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The Influence Of Bedhead Elevation On Patients With Obstructive Sleep Apnea

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/ Poster Discussion Session / Monday, May 16/8:15 AM-10:45 AM /B29 TREATMENT OF SLEEP DISORDERED BREATHING
Room 403-404 (Street Level), Colorado Convention Center
The Influence Of Bedhead Elevation On Patients With Obstructive Sleep Apnea
, A. Souza Filho , G. Lorenzi-FilhoF. F.B. Souza1 2 3
Laboratório do Sono - PULMONAR, Criciúma, Brazil, Laboratório do Sono -PULMONAR, Criciúma, Brazil, Heart Institute (InCor)
1 2 3
University of São Paulo, São Paulo, Brazil
Corresponding author's email: fsouzapneumo@hotmail.com
RATIONALE: The treatment of choice for severe OSA is the use of continuous positive airway pressure (CPAP), but not all patients have
access to treatment. Some studies suggest that the bedhead elevation can stabilize the upper airway in OSA patients. However, this
position was never tested as a possible therapy for OSA. The objective of the study is to evaluate the impact of the slope of the bedhead in
patients with OSA.
METHODS: Cross-sectional study conducted at the clinic of Sleep Medicine. All patients underwent standard polysomnography (PSGs)
using the scoring system of the American Academy of Sleep Medicine (AASM Manual for Scoring Sleep, 2007) with equipment ALICE 5,
Respironics ®. In a period of up to 2 weeks underwent polysomnography with slope obtained by elevating the head at 15 cm, resulting in
an inclination of 30 ° (PSGe). Data were analyzed with SPSS 10.0, using t test for paired samples. The p value <0.05 was considered
significant.
RESULTS: We evaluated 17 patients (8 men), aged 51.31 ± 9.76, body mass index 30.86 ± 5.49. The time between the first and second
polysomnography was 10 ± 3 days. Regarding the baseline PSG, there were significant improvements with significant reduction in
apnea-hypopnea index (AHI) total (PSGs1 20 ± 14 vs PSGe 15 ± 14, p = 0.0003), NREM AHI (PSGs 18 ± 14 vs PSGe 13 ± 13, p = 0.0002),
number of respiratory events (baseline PSGs 123 ± 91 vs PSGe 91 ± 82, p = 0.0047), number of hypopneas (PSGs 101 ± 78 vs PSGe 71 ± 70,
p = 0.0038), duration of snoring percentage (PSGs 32 ± 21 vs PSGe 21 ± 16, p = 0.023) and snoring in minutes (PSGs 123 ± 77 vs PSGe 79 ±
61, p = 0.036), hypopnea index (PSGs17 ± 13 vs PSGe12 ± 12, p = 0.0017) and REM sleep latency (175.61 ± 76.84 PSGs, PSGe130.91 ± 50.56,
p = 0.012). The minimum oxygen saturation showed a trend toward improvement (baseline PSGs83 ± 8 vs 85 ± 8 with elevation, p =
0.079).
CONCLUSION: Elevation of the head at 30 degrees obtained with inclination of 30 degres (15 cm) significantly reduces the AOS, which is a
simple measure that may help patients awaiting diagnosis or treatment. More studies with more patients are needed to confirm the real
benefits posture in varying degrees of OSA.
This abstract is funded by: None
Am J Respir Crit Care Med 183;2011:A2732
Internet address: www.atsjournals.org Online Abstracts Issue
... (6) Although there have been studies showing that maintaining a lateral position reduces the AHI, there have been few studies evaluating head elevation as a therapeutic intervention. (9,10) Therefore, a study on postural intervention is warranted in order to evaluate the influence of head elevation in patients previously diagnosed with OSAS on the basis of determination of upper airway volumes by cervical CT. ...
... (22,23) However, few studies have examined the effect of head or head-and-shoulder elevation on OSAS. (9,10,24,25) McEvoy et al. (10) studied 13 male patients during the same night and reported a reduction in AHI from 49 ± 5 events/h to 20 ± 7 events/h when patients changed from the supine position to a sitting position at a 60° angle. Skinner et al. (24) studied 14 subjects in the supine position (no elevation), comparing it with head-and-shoulder elevation (with a shoulder-head elevation pillow), and reported a 22% reduction in AHI. ...
... Studies have shown that upper airway closing pressure is reduced when the individual is moved from the supine position (no elevation) to an inclined position (30° head elevation), (25) as well as when the individual is moved from the supine position to a sitting position. (26) In a study of 17 patients undergoing polysomnography, Souza et al. (9) evaluated AHIs at baseline (i.e., during standard polysomnography) and after elevating the head of the bed 15 cm, reporting a significant reduction in the mean AHI (20 ± 14 events/h vs. 15 ± 14 events/h; p = 0.0003). It has been hypothesized that head elevation contributes to upper airway clearance, prevents rostral fluid shift, (27) and averts tongue collapse, (28) reducing upper airway resistance, (10) changing upper airway critical pressure, (29) affecting gravitational effects, (30) and altering neuromuscular activity. ...
