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History of Positional Therapy: Transition from Tennis Balls to New Devices
Abstract
During the past centuries, various techniques have been described to prevent patients from assuming the supine position such as an upright sleep posture, positional alarms, verbal instructions, tennis balls, vests, “shark fins” or special pillows. Different inventions have been patented over the years. Scientific research shows that positional therapy has a significant influence on the apnoea–hypopnoea index. These studies are predominantly performed as case series on a comparably small number of patients. The aim of this chapter is to provide an overview of the literature on positional therapy and its origin and evolution. A broad search strategy was run electronically in the MEDLINE, Embase and Google Scholar databases using synonyms for position, sleep apnoea, positional therapy and patents. Next to a great number of patents, 17 scientific studies were found which examined the effect of positional therapy on OSA. In this chapter we discuss the various techniques, results and compliance rates. Long-term compliance for positional therapy remains an issue, and although remarkable results have been shown using innovative treatment concepts for positional therapy, there is room for both technical improvement of the devices and for further long-term research.
... 23 Recently, a chapter on the history of PT has highlighted these findings. 24 Several techniques for avoiding the supine posture during sleep have been developed; the tennis ball technique (TBT) has been the most popular. TBT is a nonsophisticated mode of behavioral therapy that requires that a tennis ball is placed within a pocket of a wide cloth belt worn around the abdomen with the ball placed at the center of the back. ...
Sleep apnea is one of the most common sleep disorders in the world. It is a common problem for patients to suffer from sleep disturbances. In this paper, we propose a deep convolutional neural network (CNN) model based on the oxygen saturation (SpO2) signal from a smart sensor. This is the reason why we called ZleepNet a network for sleep apnea detection. The proposed model includes three convolutional layers, which include ReLu activation function, 2 dense layers, and one dropout layer for predicting sleep apnea. In this proposed model, the use of signals for detecting the sleep apnea can be reduced from 25 sensors to 1 sensor. We conducted experiments to evaluate the performance of the proposed CNN using real patient data and compared them with traditional machine learning methods such as least discriminant analysis (LDA) and support vector machine (SVM), baggy representation tree, and artificial neural network (ANN) on publicly available sleep datasets using the same parameter setting. The results show that the proposed model outperformed the other methods with the accuracy of 91.30% with the split rate of 0.2% in which the training data are 20% and testing data are 80%. The accuracy of the proposed CNN is 90.33% when compared with the LDA which achieved 86.5% accuracy with the split rate of 0.5% in which training data are 50% and testing data are 50%. It achieved 91.56% accuracy when compared with the support vector machine (SVM) in which training data are 70% and testing data are 30%. The achieved accuracy of the proposed CNN is 91.89% when compared with bagging representation tree in which training data are 90% and testing data are 10%. The accuracy of the proposed CNN is 91.30% in which training data are 83% and testing data are 17% when compared with artificial neural networks (ANN).
Treatment-emergent central sleep apnea (TE-CSA) is commonly encountered during the treatment for obstructive sleep apnea (OSA) with positive airway pressure (PAP) and usually remains self-limited. Persistent TE-CSA is sporadically seen with PAP therapy and has only rarely been described with hypoglossal nerve stimulation (HGNS). We report the case of a 60-year-old female patient with moderate OSA that progressed to TE-CSA with PAP therapy. A prolonged trial with PAP therapy was limited because the patient experienced recurrent aerophagia and subsequently underwent HGNS implantation. HGNS titration led to improved control of the patient’s OSA, but TE-CSA recurred and demonstrated a strong positional component. Lateral positional therapy was implemented with adequate control of respiratory events. TE-CSA can persist throughout different treatment modalities, including HGNS. The patient’s successful lateral sleep therapy for persistent and positionally exacerbated TE-CSA demonstrates the benefit of a well-known sleep apnea treatment for this poorly understood condition.
