A randomized, controlled trial of positional therapy versus oral appliance therapy for position-dependent sleep apnea
Objective To compare the effectiveness of positional therapy (PT) with the sleep position trainer (SPT) to oral appliance therapy (OAT) in patients with mild-to-moderate positional obstructive sleep apnea (POSA). Methods Multicenter, prospective, randomized, controlled trial. Patients with mild-to-moderate POSA (apnea-hypopnea index (AHI) ≥5 ≤ 30/hour sleep) were randomized for PT or OAT. Polysomnography was repeated after 3 months. Efficacy, adherence, mean disease alleviation (MDA), quality of life, dropouts and adverse events were evaluated. Results A total of 177 patients were screened for the study; 99 underwent randomization and 81 completed the study. Intention-to-treat (ITT) analysis of median [IQR] AHI showed a reduction in the PT group from 13.0 [9.7–18.5] to 7.0 [3.8–12.8], p < 0.001 and in the OAT group from 11.7 [9.0–16.2] to 9.1 [4.9–11.7], p < 0.001. Mean adherence (≥4 h/night, ≥5 days/week) was 89.3 ± 22.4% for SPT versus 81.3 ± 30.0% in OAT patients, p = 0.208. Conclusions Oral appliance therapy and positional therapy were equally effective in reducing the median AHI in patients with mild-to-moderate POSA. The results of this study have important implications for future OSA treatment guidelines and daily clinical practice. ClinicalTrials.gov number NCT02045576.
|Keywords||Obstructive sleep apnea, Oral appliances, Positional obstructive sleep apnea, Positional therapy, Randomized, controlled trial|
|Persistent URL||dx.doi.org/10.1016/j.sleep.2017.01.024, hdl.handle.net/1765/99370|
Benoist, L. (Linda), de Ruiter, M. (Maurits), de Lange, J, & de Vries, N.A. (2017). A randomized, controlled trial of positional therapy versus oral appliance therapy for position-dependent sleep apnea. Sleep Medicine, 34, 109–117. doi:10.1016/j.sleep.2017.01.024