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Positional Therapy for the Treatment of Positional Obstructive Sleep Apnea in Children: A Pilot Study.
Very nice poster and research. I am just curious, is there any other type of devices that can be used as Positional therapy? If so, which ones?
Also, what are the next steps? Are you planning on increasing the sample size?
Nice data and important given the non-invasive nature of the intervention. If I remember correctly the adult positional OSA literature shows that the benefit gained by changing position is reduced with increasing BMI, do you find this in your sample (e.g., correlation analysis)? Also the benefits may also decline in the presence of adenotonsillar hypertrophy. If sample size increases this could also be looked at, and positional interventions may benefit post adenotonsillectomy.
Thanks for your comment and questions!
We used positional sleep belts with built in cushions on the back to prevent supine sleep. There are new generation positional vibrating devices (neck or chest worn) that have been studied in adults but have never been studied in children. The positional sleep belts are advantageous for their cost-effectiveness and simple design but new generation devices have the benefit of tracking adherence data. Studying new generation devices in pediatrics will be an important future step.
Our next step is to complete a RCT to evaluate the effectiveness and comfort of positional device therapy compared to CPAP in children. From there, we would also like to examine the long-term effects of positional therapy in the home setting on quality of life as well as adherence.
Thanks for your interest in the project!
That is very nice, Lena.
Thank you for your answers and good luck with the next steps.
Hi Dr. Horner,
Thanks for your comment and suggestions.
Spearman correlation analysis on the percent change in OAHI and BMI z-score was non-significant in our small sample (r=0.50, p=0.14) but it would be interesting to examine this in a bigger cohort.
I agree that fixed airway lesions (like adenotonsillar hypertrophy) may limit the benefits from positional therapy. We are planning a RCT to compare the efficacy of positional therapy to CPAP and will have standardized ENT evaluations in order to evaluate the effect of adenotonsillar hypertrophy on positional device therapy efficacy.
Thanks for your comments.
There is a small reduction in total sleep time on the night that the positional therapy device was worn. Although it was not statistically significant, I think it might be important to make sure that forcing kids to sleep in a non-preferred position does not disrupt their sleep more than the OSA itself. It would be helpful to have longer term data, and function outcomes of this intervention, rather than just AHI.
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