FPIN's Clinical Inquiries

Positional Therapies for Obstructive Sleep Apnea


Am Fam Physician. 2021 May 1;103(9):568-569.

Clinical Question

Are positional therapies an effective method of treating obstructive sleep apnea (OSA)?

Evidence-Based Answer

Positional therapies for OSA produce moderate improvements (16% to 40%) in clinical apnea measures compared with no treatment. (Strength of Recommendation [SOR]: B, based on a meta-analysis of small randomized controlled trials [RCTs].) Positional therapies are not as effective as continuous positive airway pressure (CPAP). (SOR: B, based on a meta-analysis of small crossover trials.)

Evidence Summary


A systematic review and meta-analysis of adults with OSA that compared the effectiveness of positional and CPAP therapies with each other or no treatment found that positional therapy was moderately effective.1 Positional therapies included vibration alarms, specialty pillows, and semi-rigid backpacks. Outcomes were the objective apnea-hypopnea index (which counts the number of apneic and hypopneic episodes per hour) and the subjective Epworth Sleepiness Scale (a self-reported questionnaire with scores ranging from 0 to 18, with higher scores representing more sleepiness) measured over six months.

Two parallel-group RCTs (n = 187) compared positional therapy and inactive control for two months in adults with OSA. They found that positional therapy improved the apnea-hypopnea index by about 40% (mean = 16.8 to 19.9 events per hour with inactive control vs. 7.4 fewer events per hour with positional therapy; 95% CI, 4.7 to 10.1). Results on the Epworth Sleepiness Scale improved by about 16% (mean = 9.4 to 10.9 points with inactive control vs. 1.6 points lower with positional therapy; 95% CI, 0.3 to 2.9). No changes were noted in quality-of-life scores or quality of sleep (i.e., percentage of rapid eye movement or slow, deep sleep). The authors rated the quality of the studies as low to moderate. At two months, patients were equally likely to continue positional therapy and the inactive control therapy (about

Address correspondence to Jon O. Neher, MD, at jon_neher@valleymed.org. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

Copyright © Family Physicians Inquiries Network. Used with permission.


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

2. Siccoli MM, Pepperell JCT, Kohler M, et al. Effects of continuous positive airway pressure on quality of life in patients with moderate to severe obstructive sleep apnea: data from a randomized controlled trial. Sleep. 2008;31(11):1551–1558.

3. Ravesloot MJL, White D, Heinzer R, et al. Efficacy of the new generation of devices for positional therapy for patients with positional obstructive sleep apnea: a systematic review of the literature and meta-analysis. J Clin Sleep Med. 2017;13(6):813–824.

4. Mok Y, Tan A, Hsu PP, et al. Comparing treatment effects of a convenient vibratory positional device to CPAP in positional OSA: a crossover randomised controlled trial. Thorax. 2020;75(4):331–337.

5. Qaseem A, Holty JEC, Owens DK, et al.; Clinical Guidelines Committee of the American College of Physicians. Management of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2013;159(7):471–483.

Clinical Inquiries provides answers to questions submitted by practicing family physicians to the Family Physicians Inquiries Network (FPIN). Members of the network select questions based on their relevance to family medicine. Answers are drawn from an approved set of evidence-based resources and undergo peer review.

The complete database of evidence-based questions and answers is copyrighted by FPIN. If interested in submitting questions or writing answers for this series, go to http://www.fpin.org or email: questions@fpin.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of FPIN's Clinical Inquiries published in AFP is available at https://www.aafp.org/afp/fpin.



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