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Permalink Reply by RockRpsgt on May 15, 2010 at 3:31pm

I find "positional therapy" to be very vague. OSA is almost always going to be worse in one position over another. Most patients that are position specific are also REM specific to some degree. Supine is the worst for most. The key here would be whether or not the tongue is the problem.

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Permalink Reply by Banyon on May 15, 2010 at 6:53pm

They do not use the term positional therapy, but they do clearly define positional and nonpositional OSA so that imprecise phrases like "worse in one position over another" can be avoided.

They did find 30 patients that meet the definition for nonpositional OSA and I also note that ResMed's literature says 40% of patients have positional OSA (without actually stating that the remaining 60% do not, but this can be inferred).

A large study of randomly selected OSA patients that checked how many have positional and how many nonpositional would be interesting to me.

In the past many doctors told patients that mild OSA cases might be treated effectively with MADs and moderate or severe cases were unlikely to be treated successfully. There was a study this year that found this general guideline was not true and some cases of moderate and severe cases were successfully treated (while conversely some cases of mild were not treated). So this old guideline may become obsolete.

Maybe eventually it is replaced with a new guideline based on the study cited in the OP? Or maybe an even more precise way of estimating the probability of MAD success is designed.

But maybe before that someone will invent a very easy and cheap cure for all sleep disorders. :):):)

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Permalink Reply by RockRpsgt on May 16, 2010 at 12:59pm

"worse in one position over another" and positional apnea are inter-changing to me. They are synonomous phrases. I am surprised that by their definition more people did not have positional OSA.

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