In Part 1 of this two-part article, the Amsterdam Positional Obstructive Sleep Apnoea Classification (APOC) was recently introduced, a classification system aimed at facilitating the identification of suitable candidates for positional therapy (PT): patients who will benefit from a clinically significant improvement of their obstructive sleep apnoea (OSA) with PT. APOC was developed with new generation PT devices in mind rather than conventional PT (tennis ball technique). New generation PT can be defined as a well-tolerated device which prevents a patient from adopting the worst sleeping position (WSP) without negatively influencing sleep efficiency, as objectified by a full night polysomnography (PSG). PT is rapidly gaining momentum in the scope of OSA treatment. The objective of this manuscript is to measure the prevalence of position-dependent obstructive sleep apnoea (POSA) according to the APOC, in a consecutive series of patients referred for PSG as well as an investigation of associations between POSA and certain patient characteristics.
We performed a retrospective, single-centre cohort study including a consecutive series of patients who underwent a PSG during the period of April 2010 until October 2010.
Within this OSA-cohort (n = 253), a prevalence of POSA of 69 % when applying APOC is measured, compared to 64 % when applying Cartwright's classification. An inverse relation between POSA and BMI was observed, likewise between POSA and apnoea hypopnoea index (AHI).
We are of opinion that APOC is a suitable tool to identify patients who will or will not benefit from PT, thus resulting in more cost-efficient treatment.
Purpose
Research during the past 10–20 years shows that positional therapy (PT) has a significant influence on the apnea–hypopnea index. These studies are predominantly performed as case series on a comparably small number of patients. Still, results have not found their way into the daily diagnostic and treatment routine. An average of 56 % of patients with obstructive sleep apnea (OSA) have position-dependent OSA (POSA), commonly defined as a difference of 50 % or more in apnea index between supine and non-supine positions. A great deal could be gained in treating patients with POSA with PT. The aim of this paper was to perform a thorough review of the literature on positional sleep apnea and its therapy.
Methods
A broad search strategy was run electronically in the MEDLINE and EMBASE databases using synonyms for position and sleep apnea.
Results
Sixteen studies were found which examined the effect of PT on OSA. In this literature review, we discuss the various techniques, results, and compliance rates.
Conclusion
Long-term compliance for PT remains an issue, and although remarkable results have been shown using innovative treatment concepts for PT, there is room for both technical improvement of the devices and for further research.
Approximately 30% of obstructive sleep apnea (OSA) patients have supine-predominant OSA, and simply avoiding supine sleep should normalise respiratory disturbance event rates. However, traditional supine-avoidance therapies are inherently uncomfortable, and treatment adherence is poor and difficult to monitor objectively. This study evaluated the efficacy of a novel, potentially more acceptable position monitor and supine-avoidance device for managing supine-predominant OSA and snoring.
In-laboratory evaluation of position recording accuracy versus video recordings (validation study), and randomized controlled crossover trial of active versus inactive supine-avoidance therapy in the home setting (efficacy study).
17 patients undergoing in-laboratory sleep studies (validation) and 15 patients with supine-predominant OSA (efficacy).
EFFICACY STUDY: 1 week of inactive and 1 week of active treatment in randomized order, separated by 1 week.
Agreement between 30-sec epoch-based posture classifications from device versus video records was high (median κ 0.95, interquartile range: 0.88-1.00), and there was good supine time agreement (bias 0.3%, 95%CI: -4.0% to 4.6%). In the efficacy study, apnea-hypopnea index (AHI) and snoring frequency were measured in-home using a nasal pressure and microphone based system during inactive and active treatment weeks. The position monitoring and supine alarm device markedly inhibited supine time (mean ± SEM 19.3% ± 4.3% to 0.4% ± 0.3%, p < 0.001) and reduced AHI (25.0 ± 1.7 to 13.7 ± 1.1 events/h, p = 0.030) but not snoring frequency.
This new position monitoring and supine alarm device records sleep position accurately and improves OSA but not snoring in patients with supine-predominant OSA.
Five patients with severe obstructive sleep apnoea were treated with continuous positive airway pressure (CPAP) applied via a comfortable nose mask through the nares. Low levels of pressure (range 4.5-10 cm H2O) completely prevented upper airway occlusion during sleep in each patient and allowed an entire night of uninterrupted sleep. Continuous positive airway pressure applied in this manner provides a pneumatic splint for the nasopharyngeal airway and is a safe, simple treatment for the obstructive sleep apnoea syndrome.
