Does elevating the head of the bed help with sleep apnea?

Elevating the Head of the Bed for Sleep Apnea

Elevating the head of the bed by 7.5-30 degrees can moderately improve obstructive sleep apnea by reducing the apnea-hypopnea index (AHI) and improving oxygen saturation, but it is not recommended as a primary treatment for OSA except in carefully selected patients with mild to moderate positional OSA.

Effectiveness of Head Elevation

• Head-of-bed elevation (HOBE) has been shown to reduce upper airway collapses, particularly at the velum and oropharyngeal lateral walls 1
• A 7.5-degree elevation can significantly decrease the AHI from an average of 15.7 to 10.7 events/hour without negatively affecting sleep architecture 2
• A 30-degree elevation of the head and trunk can reduce AHI from 23.8 to 17.7 events/hour and decrease the percentage of apneas from 55% to 44% 1
• Mild head-of-bed elevation can improve minimum oxygen saturation from 83.5% to 87% 2

Patient Selection and Limitations

• Head elevation works best for patients who are:

  • Younger
  • Have lower BMI
  • Have milder OSA
  • Have positional OSA (where AHI in supine position is at least twice as high as in non-supine positions) 3

• Positional therapy (including head elevation) is clearly inferior to CPAP for treating OSA 4

• Long-term compliance with positional therapy is generally poor 4

• The European Respiratory Journal specifically states that "positional therapy is not recommended for the treatment of OSA, except in carefully selected patients" 4

Implementation Considerations

• If using head elevation:
  • Sleep studies should be performed to document individual success 4
  • Long-term compliance should be secured through follow-up studies 4
  • An adjustable bed can be used to implement mild head elevation (7.5 degrees) without causing significant discomfort 5
  • Elevation of the head of the bed may be used as a strategy to allow down-titration of EPAP pressure in patients using NPPV who find the pressure difficult to tolerate 4

Alternative Treatments

• CPAP remains the gold standard treatment for moderate to severe OSA 3
• For patients with mild to moderate positional OSA, other options include:
  • Mandibular advancement devices (MADs)
  • Vibratory positional therapy devices 3

Conclusion

While head elevation can provide some improvement in sleep apnea symptoms, particularly in mild to moderate cases with positional dependence, it should not be relied upon as the primary treatment for most patients with OSA. CPAP remains the most effective treatment, especially for moderate to severe cases.