References for Dr. Arie Oksenberg’s interview
Souza, F.J.F., Genta, P.R., de Souza Filho, A.J. et al. The influence of head-of-bed elevation in patients with obstructive sleep apnea. Sleep Breath 21, 815–820 (2017). https://doi.org/10.1007/s11325-017-1524-3
El estudio evaluó el efecto de elevar la cabecera de la cama aproximadamente 15 cm (mediante el uso de una tabla debajo de las patas de la base de la cabecera de la cama resultando en una elevación de la cabecera de 7.5°) en la severidad de la Apnea Obstructiva del Dormir en un grupo de 52 pacientes de una clínica en Criciúma, Santa Catarina, Brazil.
Los pacientes fueron estudiados polisomnograficamente en por lo menos dos ocasiones (al diagnostico y al evaluar el efecto de la elevación de la cabecera de la cama). La edad promedio de la cohorte fue de 53.2 ± 9.1 años; IMC 29.6 ± 4.8; la talla del cuellow 38.9 ± 3.8 cm, y la calificación en la Escala de Somnolencia de Epworth 15 ± 7. Reducción significativa en el índice de apnea hypopnea fue documentado con la elevación de la cabecera de la cama de 15.7 [11.3–22.5] a 10.7 [6.6–16.5]; p < 0.001 y el nivel mínimo de saturación de oxígeno se mejoró de 83.5 [77.5–87] a 87 [81–90]%; p = 0.003. No hubo cambios significativos en la arquitectura del sueño.
Los resultados del estudio sugieren que la elevación de la cabecera de la cama de unos 15 cm puede tener efectos terapéuticos en el índice de apnea-hypopnea.
The study evaluated the effects of a head-of-bed elevation (HOBE) of about 7.5° on the severity of obstructive sleep apnea (OSA).
OSA patients were recruited from a single sleep clinic (Criciúma, Santa Catarina, Brazil). Following a baseline polysomnography (PSG), patients underwent a PSG with HOBE (within 2 weeks). In addition, a subset of patients performed a third PSG without HOBE.
Fifty-two patients were included in the study (age 53.2 ± 9.1 years; BMI 29.6 ± 4.8; neck circumference 38.9 ± 3.8 cm, and Epworth Sleepiness Scale 15 ± 7).
Compared to baseline, HOBE decreased the apnea-hypopnea index (AHI) from 15.7 [11.3–22.5] to 10.7 [6.6–16.5] events/h; p < 0.001 and increased minimum oxygen saturation from 83.5 [77.5–87] to 87 [81–90]%; p = 0.003. The sleep architecture at baseline and HOBE were similar. The sleep efficiency increased slightly with HOBE (87.2 [76.7–90.7] vs 88.8 [81.6–93.3]; p = 0.005). The AHI obtained at the third PSG without HOBE (n = 7) returned to baseline values.
Conclusion: a 7.5° HOBE decreased the OSA severity without interfering in sleep architecture and therefore might represent an alternative treatment for mild OSA.
Oksenberg A, Goizman V, Eitan E, Nasser K, Gadoth N, Leppänen T. Obstructive Sleep Apnea: Do Positional Patients Become Nonpositional Patients With Time? Laryngoscope. 2020 Sep; 130(9):2263-2268. doi: 10.1002/lary.28387. Epub 2019 Nov 13.
Sabil A, Blanchard M, Trzepizur W, Goupil F, Meslier N, Paris A, Pigeanne T, Priou P, Le Vaillant M, Gagnadoux F; Pays de la Loire Sleep Cohort Group. Positional obstructive sleep apnea within a large multicenter French cohort: prevalence, characteristics, and treatment outcomes. J Clin Sleep Med. 2020 Aug 17. doi: 10.5664/jcsm.8752. Online ahead of print.
Srijithesh PR, Aghoram R, Goel A, Dhanya J. Positional therapy for obstructive sleep apnoea. Cochrane Database Syst Rev. 2019 May 1;5(5):CD010990. doi: 10.1002/14651858.CD010990.pub2
Heinzer R, Petitpierre NJ, Marti-Soler H, Haba-Rubio J. Prevalence and characteristics of positional sleep apnea in the HypnoLaus population-based cohort. Sleep Med. 2018 Aug; 48:157-162. doi: 10.1016/j.sleep. 2018.02.011. Epub 2018 Mar 9.
Ravesloot MJL, White D, Heinzer R, Oksenberg A, Pépin JL. Efficacy of the New Generation of Devices for Positional Therapy for Patients With Positional Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis. J Clin Sleep Med. 2017 Jun 15;13(6):813-824. doi: 10.5664/jcsm.6622.
Oksenberg A, Gadoth N. Breathe well, sleep well: avoid the supine and adopt the lateral posture. Sleep Health. 2016 Jun; 2(2):90-93. doi: 10.1016/j.sleh.2016.02.001. Epub 2016 Mar 21.
Oksenberg A, Gadoth N. Are we missing a simple treatment for most adult sleep apnea patients? The avoidance of the supine sleep position. J Sleep Res. 2014 Apr;23(2):204-10. doi: 10.1111/jsr.12097. Epub 2013 Oct 10.
Oksenberg AS. Positional therapy for sleep apnea: a promising behavioral therapeutic option still waiting for qualified studies. Sleep Med Rev. 2014 Feb;18(1):3-5.
Oksenberg A, Khamaysi I, Silverberg DS, Tarasiuk A. Association of body position with severity of apneic events in patients with severe nonpositional obstructive sleep apnea. Chest. 2000 Oct;118(4):1018-24. doi: 10.1378/chest.118.4.1018.
Berger M, Oksenberg A, Silverberg DS, Arons E, Radwan H, Iaina A. Avoiding the supine position during sleep lowers 24 h blood pressure in obstructive sleep apnea (OSA) patients. J Hum Hypertens. 1997 Oct;11(10):657-64. doi: 10.1038/sj.jhh.1000510.PMID: 9400908
Oksenberg A, Silverberg DS, Arons E, Radwan H. Positional vs nonpositional obstructive sleep apnea patients: anthropomorphic, nocturnal polysomnographic, and multiple sleep latency test data. Chest. 1997 Sep;112(3):629-39. doi: 10.1378/chest.112.3.629.