Unlabelled:
The study was performed to determine the ability of a new inclined pillow to treat snoring and obstructive sleep apnea syndrome. The SONA Pillow is a triangular pillow with space to place your arm under the head while sleeping on the side. Twenty-two patients with nocturnal polysomnogram (NPSG)-proven obstructive sleep apnea syndrome were included in this study; the group included 11 mild, 8 moderate, and 3 severe sleep apnea patients. All patients had a second attended NPSG performed while utilizing this specific inclined pillow. The pillow was found to be an effective and easily used treatment for mild (respiratory disturbance index [RDI] 5 to 19) and moderate (RDI 20 to 40) obstructive sleep apnea and snoring. In this group, RDI ranged from 5.1 to 35.2 and decreased on the average from 17 events per hour to fewer than 5 events per hour while utilizing the inclined pillow (<0.0001). Also, a statistically significant difference was noted in rapid eye movement (REM) RDI decrement in all patients with mild to moderate sleep apnea (p=0.001) and the increase in SaO2 was also significant (p=0.004). Overall, snoring was decreased or eliminated (p=0.017).
Conclusion:
A uniquely designed pillow (SONA Pillow) is effective in reducing the number of events in patients with mild to moderate obstructive sleep apnea. Using this pillow also reduces snoring.
A 'Positioner' preventing sleeping on the back can effectively reduce obstructive sleep apnea (OSA), but not always snoring for patients with long-term OSA. By preference, the device should be used for younger snorers without OSA as a training tool to avoid sleeping on the back. Instructions and support by a nurse are necessary for compliance.
Snoring is a progressive condition with a prevalence of 25-30% among the adult male population. Long-term snoring seems to be the basis for apneas caused by vibration damage to the pharyngeal tissue. Patients with OSA often have more apneas in the supine position than in the lateral position. Preventing sleeping on the back is a way to treat OSA. The aim of this study was to evaluate the efficacy and comfort of a recently developed Positioner.
A total of 23 patients diagnosed with positional sleep apnea (AHI>15 in supine position and AHI<5 in lateral position), were included. The Positioner--a soft vest, attached to a board placed under the pillow, makes it impossible for the patient to sleep on his back. It was fitted and tried out individually. Patients answered sleep questionnaires and kept sleep diaries before beginning use. After 3 months, a new sleep study was done while using the Positioner and new questionnaires were filled out.
Eighteen patients (5 women and 13 men) completed the study. The rest could not tolerate being strapped into the Positioner. Of those participating, 61% demonstrated a decrease of AHI to<10 using the Positioner. The Epworth Sleepiness Scale (ESS) decreased from a mean of 12.3 to 10.2. Half of the patients snored more frequently with the Positioner. The evaluation of comfort showed that minor adjustments are desirable.
• It is generally believed that the first description of the sleep apnea syndrome was made by Charles Dickens in the Pickwick Papers and that the first medical description was published in 1956. In fact, some of the features of the sleep apnea syndrome were described in antiquity and brief medical reports were published prior to the Pickwick Papers. This article traces the literary and medical contributions to our understanding of sleep apnea.(Arch Intern Med 1983;143:2301-2303)
Background:
Positional obstructive sleep apnoea (POSA), defined as a supine apnoea-hypopnoea index (AHI) twice or more as compared to the AHI in the other positions, occurs in 56 % of obstructive sleep apnoea patients. Positional therapy (PT) is one of several available treatment options for these patients. So far, PT has been hampered by compliance problems, mainly because of the usage of bulky masses placed in the back. In this article, we present a novel device for treating POSA patients.
Methods:
Patients older than 18 years with mild to moderate POSA 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.
Results:
Thirty-six 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 AHI decreased from 16.4 [6.6-29.9] to 5.2 [0.5-46.5] (p < 0.001). Fifteen patients developed an overall AHI below five. Sleep efficiency did not change significantly. Epworth Sleepiness Scale decreased significantly. Functional Outcomes of Sleep Questionnaire increased significantly. Compliance was found to be 92.7 % [62.0-100.0 %].
