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Positional therapy for the treatment of positional obstructive sleep apnea in children: A randomized controlled
Lena Xiao1, Adele Baker2, Colin Massicotte2
1Department of Pediatrics, The Hospital for Sick Children, 170 Elizabeth Street, Toronto, M5G 1E8, Canada; University of Toronto, 27 King's College Circle, Toronto, M5S 1A1, Canada; Department of Pediatrics, British Columbia Children's Hospital, 4500 Oak Street, Vancouver, V6H 3N1, Canada; University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, V6T 1Z3, Canada.
Insights
Positional devices reduced supine sleep time in children with positional obstructive sleep apnea (OSA). However, the study did not find a significant reduction in the obstructive apnea-hypopnea index (OAHI) across all participants.
Area of Science:
- Pediatric Sleep Medicine
- Respiratory Physiology
Background:
- Obstructive sleep apnea (OSA) is common in children, with many cases undiagnosed or untreated.
- Positional OSA, characterized by airway obstruction when supine, affects up to half of children with OSA.
- Positional therapy devices aim to prevent supine sleeping and may benefit this specific phenotype.
Purpose of the Study:
- To evaluate the efficacy of positional devices in treating positional obstructive sleep apnea (OSA) in pediatric patients.
- To determine if positional therapy can reduce the severity of airway obstruction during sleep in children with positional OSA.
Main Methods:
- A randomized crossover trial involving children aged 4-18 years with diagnosed positional OSA.
- Participants underwent one-night in-laboratory polysomnography with either an active positional device or an inactive control device.
- The primary outcome measure was the change in the obstructive apnea-hypopnea index (OAHI) between the two conditions.
Main Results:
- The study included 24 children (median age 9.0 years, 63% males).
- Positional therapy significantly reduced the percentage of total sleep time spent in the supine position (-65.9%, p<0.001).
- No statistically significant reduction in the obstructive apnea-hypopnea index (OAHI) was observed between positional therapy and the control group (p=0.13).
Conclusions:
- Positional therapy effectively reduces supine sleep time in children with positional OSA.
- Current evidence suggests positional therapy may not consistently reduce the obstructive apnea-hypopnea index in all pediatric patients with positional OSA.
- Larger studies are needed to explore treatment effect heterogeneity and identify patient subgroups that may benefit more from positional therapy.
Background:
Obstructive sleep apnea (OSA) is prevalent in children, but many children remain untreated. Up to one half of children with OSA have positional OSA, a phenotype characterized by the predominance of airway obstruction while supine. Positional devices that prevent sleeping supine may be beneficial for positional OSA. We evaluated the efficacy of positional devices for treating positional OSA in children.
Study Design And Methods:
This was a randomized crossover trial of children aged 4-18 years old with positional OSA. There were two treatment periods separated by 1-4 weeks. Each period consisted of a one-night in-laboratory polysomnogram with the experimental intervention (positional device with inflated cushions) or the inactive control (positional device with no cushions). The primary outcome was the difference in the obstructive apnea-hypopnea index (OAHI) between positional therapy and the control.
Results:
24 participants were randomized (median age = 9.0 years, 63% males). The adjusted relative percentage difference in the OAHI (positional therapy minus control) was -29.9% (95% CI -55.9% to 11.6%; p = 0.13). The adjusted relative percentage differences for the desaturation index, arousal index, and percentage of total sleep time supine were -23.4% (95% CI -45.0% to 6.7%; p = 0.11), -16.7% (95% CI -30.8% to 0.22%; p = 0.053), and -65.9% (95% CI -79.3% to -43.9%; p<0.001), respectively. There were no significant differences in comfort scores or adverse events.
Interpretation:
Positional therapy reduced supine sleep time, but did not reduce the OAHI in all participants. Future studies with larger sample sizes to evaluate heterogeneity of treatment effects are warranted.
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