Article
Full-text available
Objective: Obstructive sleep apnea syndrome (OSAS) has a high prevalence and carries significant cardiovascular risks. It is important to study new therapeutic approaches to this disease. Positional therapy might be beneficial in reducing the apnea-hypopnea index (AHI). Imaging methods have been employed in order to facilitate the evaluation of the airways of OSAS patients and can be used in order to determine the effectiveness of certain treatments. This study was aimed at determining the influence that upper airway volume, as measured by cervical CT, has in patients diagnosed with OSAS. Methods: This was a quantitative, observational, cross-sectional study. We evaluated 10 patients who had been diagnosed with OSAS by polysomnography and on the basis of the clinical evaluation. All of the patients underwent conventional cervical CT in the supine position. Scans were obtained with the head of the patient in two positions (neutral and at a 44° upward inclination), and the upper airway volume was compared between the two. Results: The mean age, BMI, and neck circumference were 48.9 ± 14.4 years, 30.5 ± 3.5 kg/m2, and 40.3 ± 3.4 cm, respectively. The mean AHI was 13.7 ± 10.6 events/h (range, 6.0-41.6 events/h). The OSAS was classified as mild, moderate, and severe in 70%, 20%, and 10% of the patients, respectively. The mean upper airway volume was 7.9 cm3 greater when the head was at a 44° upward inclination than when it was in the neutral position, and that difference (17.5 ± 11.0%) was statistically significant (p = 0.002). Conclusions: Elevating the head appears to result in a significant increase in the caliber of the upper airways in OSAS patients.
... The fact that the patients have stayed with the head of the bed elevated during the first night after surgery may have had some influence on the reduction of respiratory events [31]. We adopted this position because it is a care routinely used in upper airway surgeries to reduce the swelling and the risk of bleeding. ...
Article
Full-text available
Purpose One of the concerns regarding surgical treatment of the obstructive sleep apnea syndrome (OSAS) has been the possibility that these patients may experience a higher rate of perioperative complications, which could be aggravated by the upper airway edema caused by surgical trauma. The purpose of this study was to evaluate the immediate impact of pharyngeal surgery on the respiratory parameters of adult patients with OSAS. Methods Twenty-three adults with moderate to severe OSAS and indications for pharyngeal surgery (with or without nasal surgery) were consecutively selected. The subjects underwent surgical treatment and monitoring of sleep parameters preoperatively (by type I polysomnography, PSG) and in the immediate postoperative period (arterial tonometry). Results Twenty-two subjects, aged 20 to 59 years (mean ± SD, 38.0 ± 12.1 years), were included in the study. Nineteen (86.4%) were male. The mean apnea-hypopnea index (AHI) was 59.3 ± 26.0 events/h. Comparison between preoperative PSG and postoperative arterial tonometry revealed statistically significant reductions in AHI (p = 0.03), respiratory disturbance index (RDI) (p = 0.05), and oxygen desaturation index (p = 0.001), as well as increases in nadir oxyhemoglobin saturation (p = 0.003) and percentage of REM sleep (p = 0.01). Conclusions In this sample of patients with moderate and severe OSAS who underwent pharyngeal surgery, the vast majority of patients did not exhibit any deterioration of respiratory parameters in the immediate postoperative period. Conversely, there was a significant improvement in the parameters.
Article
Background Low acceptance rate of continuous positive airway pressure therapy in postoperative patients with untreated obstructive sleep apnea (OSA) indicates the necessity for development of an alternative postoperative airway management strategy. We considered whether the combination of high-flow nasal cannula and upper body elevation could improve postoperative OSA. Methods This non-blinded randomized crossover study performed at a single university hospital investigated the effect on a modified apnea hypopnea index, based exclusively on the airflow signal without arterial oxygen saturation criteria (flow-based apnea hypopnea index, primary outcome), of high-flow nasal cannula (20 liter.minute-1 with 40% oxygen concentration) with and without upper body elevation in patients with moderate to severe OSA. Preoperative sleep studies were performed at home (control, no head-of-bed elevation) and in hospital (30-degree head-of-bed elevation). On the first and second postoperative nights, high-flow nasal cannula was applied with or without 30-degree head-of-bed elevation, assigned in random order to 23 eligible participants. Results Twenty-two out of the 23 (96%) accepted high-flow nasal cannula. Four participants resigned from the study. Control flow-based apnea hypopnea index (mean±SD: 59.6 ± 12.0 events.hour-1, n=19) was reduced by 14.7 (95% CI: 5.5 to 30.0) events.hour-1 with head-of-bed elevation alone (p=0.002), 10.9 (1.2 to 20.6) events.hour-1 with high-flow nasal cannula alone (p=0.028), and 22.5 (13.1 to 31.9) events.hour-1 with combined head-of-bed elevation and high-flow nasal cannula (p<0.001). Compared to sole high-flow nasal cannula, additional intervention with head-of-bed elevation significantly decreased flow-based apnea hypopnea index by 11.5 events.hour-1 (1.7 to 21.4) (p=0.022). High-flow nasal cannula, alone or in combination with head-of-bed elevation also improved overnight oxygenation. No harmful events were observed. Conclusion The combination of high-flow nasal cannula and upper body elevation reduced OSA severity and nocturnal hypoxemia, suggesting a role for it as an alternate postoperative airway management strategy.
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