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.

Additional Metadata
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
Journal Sleep Medicine
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