Conclusions:
The Sleep Position Trainer applied for 1 month is a highly successful and well-tolerated treatment for POSA patients, 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.
This study was performed to evaluate the efficacy of positional therapy using a recently developed vest-type device to treat snoring in positional-dependent snorers. Seventeen (60.7%) of the 28 subjects were diagnosed as position-dependent snorers with or without mild obstructive sleep apnea through laboratory nocturnal polysomnography and were included in a pre- and post-treatment comparative parallel study. The mean total snoring rate (from 36.7 ± 20.6% to 15.7 ± 16.2%, P < 0.0001) and snoring rate in the supine position (from 45.8 ± 22.8% to 25.4 ± 20.6%, P < 0.0001) decreased significantly with use of the vest. The mean percent change of total snoring rate between baseline and with the positional device was significant (63.5 ± 22.5%, P < 0.0001). Of the 17 subjects, 15 (88.2%) decreased their snoring rate more than 50% without subjective adverse effects. There were no significant differences in sleep efficiency, arousal index, and wake after sleep onset while sleeping with the vest-type positional device. In conclusion, positional therapy using the recently developed vest-type device is effective at decreasing snoring without subjective and objective adverse effects in position-dependent snorers with or without mild obstructive sleep apnea.
Background:
Approximately half of obstructive sleep apnea (OSA) patients are positional (i.e., the majority of their breathing abnormalities during sleep appear in the supine posture). Little information exists as to whether avoiding the supine posture during sleep (positional therapy) is a valuable form of therapy for these patients.
Aim:
To assess the use of positional therapy (by the tennis ball technique [TBT]) during a 6 month period in 78 consecutive positional OSA patients.
Methods:
Demographic, polysomnographic, and self-reported questionnaire data on the use of the TBT were analyzed.
Results:
Of the 50 patients who returned the questionnaire, 19 (38%) (group A) said they were still using the TBT, and 12 (24%) (group B) said they used it initially and stopped using it within a few months but were still avoiding the supine position during sleep. Nineteen patients (38%) (group C) stopped using the TBT within a few months but did not learn how to avoid the sleep supine posture. Patients still using the TBT showed a significant improvement in their self-reported sleep quality (P < .005) and daytime alertness (P < .046) and a decrease in snoring loudness (P < .001). Patients of groups A and B were older than patients who did not comply with this therapy (P < .001). The main reason for patients stopping the use of the TBT in group C was that using it was uncomfortable.
Conclusions:
Positional therapy appears to be a valuable form of therapy mainly for some older aged positional OSA patients.
Obstructive sleep apnoea syndrome is a common clinical problem. Positional sleep apnoea syndrome, defined as having a supine apnoea-hypopnoea index of twice or more compared to the apnoea-hypopnoea index in the other positions, occurs in 56% of obstructive sleep apnoea patients. A limited number of studies focus on decreasing the severity of sleep apnoea by influencing sleep position. In these studies an object was strapped to the back (tennis balls, squash balls, special vests), preventing patients from sleeping in the supine position. Frequently, this was not successful due to arousals while turning from one lateral position to the other, thereby disturbing sleep architecture and sleep quality. We developed a new neck-worn device which influences sleep position by offering a vibration when in supine position, without significantly reducing total sleep time. Thirty patients with positional sleep apnoea were included in this study. No side effects were reported. The mean apnoea-hypopnoea index dropped from 27.7 ± 2.4 to 12.8 ± 2.2. Seven patients developed an overall apnoea-hypopnoea index below 5 when using the device in ON modus. We expect that positional therapy with such a device can be applied as a single treatment in many patients with mild to moderate position-dependent obstructive sleep apnoea, while in patients with a more severe obstructive sleep apnoea such a device could be used in combination with other treatment modalities.
Obstructive sleep apnea (OSA) is common in stroke patients and is associated with poor functional outcome. The effects of positional therapy in ischemic stroke patients with OSA have not been investigated. We tested the hypothesis that ischemic stroke patients have less severe OSA during positional therapy that promotes nonsupine positioning.
