Cochrane for Clinicians

Putting Evidence into Practice

Positional Therapy for Obstructive Sleep Apnea


Am Fam Physician. 2020 Jan 1;101(1):16-17.

Clinical Question

Is positional therapy effective for the treatment of obstructive sleep apnea (OSA)?

Evidence-Based Answer

Positional therapy for OSA reduces scores on the apnea-hypopnea index (AHI) and Epworth Sleepiness Scale compared with no treatment. Although continuous positive airway pressure (CPAP) improves AHI scores more than positional therapy, patients seem to better tolerate positional therapy and, therefore, have improved adherence vs. those treated with CPAP.1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

OSA affects 2% to 38% of the population in North America and Europe.2 The severity of OSA symptoms is estimated by the AHI and the Epworth Sleepiness Scale. OSA has been associated with higher morbidity and mortality rates, lower quality-of-life scores, and health problems such as atrial fibrillation, congestive heart failure, coronary artery disease, depression, diabetes mellitus, hypertension, and stroke.3 CPAP is the current first-line therapy; however, up to two-thirds of patients do not adhere to treatment.4 Positional therapies for OSA ideally prevent patients from lying in a supine position and promote side sleeping. Available positional therapy devices include lumbar or abdominal binders, backpacks, full-length pillows, tennis balls attached to the back of nightwear, and alarms with positional sensors.1

This Cochrane review of eight studies explored the effectiveness of positional therapy for OSA compared with CPAP (n = 72) and with an inactive control (n = 251).1 Three studies used vibration alarm devices, and five studies included physical positioning equipment such as pillows and semirigid backpacks. All of the trials were of relatively short duration, ranging from one night to two months.

CPAP reduced AHI scores compared with positional therapy (mean difference [MD] = 6.4 events per hour; 95% CI, 3.0 to 9.8; n = 33). However, patients used positional therapy more than CPAP (MD

Author disclosure: No relevant financial affiliations.


show all references

1. Srijithesh PR, Aghoram R, Goel A, et al. Positional therapy for obstructive sleep apnoea. Cochrane Database Syst Rev. 2019;(5):CD010990....

2. Senaratna CV, Perret JL, Lodge CJ, et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev. 2017;3470–81.

3. Semelka M, Wilson J, Floyd R. Diagnosis and treatment of obstructive sleep apnea in adults. Am Fam Physician. 2016;94(5):355–360.

4. Sarrell EM, Chomsky O, Shechter D. Treatment compliance with continuous positive airway pressure device among adults with obstructive sleep apnea (OSA): how many adhere to treatment? Harefuah. 2013;152(3):140–144.

5. Epstein LJ, Kristo D, Strollo PJ Jr, et al.; Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263–276.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at



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