Sleep Position Trainer vs. Tennis Ball Technique
in Positional Obstructive Sleep Apnoea Syndrome
M.M.M. Eijsvogela, R. Ubbinkb, J. Dekkerb, E. Oppersmab, F.H.C.de Jongha b, J van der Palenc d, M.G.J. Brusse-Keizerd.
a Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, The Netherlands.
b Department of Technical Medicine University of Twente, Enschede, The Netherlands.
c Department of Research Methodology, Measurement, and Data Analysis, University of Twente, Enschede, The Netherlands.
d Department of Scientific research, Medisch Spectrum Twente, Enschede, The Netherlands.
Background
Intervention:
1. SPT (Nightbalance™) is a device
with sensors and micro-PC worn in a ventral pocket in
3RVLWLRQDO26$326$GHILQHGDVD$+,•[VXSLQH
a strap around the chest vibrating when remaining in
compared with non-supine position and a AHI < 5 in
supine position. 2. TBT is a classical form of PT with
non-supine position is found in 49% in mild and 19% in
3 airbags (Rematee™).
Both therapies prevent the supine position and
reduce AHI to approximately normal values.
No significant differences in these and other PSG
respiratory and sleep variables between baseline and
1 month or between SPT and TBT were observed.
Objective daily compliance (dropouts included)
moderate OSA1. Classical Positional Therapy (PT) is
done with the Tennis Ball Technique (TBT) with a tennis
Measurements: home PSG (Alice Pdx) at baseline &
ball, a wedge of hard foam, or airbags positioned
after 1 month. ESS, Quebec Sleep Questionnaire
between the shoulder blades preventing supine
(QSQ),VAS scores. Compliance was measured with
80%
position. Efficacy in reducing AHI is identical to CPAP in
a 1 night crossover study2. However for therapeutic
the SPT in both groups (also in TBT group with build-
70%
in SPT in non-vibrating mode).
60%
effectiveness compliance is crucial and this is known to
Compliant patients were defined as use of •KRXUVD
be low in PT. So effective, tolerable PT with good
GD\IRU•GD\VDZHHNH[SUHVVHGDVIRUPRQWKRU
compliance is needed.
on daily basis.
compliance with a new ergonomic device, the Sleep
Position Trainer3 (SPT) with classical TBT in patients
with POSA.
Methods
Patients: 55 new POSA patients with an AHI 5-30, were
AHIsupine
•[AHInon-supine +
AHInon-supine
< 10
+
Positionsupine 10-90% TST
1. Mador. Prevalence of positional sleep apnea in patients undergoing polysomnography.Chest 2005;128:2130-7
P = 0.01
40%
30%
11/26
22/29
% Compliance SPT
% Compliance TBT
42%
76 %
0%
TBT
SPT
days
ESS, QSQ, VAS, Dropouts and side-effects
TBT (n 26)
SPT (n 29)
13.2 ± 9.1
11.4 ± 4.9
37.3 ± 24
30.7 ± 15.3
31.1 (10.7-73.7) 27.9 (10.3-77.6)
7.3 ± 4.2
6.4 ± 3.4
27.0 ± 3.0
27.9 ± 4.4
50.6 ± 12.6
49.9 ± 10.6
P
0.386
0.228
0.886
0.405
0.420
0.482
AHI
AHI supine
Supine % TST
Sleepefficiency %
Awak.+Arous. Ind.
REM+N3/TST %
VAS - “Feeling positive effect PT therapy” is more
positive for the SPT vs TBT (P=0.02)
No other significant differences between TBT and
SPT in ESS, QSQ or other VAS scores
7 dropouts: 5 TBT, 2 SPT (P>0.05) due to discomfort
Conclusions
Polysomnography
randomized to the SPT (29) and standard position
therapy with TBT(26). POSA was defined as a:
Compliant /day
50%
10%
Baseline
AHI
AHI supine
Supine % TST
ESS
BMI
Age
Compliant 4 h/d + 5 d/w
&RPSOLDQFH•XZ
90%
20%
Results
Objectives: to compare the effectiveness of and
100%
TBT
5.8
0.0
0.0
81.3
13.2
43.7
(n 21)
(0.2-23.1)
(0.0-116.1)
(0.0-38.9)
± 8.7
(2.8-24.4)
± 9.1
SPT
3.9
0.0
0.0
82.8
10.5
44.5
(n 26)
(0.4-30.8)
(0.0-64.2)
(0.0-67.6)
± 9.8
(5.6-37.5)
± 9.1
P
0.076
0.249
0.205
0.172
0.329
0.777
2. Permut. Comparison of positional therapy to CPAP in patients with positional obstructive sleep apnea.J Clin.Sleep Med 2010;6:238-3
In mild POSA position therapy is an effective
therapy without loss of sleep quality.
1 month compliance is significantly better with
the SPT compared with standard TBT therapy.
3. van MaanenThe sleep position trainer: a new treatment for positional obstructive sleep apnoea.Sleep Breath. 2013;17:771-9
Sleep Position Trainer: a new treatment for positional obstructive sleep apnoea
J.P. van Maanen, K.A.W. Meester*, L.N. Dun, I. Koutsourelakis, D.M. Laman*, A.A.J. Hilgevoord*, N. de Vries
Department of Otorhinolarnygology, Sint Lucas Andreas Hospital, Amsterdam, the Netherlands
*Department of Clinical Neurophysiology, St. Lucas Andreas Hospital, Amsterdam, the Netherlands
INTRODUCTION: Obstructive sleep apnoea syndrome (OSAS) is the most common sleep disorder and increasingly recognised as a major
health problem. The prevalence of sleep apnoea is increasing with trends of increased obesity and in 2009 it was estimated to have a
prevalence in the general population of approximately 20%. OSAS is being treated because of its complaints, such as snoring and daytime
somnolence but also since it is becoming increasingly clear that OSAS is associated with considerable comorbidity, including hypertension and
increased risk for other cardiovascular diseases. Identification and treatment of OSAS may be an important factor in improving quality of life.