We conducted a randomized, controlled, cross-over study. Sleep apnea screening studies were performed on two consecutive nights, using a portable respiratory monitoring system, on 18 subjects within the first 14days of ischemic stroke. An apnea-hypopnea index (AHI) ⩾5 established the diagnosis of OSA. Subjects were randomized to positional therapy that included the use of a therapeutic pillow on either the first or second night. On the control night, subjects used the hospital pillow and were positioned ad lib. Treatment effect on AHI was estimated using a repeated measures model.
All ischemic stroke subjects studied had OSA. The predominantly male group had a median age of 58years, BMI of 29kg/m(2), NIH Stroke Scale score of 3, and a median AHI on the nontherapeutic night of 39 (interquartile range: 21-54). Positional therapy reduced the amount of supine positioning by 36% (95% CI: 18-55% (P<0.001)). The AHI was reduced by 19.5% (95% CI: 4.9-31.9% (P=0.011)), when using positional therapy compared to sleeping ad lib.
Positional therapy to avoid supine positioning modestly reduces sleep apnea severity after ischemic stroke, and may therefore improve outcomes.
We hypothesized that positional therapy would be equivalent to continuous positive airway pressure (CPAP) at normalizing the apnea-hypopnea index (AHI) in patients with positional obstructive sleep apnea (OSA).
Thirty-eight patients (25 men, 49 +/- 12 years of age, body mass index 31 +/- 5 kg/m2) with positional OSA (nonsupine AHI <5 events/h) identified on a baseline polysomnogram were studied. Patients were randomly assigned to a night with a positional device (PD) and a night on CPAP (10 +/- 3 cm H2O).
Positional therapy was equivalent to CPAP at normalizing the AHI to less than 5 events per hour (92% and 97%, respectively [p = 0.16]). The AHI decreased from a median of 11 events per hour (interquartile range 9-15, range 6-26) to 2 (1-4, 0-8) and 0 events per hour (0-2, 0-7) with the PD and CPAP, respectively; the difference between treatments was significant (p < 0.001). The percentage of total sleep time in the supine position decreased from 40% (23%-67%, 7%-82%) to 0% (0%-0%, 0%-27%) with the PD (p < 0.001) but was unchanged with CPAP (51% [36%-69%, 0%-100%]). The lowest SaO2 increased with the PD and CPAP therapy, from 85% (83%-89%, 76%-93%) to 89% (86%-9%1, 78%-95%) and 89% (87%-91%, 81%-95%), respectively (p < 0.001). The total sleep time was unchanged with the PD, but decreased with CPAP, from 338 (303-374, 159-449) minutes to 334 (287-366, 194-397) and 319 (266-343, 170-386) minutes, respectively (p = 0.02). Sleep efficiency, spontaneous arousal index, and sleep architecture were unchanged with both therapies.
Positional therapy is equivalent to CPAP at normalizing the AHI in patients with positional OSA, with similar effects on sleep quality and nocturnal oxygenation.
Avoidance of sleep in the supine position is recommended in the management of position-dependent OSA hypopnoea syndrome (OSAHS). Our aim was to evaluate the efficacy of a thoracic anti-supine band (TASB), designed to mimic the so-called 'tennis ball technique', compared with nasal CPAP (nCPAP).
Twenty adults with mild to moderately severe position-dependent OSAHS (mean AHI +/- SD) 22.7 +/- 12.0/H (range 6.0-51.2); AHI supine, 59.6 +/- 27.5/H, were included in a randomized cross-over trial. Portable sleep studies were undertaken at baseline and after 1 month on each treatment. A successful treatment outcome was defined as AHI <or= 10/H.
