Do adjustable beds help with obstructive sleep apnea (OSA)?

Adjustable Beds for Obstructive Sleep Apnea

Adjustable beds can provide modest benefits for obstructive sleep apnea (OSA) through positional therapy, but they are not recommended as primary treatment except in carefully selected patients with positional OSA. 1

Effectiveness of Adjustable Beds for OSA

Adjustable beds can help with OSA through two main mechanisms:

1. Head/trunk elevation:

   • Mild head of bed elevation (7.5 degrees) has been shown to significantly reduce respiratory distress index (RDI) and apnea-hypopnea index (AHI) 2
   • A shoulder-head elevation pillow (SHEP) showed treatment success (AHI ≤10/h) in only 4 out of 14 subjects, with partial success in 3 more 3

2. Position modification:

   • Adjustable beds can help maintain non-supine sleeping positions
   • Robotic beds that automatically adjust position when apneas are detected show some promise but have limited effectiveness 4
   • Prone positioning has shown significant reductions in AHI (from median 23 to 7) and oxygen desaturation index (from 21 to 6) 5

Patient Selection for Positional Therapy

Positional therapy works best for patients who:

• Are younger
• Have lower AHI scores
• Are less obese
• Have clear positional OSA (defined as supine AHI at least twice that in non-supine positions) 1, 6

Limitations of Positional Therapy

Despite potential benefits, positional therapy using adjustable beds has significant limitations:

• Long-term compliance is poor (only 29% continued using positional devices after 2 years) 1
• Effectiveness is limited even in patients with clear positional sleep apnea 1
• Positional therapy is clearly inferior to CPAP in reducing AHI 1

Treatment Algorithm for OSA

1. First-line therapy: CPAP remains the gold standard treatment for moderate to severe OSA 1

2. Second-line options (when CPAP is not tolerated):

   • Mandibular advancement devices (MADs) for mild to moderate OSA 1
   • Positional therapy using adjustable beds for selected patients with documented positional OSA 1

3. Adjunctive therapies (to be used alongside primary treatment):

   • Weight loss (ideally to BMI ≤25 kg/m²) 1
   • Avoidance of alcohol and sedatives before bedtime 1
   • Positional therapy for those with documented positional OSA 1

Implementation of Positional Therapy

If using an adjustable bed for positional OSA:

• Document effectiveness with sleep studies before and after implementation 1
• Consider mild head of bed elevation (7.5 degrees) which has been shown to reduce AHI without causing significant discomfort 2
• Monitor long-term compliance and effectiveness with follow-up studies 1
• Use objective position monitoring to verify effectiveness at home 1

Conclusion

While adjustable beds may provide some benefit for OSA through positional therapy, they should not be considered primary treatment except in carefully selected patients with documented positional OSA. CPAP remains the most effective treatment for OSA, with MADs as a viable alternative for those who cannot tolerate CPAP. If positional therapy with adjustable beds is used, its effectiveness should be documented with sleep studies and long-term compliance monitored.