Is sleeping with the head propped up an effective treatment for Obstructive Sleep Apnea (OSA)?

From the Guidelines

Sleeping with the head propped up is not a recommended treatment for Obstructive Sleep Apnea (OSA) except in carefully selected patients, as it is clearly inferior to CPAP and has poor long-term compliance. This approach may yield moderate reductions in apnoea–hypopnoea index (AHI) in younger patients, those with low AHI, and less obese individuals, but it is not a substitute for standard treatments like CPAP therapy, weight management, and avoiding alcohol before bedtime 1. The European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea suggests that positional therapy, including sleeping with the head elevated, can be considered in selected patients, but it is essential to document individual success with sleep studies and ensure long-term compliance with follow-up studies 2.

Some key points to consider when evaluating the effectiveness of sleeping with the head propped up for OSA include:

• The patient's age, AHI, and body mass index (BMI), as these factors can influence the effectiveness of positional therapy 1
• The importance of comprehensive treatment plans that may include CPAP therapy, weight management, and lifestyle modifications to manage OSA symptoms effectively
• The need for sleep studies to document individual success with positional therapy and ensure long-term compliance 1

It is crucial to prioritize evidence-based treatments for OSA, and CPAP therapy remains the standard of treatment, with positional therapy considered only in carefully selected patients. The most recent and highest-quality study on this topic, published in 2021, emphasizes the importance of CPAP therapy in managing OSA symptoms and highlights the need for individualized treatment approaches 2.

From the Research

Effectiveness of Sleeping with Head Propped Up for OSA

• Sleeping with the head propped up, also known as head-of-bed elevation (HOBE), has been studied as a potential treatment for Obstructive Sleep Apnea (OSA) 3.
• A study published in 2022 found that HOBE with a 30° elevation of the head and trunk reduced upper airways collapses and improved apnea/hypopnea events and nightly respiratory outcomes in OSA patients 3.
• The average AHI score decreased from 23.8 to 17.7 with the HOBE position, and the percentage of apneas decreased from 55 to 44 3.

Positional Therapy for OSA

• Positional therapy, which involves avoiding the supine posture during sleep, may be a valuable therapy for mild-moderate OSA patients, as the vast majority of these patients are positional patients 4.
• A study published in 2012 found that positional therapy was effective in reducing AHI and improving sleep quality in patients with positional OSA, with patients using the device on average 73.7% of nights for 8.0 hours/night 5.
• Another study published in 2015 found that prone positioning was effective in reducing AHI and improving sleep oxygen saturation in mild to moderate OSA patients 6.

Mechanism of Action

• The mechanism of action of sleeping with the head propped up for OSA is thought to be related to the reduction of upper airways collapses and the improvement of apnea/hypopnea events 3.
• Proper head and neck posture during sleep may also play a role in reducing upper-airway obstruction during sleep 7.
• The use of cervical-support pillows may be considered as an adjunctive treatment modality in patients suffering from snoring and obstructive sleep apnea 7.