Mean AHI was 12.0 +/- 14.5/H with the TASB and 4.9 +/- 3.9/H with nCPAP (P = 0.02; 95% confidence interval for the difference: -13.1 to -1.0). With the TASB, treatment 'success' was achieved in 13/18 subjects, whereas 'success' was achieved in 16/18 subjects using nCPAP (P = 0.004). In the two subjects with baseline AHI < 10/H, AHI remained below 10 for both therapies. The TASB successfully reduced time spent in the supine position. Mean percentage supine sleep time was 6.3 +/- 5.9% with the TASB, and 35.4 +/- 34.1% with nCPAP (P < 0.001). No significant differences in sleep efficiency or subjective responses were observed between treatments.
Control of body position during sleep using an anti-supine device mimicking the so-called 'tennis ball technique' provides benefit in the management of position-dependent OSAHS in subjects who meet strict inclusion criteria. The overall improvement is, however, less than for nCPAP.
The Apnea Plus Hypopnea Index (A + HI) of 60 male positional sleep apneics was analyzed by sleep stage to determine if positional differences are limited to NREM sleep. Differences in apnea severity by sleep position were found to persist in REM sleep and to be of equal extent to those differences found in NREM sleep, despite the fact that there is also a significant increase in the frequency of apneic events associated with REM sleep. The positional effect persists in REM sleep, making treatments to control sleep posture a viable option.
Ten male patients selected as having sleep apnea predominantly of the obstructive type associated with the supine sleep position on their evaluation night were trained for 1 additional night to avoid the back sleep position by wearing a gravity-activated position monitor/alarm on the chest. This device emitted an auditory signal if the patient remained supine for more than 15 s. The number of apneic events was significantly reduced, as were the number of episodes of significant O2 desaturation. While wearing the alarm, the apnea index of seven patients remained within or near normal limits. On a follow-up night, with only instructions to maintain the lateral decubitus posture, five patients remained significantly improved. Sleep position training may be appropriate as a single or interim treatment for a significant number of sleep apnea patients who have position-related obstruction.
Four patients who were evaluated for hypersomnia-sleep apnea syndrome were found in all-night sleep studies to have obstructive or mixed apneas related to their sleeping positions. All four were available for comprehensive follow-up and were subsequently restudied while avoiding the supine position. Supine, prone, and lateral decubitus apnea indices were calculated for each patient for each night. The supine sleeping position was associated with significantly more apneas than the non-supine positions. Keeping these patients off their backs when they slept was effective treatment. Additionally, when results of surgical or pharmacologic treatments of apnea are evaluated, positional apnea indices should be considered.
It is generally believed that the first description of the sleep apnea syndrome was made by Charles Dickens in the Pickwick Papers and that the first medical description was published in 1956. In fact, some of the features of the sleep apnea syndrome were described in antiquity and brief medical reports were published prior to the Pickwick Papers. This article traces the literary and medical contributions to our understanding of sleep apnea.
The benefits of using a nasal decongestant, sleeping on one's side and the combination thereof were studied in 20 asymptomatic male snorers. Both the apnea-hypopnea index (AHI) and snoring were evaluated. Four consecutive nocturnal polysomnographic studies were done. Night 1 was a control; the other 3 nights were randomly assigned to nasal decongestant, best sleeping position and a combination of the two. Results were calculated based on sleep period time. The mean control AHI +/- the standard error of the mean (SEM) was 17.5 +/- 6.5. AHI improved to 14.1 +/- 6.3 with sleep in the best position (p = 0.03). The AHI also improved to 13.2 +/- 6.04 with both nasal decongestant and position (p = 0.0012). Using nasal decongestant alone, the mean AHI was 18.1 +/- 6.3 (p = 0.765). During the control night, the mean number of snores/hour +/- SEM was 356 +/- 46.0. Using nasal decongestant alone, the mean number of snores was 381 +/- 50.4 (p = 0.50). With position alone, the mean number of snores was 356 +/- 46.0 (p = 0.8). Using the combination of nasal decongestant and position, mean snores were 352 +/- 48.9 (p = 0.91). In conclusion, a statistically significant improvement in AHI was produced using the general measures of altering the position of the body during sleep and by the combination of nasal decongestant and positional change. There was no significant change in snoring using any of these general measures.
The aim of this study was to compare the relative efficacy of continuous positive airway pressure (CPAP) and positional treatment in the management of positional obstructive sleep apnea (OSA), using objective outcome measures.