60% Of OSA patients suffer from positional obstructive sleep apnoea (POSA) defined as an apnoea-hypopnoea index (AHI) during sleep in
supine position that is at least twice as high as the AHI during sleep in other positions.
Objective
To assess the effectiveness of a new treatment in patients with positional obstructive sleep apnoea
(POSA).
Main outcome measure
Primary outcomes: reduction of apnoea-hypopnoea index and reduction of supine sleeping time
without
disturbance of sleep quality.
Secondary outcome: compliance and sleep related quality of life.
PATIENTS AND METHODS: Patients older than 18 years with mild to moderate POSA. Patients slept with the Sleep Position Trainer (SPT),
strapped to the chest, for a period of 29 +/- 2 nights.SPT measures the body position and vibrates when the patient lies in supine
position.Patients started using the SPT in June 2011, the last patient finished the study in February 2012.
RESULTS: 36 Patients were included, 31 patients (mean age 48.1±11.0 years; mean body mass index 27.0±3.7 kg•m-2) completed the study
protocol. The median percentage of supine sleeping time decreased from 49.9% [20.4 – 77.3%]to 0.0% [range: 0.0 - 48.7%] (p<0.001). The
median apnoea-hypopnoea index decreased from 16.4 [6.6 – 29.9] to 5.2 [0.5 – 46.5] (p<0.001). 15 Patients developed an overall apnoea–
hypopnoea index below five when using the SPT. Sleep efficiency did not change significantly. Epworth Sleepiness Scale decreased
significantly and the Functional Outcomes of Sleep Questionnaire increased significantly. Compliance was found to be 92.7% [62.0 – 100.0%].
CONCLUSION: The Sleep Position Trainer applied for one month is a highly successful and welltolerated treatment for patients with POSA, which diminishes subjective sleepiness and improves
sleep-related quality of life without negatively affecting sleep efficiency. Further research, especially
on long term effectiveness, is ongoing.
Data are presented as mean ± SD (normally distributed data) or
median [range] (skewed data distribution). SPT: Sleep Position Trainer.
*: p<0.005; **: p<0.001.
Long-term evaluation of positional therapy with
the sleep position trainer (SPT)
in the treatment of positional OSA (POSA)
J.P. van Maanen, N. de Vries
Department of Otolaryngology, Sint Lucas Andreas Hospital, Amsterdam, the Netherlands
Introduction
Obstructive sleep apnoea syndrome (OSA)
is the most common sleep disorder and
increasingly recognised as a major health
problem. 60% Of OSA patients suffer from
positional obstructive sleep apnoea (POSA)
defined as an apnoea-hypopnoea index (AHI)
during sleep in supine position that is at
least twice as high as the AHI during sleep in
other positions.
Percentage Supine Sleep Time
Van Maanen JP, de Vries N. Long-term effectiveness and compliance of positional therapy
with the Sleep Position Trainer in the treatment of positional obstructive sleep apnea syndrome.
Sleep 2014;37(7):1209-1215.
40
Figure 1
Median percentage of sleep time in the supine position
per night (dots); the bars depict the interquartile range
30
20
10
0
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157
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145
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Day of use
Objective
To investigate long-term compliance and
effects on subjective sleep parameters in a
group of POSA patients using the SPT for a
period of 6 months.
Methods
Multicentre, prospective, observational
study. Patients older than 18 years with mild
to moderate POSA were enrolled from 18
participating hospitals in the Netherlands.
Patients slept with the Sleep Position
Trainer (SPT, NightBalance™), strapped to
the chest, for a period of 6 months (or less
when the device was not tolerated well). The
SPT measures body position and vibrates
when the patient lies in supine position.
Patients filled in the Epworth Sleepiness
Scale (ESS), Functional Outcomes of Sleep
Questionnaire (FOSQ) and Pittsburgh Sleep
Quality Index (PSQI) at inclusion and after 1,
3 and 6 months.
T=0
T=1
T=3
T=6
Median
Median
Median
Median
ESS
11 [6]
9 [8]
8 [8]
7 [6]
FOSQ
91 [29]
98 [19]
99 [27]
103 [21]
PSQI
7 [5]
5 [4]
6 [5]
6 [6]
21 [30]
2 [4]
2 [5]
2 [5]
Variable
% Supine
Table 1
Questionnaire values and percentage of supine sleep time
during 6 months of Sleep Position Trainer treatment (n = 53)
Data are presented as median [interquartile range]
ESS = Epworth Sleepiness Scale
FOSQ = Functional Outcomes of Sleep Questionnaire
PSQI = Pittsburgh Sleep Quality Index
Results
Conclusion
145 POSA patients were included. 106 patients registered
online and uploaded their SPT data to the online database.
Compliance, defined as use of the SPT for at least four hours
per night, was 64.4%. During the 6 months follow up median
percentage of supine sleep decreased rapidly after therapy
started and this decrease was stable over time (Figure 1).
Median ESS changed from 11 to 7, FOSQ from 91 to 103, PSQI
from 7 to 6 (Table 1).
The SPT applied for 6 months is a successful
and well-tolerated treatment for patients
with POSA, which diminishes subjective
sleepiness, improves sleep-related quality
of life and effectively reduces percentage
of supine sleep time. Further research,
especially in comparing its efficacy to other
treatments, is ongoing.