Positional treatment vs continuous positive airway pressure in patients with positional obstructive sleep apnea syndrome

Objectives: The aim of this study was to compare the relative efficacy of c ontinuous positive airway pressure (CPAP) and positional treatment in the m anagement of positional obstructive sleep apnea (OSA), using objective outc ome measures. Design: A prospective, randomized, single blind crossover comparison of CPA P and positional treatment for 2 weeks each. Setting: A university teaching hospital. Patients: Thirteen patients with positional OSA, aged (mean +/- SD) 51 +/- 9 years, with an apnea-hypopnea index (AHI) of 17 +/- 8. Measurements: (1) Daily Epworth Sleepiness Scale scores; (2) overnight poly somnography, an objective assessment of sleep quality and AHI; (3) maintena nce of wakefulness testing; (4) psychometric test battery; (5) mood scales; (6) quality-of-life questionnaires; and (7) individual patient's treatment preference. Results: Positional treatment was highly effective in reducing time spent s upine (median, 0; range, 0 to 32 min), The AHI was lower(mean difference, 6 .1; 95% confidence interval [CII, 2 to 10.2; p = 0.007), and the minimum ox ygen saturation was higher (4%; 95% CI, 1% to 8%; p = 0.02) on CPAP as comp ared with positional treatment. There was no significant difference, howeve r, in sleep architecture, Epworth Sleepiness Scale scores, maintenance of w akefulness testing sleep latency, psychometric test performance, mood scale s, or quality-of-life measures, Conclusion: Positional treatment and CPAP have similar efficacy in the trea tment of patients with positional OSA.