Authors (including presenting author) :
KY Chiang 1, SL Choi1, PL Lam1, PY Chu1, LY Sin1, KY Mar1, KF Cheng1, MSM Ip1, MS Lui 1
Affiliation :
1 Division of Respiratory Medicine, Department of Medicine, QMH
Introduction :
Obstructive sleep apnea (OSA) is a chronic disorder that affects up to 7% of population in Hong Kong. Sleep position influenced OSA severity in more than 50% of the patients. Wearable device that works to maintain lateral sleep position could ameliorate positional OSA, and serves as an alternative to positive airway pressure (PAP) therapy during the time of COVID-19 pandemic.
Objectives :
To assess efficacy of FDA-approved NightShift ™ sleep positioner for patients with positional OSA, defined as supine to non-supine apnea-hyponea index (AHI) ratio of ≥2, and to evaluate on patients’ acceptance and willingness to start this treatment.
Methodology :
From 1 July, 2020 to 30 June 2021, 20 patients who were diagnosed with positional OSA in Queen Mary Hospital were offered a trial of night sleep positioner. Baseline in-lab polysomnography (PSG) without night sleep positioner was compared to repeated PSG with sleep positioner worn over the neck. Baseline demographics, sleep architecture and AHI were analyzed. A questionnaire was collected after the use of the device, which recorded patients’ feedback and willingness of pursing the therapy.
Result & Outcome :
Result
Twenty patients had a single-night trial of sleep positioner. Their median AHI was 20 (IQR13-30), 13 were males and mean age was 56. Mean body mass index was 26.5 kg/m2 and baseline median Epworth Sleepiness Scale was 7.5 (IQR 4.3 –10.8). With the use of neck device, supine time significantly decreased from 51.5% to 4.2% (p< 0.001) and mean AHI dropped from 23/hour to 12.7/hour (p=0.007). Eleven patients (55%) achieved 50% reduction in AHI while on sleep positioner. Oxygen desaturation index decreased from mean 17.6 /hour to 10.1/hour (p=0.015). Arousal index also reduced significantly from 12/hour to 7.6/hour (p=0.012).
Concerning sleep architecture, there was an increase in percent time in REM sleep from 17 % to 21% (p=0.002). There was no significant change in sleep efficiency, total sleep time and other sleep stages.
Only 6/11 patients (55% among those with ≥50% AHI reduction on therapy) would consider to acquire night sleep positioner for long-term treatment of OSA. Reasons for low acceptance included discomfort with prolonged lateral sleep position, poor adaptation to the vibration caused by the device and its cost.
Conclusion
Night sleep positioner is a viable alternative for treatment of positional OSA, albeit of a lower efficacy in suppressing AHI than PAP therapy. Comparing to PAP, it poses less burden on infection control which makes it deserved for more consideration in the time of COVID-19 pandemic. More widespread use is limited by patients’ acceptance and its cost.
