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Title Positional Therapy May Be Useful for Obstructive Sleep Apnea Patients Undergoing Orthodontic Dental Treatment
Clinical Question For a 30 year old male with mild obstructive sleep apnea that is undergoing orthodontic treatment and unable to use the CPAP or any other occlusal appliance modalities, would positional therapy be an acceptable strategy to manage his sleep apnea while continuing orthodontic treatment?
Clinical Bottom Line For patients undergoing orthodontic treatment, positional therapy may be an alternative treatment approach for OSA, however, current research is limited with respect to its long-term effectiveness, even in non-orthodontic OSA patients, and there is a lack of published reports of the use of positional therapy with orthodontic patients.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22927107 Van Maanen/201231 patients (mean age, 48.1 ±11.0 years; mean BMI, 27.0 ± 3.7kg/m(2)).Case Series
Key resultsThe median AHI decreased from 16.4 [6.6-29.9] to 5.2 [0.5-46.5] when patients stopped sleeping on their back (p<0.001). Fifteen of sixteen patients developed an overall AHI below 5. Functional Outcomes of Sleep Questionnaire increased significantly, however, sleep efficiency did not change significantly. Epworth Sleepiness Scale was also reported to have a significant decrease. Compliance was reported to be 92.7% [62.0-100%].
#2) 22261242Heinzer/201216 patients with positional OSA Case Series
Key resultsCompared to baseline (diagnostic night), mean AHI decreased from 26.7 ± 17.5 to 6.0 ± 3.4 with usage of the positional device during the first night test (T0) (p<0.0001). Oxygen desaturation index also decreased from 18.4 ± 11.1 to 7.1 ± 5.7, as well as the time spent supine from 42.8 ± 26.2% to 5.8 ± 7.2% (p<0.001). The results persisted at three months (T3) with no difference in AHI (p=0.58) or in time spent in the supine position (p=0.98). The Epworth Sleepiness scale showed a significant decrease from 9.4 ± 4.5 to 6.6 ± 4.7 (p=0.02). Compliance was on average 73.7 ± 29.3 % (mean ± SD) of the nights for 8.0 ± 2.0 hr/night.
Evidence Search “Effectiveness of Positional Therapy for Obstructive Sleep Apnea”
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The Evidence
Van Maanen conducted a case series on 31 patients with the use of a new sleep position trainer (SPT) for the treatment of positional obstructive sleep apnea. In this study, data that was collected from the SPT were manually reviewed for analysis by an experienced sleep investigator, a sufficient completion rate was reported, and compliance for the one-month use of this device was adequate. Limitations of this study include its small sample size and short-term duration. Heinzer also conducted a case series evaluating the use of a positional therapy device used among 16 patients with positional obstructive sleep apnea. The device allowed an objective measurement of nightly use at home for a 3-month duration by means of an actigraphic recorder placed inside the positional device. In this study, there was 100% completion rate and adequate follow-up was observed. Limitations of this study include its small sample size and an issue with compliance with 10/16 patients only using the device more than 80% of the nights.
Applicability Although these two studies are limited by their small sample sizes, it appears that positional therapy may be a viable treatment option for a patient undergoing orthodontic treatment. Evaluation of a longer duration of use and higher levels of evidence are warranted to further clarify the role of positional therapy in managing obstructive sleep apnea.
Specialty/Discipline (General Dentistry) (Orthodontics)
Keywords Obstructive sleep apnea, positional therapy
ID# 2479
Date of submission: 05/13/2013spacer
E-mail bemis@livemail.uthscsa.edu
Author Katie Bemis
Co-author(s) e-mail
Faculty mentor/Co-author John D. Rugh, PhD
Faculty mentor/Co-author e-mail rugh@uthscsa.edu
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