx lateral wall collapses was observed at 30° HOBE compared to the 0° position.
  • No significant differences in tongue base or epiglottis obstruction were found between the two positions.
  • The average apnea-hypopnea index (AHI) decreased from 23.8 to 17.7 (p=0.03), and the percentage of apneas decreased from 55% to 44% (p=0.05) with HOBE.

Conclusions:

  • Adopting a 30° HOBE position effectively reduces upper airway collapses in OSA patients.
  • This simple positional modification leads to a significant improvement in apnea/hypopnea events and nightly respiratory outcomes.
  • HOBE presents a viable non-invasive strategy for managing obstructive sleep apnea.