A prospective, randomized, single blind crossover comparison of CPAP and positional treatment for 2 weeks each.
A university teaching hospital.
Thirteen patients with positional OSA, aged (mean+/-SD) 51+/-9 years, with an apnea-hypopnea index (AHI) of 17+/-8.
(1) Daily Epworth Sleepiness Scale scores; (2) overnight polysomnography, an objective assessment of sleep quality and AHI; (3) maintenance of wakefulness testing; (4) psychometric test battery; (5) mood scales; (6) quality-of-life questionnaires; and (7) individual patient's treatment preference.
Positional treatment was highly effective in reducing time spent supine (median, 0; range, 0 to 32 min). The AHI was lower (mean difference, 6.1; 95% confidence interval [CI], 2 to 10.2; p = 0.007), and the minimum oxygen saturation was higher (4%; 95% CI, 1% to 8%; p = 0.02) on CPAP as compared with positional treatment. There was no significant difference, however, in sleep architecture, Epworth Sleepiness Scale scores, maintenance of wakefulness testing sleep latency, psychometric test performance, mood scales, or quality-of-life measures.
Positional treatment and CPAP have similar efficacy in the treatment of patients with positional OSA.
Historians are divided as to whether Johannes Brahms (1833–1897), whose music is among the most beloved and masterful in history, actually made the above remark on taking his leave from a party.1–² But there is little doubt that he could have. Brahms was possessed of a crusty personality, and even long, close friendships with Clara Schumann and the violin virtuoso Josef Joachim were frequently punctuated by bursts of rancor and thoughtlessness. Brahms’ personality was probably influenced by humiliating childhood experiences playing the piano in Hamburg bordellos to augment the meager family income, although considerable debate persists as to the exact nature of these episodes.3–⁵ Also, the overwhelming expectations thrust on him by no less than Robert Schumann and Hans von Bulow (the leading music critic of the day) as the successor to Bach and especially Beethoven contributed an additional huge psychic burden. Indeed, it is a measure of his genius that Brahms was able to meet and even exceed these daunting predictions. The reader is referred to Jan Swafford’s fine biography³ of the composer for a more complete understanding of Brahms’ personality and life.
Published in Sudhoffs Archiv für Geschichte der Medizin und Naturwissenschaften, 1941.
The association of alveolar hypoventilation with obesity is described. The literature relating to the clinical manifestations of this association is reviewed.
Treating the positional obstructive sleep apnea with a vest preventing the supine position is well known to be riskless and inexpensive. It was the aim of this study to test the efficacy and, for the first time, the longterm compliance of this treatment.
14 patients with positional obstructive sleep apnea (age 48.2 +/- 12.1 years; body-mass-index: 28.1 +/- 4.6 kg/m2 mean, +/- SD) were investigated polysomnographically without and with a vest preventing the supine position. 13.7 +/- 15.9 months later the patients were asked about the comfort of the vest and the nocturnal using time using the Likert-scale, and data about the latest Epworth Sleepiness Scale (ESS) was collected.
The respiratory disturbance index (RDI) was reduced statistically significant from 31.3 +/- 12.9/h to 13.8 +/- 9.0/h by wearing the vest (p < 0.001). Total sleep time at an oxygen saturation below 90% decreased from 8.2 +/- 7.1% to 3.8 +/- 4.5% (p < 0.001), the snoring time from 15.4 +/-19.6 % to 9.8 +/-13.1% (p < 0.05) of the total sleep time (TST) and the arousal index from 23.1 +/-16.0/h to 18.6 +/-11.4/h (p < 0.05). 24 +/-28.8 months later 28.6% of the patients were still using the vest. Of these patients the ESS decreased from 8.5 +/-3.2 to 6.5 +/-2.9 (p < 0.05). 72.4% of the patients refused the longterm therapy with the vest because of its low wearing comfort.
Although the vest approved to be effective against positional obstructive sleep apnea, the longterm compliance is low because of its need getting used to.
Various history: Book IX. London: Thomas Dung; 1666
- C Aelianus
Aelianus C. Various history: Book IX. London: Thomas Dung; 1666. p. 177. Chap 13.
Winston Churchill's afternoon nap
- J Campbell
Campbell J. Winston Churchill's afternoon nap. New York: Simon and Schuster; 1986.
The death of kings: a medical history of the kings and queens of England
- C Brewer
Brewer C. The death of kings: a medical history of the kings and queens of England. London:
Abson; 2000.
Grover Cleveland: a study in character
- A Brodsky
The dying president: Franklin D. Roosevelt 1944-1945
- R H Ferrell
Ferrell RH. The dying president: Franklin D. Roosevelt 1944-1945. Columbia, MO: University
of Missouri Press; 1998.
Snoring: new answers to an old problem Cited by: Fairbanks DNF. Snoring: an overview with historical perspectives
- Mh Boulware
The role of the tongue in sleep apnoea
- R Harper
- E Sauerland
Harper R, Sauerland E. The role of the tongue in sleep apnoea. In: Guilleminault C, Dement
W, editors. Sleep apnoea syndromes. New York: Alan R Liss; 1978. p. 219-34.
European respiratory society monograph. Sheffi eld
- W T Mcnicholas
- M R Bonsignore
McNicholas WT, Bonsignore MR, editors. Sleep apnoea, European respiratory society monograph. Sheffi eld, UK: European Respiratory Society; 2010.
Bedlam in the boudoir. Colliers. 1947; Feb. 22 Cited by: Fairbanks DNF. Snoring: an overview with historical perspectives
- H Dugan
Presidential anecdotes
- Pf Jr
Obstructive sleep apnoea, pathophysiology, comorbidities and consequences: pathophysiology, comorbidities, and consequences (sleep disorders)
- M Zupancic
- P Lavie
- History
Zupancic M, Lavie P. History. In: Kushida CA, editor. Obstructive sleep apnoea, pathophysiology, comorbidities and consequences: pathophysiology, comorbidities, and consequences
(sleep disorders). 1st ed. Boca Raton, FL: CRC; 2007.
Cleveland: a study in character
- A Brodsky
- Grover
Brodsky A. Grover Cleveland: a study in character. New York: St. Martin's Press; 2000. p. 4, 312.
Cited by: Fairbanks DNF. Snoring: an overview with historical perspectives
- H Dugan
Dugan H. Bedlam in the boudoir. Colliers. 1947; Feb. 22. Cited by: Fairbanks DNF. Snoring:
an overview with historical perspectives. In: Fairbanks DNF, Fujita S, editors. Snoring and
obstructive sleep apnoea. 2nd ed. New York: Raven, 1994. p. 1-16.
Presidential anecdotes
- P F Boller
Boller Jr PF. Presidential anecdotes. New York: Oxford University Press; 1981. p. 178.
Cited by: Fairbanks DNF. Snoring: an overview with historical perspectives
- M H Boulware
Boulware MH. Snoring: new answers to an old problem. Rockaway, NJ: American Faculty
Press; 1974. Cited by: Fairbanks DNF. Snoring: an overview with historical perspectives. In:
Fairbanks, DNF, Fujita S, editors. Snoring and obstructive sleep apnoea. 2nd ed. New York:
Raven; 1994. p. 1-16.
The touchstone of complexions. London
- Levinus Lemnious
Levinus Lemnious. The touchstone of complexions. London; 1581.
- Robin Ig Snoring
Robin IG. Snoring. Proc R Soc Med. 1948;41(3):151-3.
Patent and Trademark Offi ce
- Rt U S Sullivan
- Patent
Sullivan RT. U.S. Patent No. 132,500. Washington, DC: U.S. Patent and Trademark Offi ce; 1872.
Patent and Trademark Offi ce
- Le U S Wilson
- Patent
Wilson LE. U.S. Patent No. 663,825. Washington, DC: U.S. Patent and Trademark Offi ce; 1900.
Patent and Trademark Offi ce
- T U S Thomas
- Patent
Thomas T. U.S. Patent No. 852,638. Washington, DC: U.S. Patent and Trademark Offi ce; 1907.