How effective are vibrotactile positional therapy devices for patients with positional OSA?

Vibrotactile PT devices reduced both the Apnoea Hypopnoea Index (AHI) and the percentage of time spent in the supine position (%Tsupine). However, the effect on daytime sleepiness, sleep quality, and disease-specific quality of life was minimal.

Obstructive sleep apnoea is a common sleep disorder affecting nearly 1 billion people. The supine sleep position is a risk factor for OSA, and those with OSA that predominantly or exclusively occur in the supine position are referred to as patients with POSA. There is a variation in the exact definition of POSA but is often defined as an AHI in the supine position that is twice that of the non-supine AHI, with an overall AHI>5 events/hour.

Vibrotactile positional therapy is a new treatment modality for positional sleep apnoea patients, which reduces time in the supine position. It is also suggested to reduce the severity of obstructive sleep apnoea (OSA), thereby improving patient-centred outcomes. Abdullah S ALQarni, National Heart and Lung Institute, Imperial College London, London, UK, and colleagues aimed to determine the effect of vibrotactile PT on the AHI and %Tsupine in POSA patients compared with baseline. Second, they aimed to investigate the effect on the quality of life, daytime sleepiness, and sleep quality.

The researchers performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and cohort studies that determine the effect of vibrotactile PT in patients with positional obstructive sleep apnoea. Searches were performed via online databases up to 29 October 2022. 1119 studies were identified of which 18 studies met the inclusion criteria comprising 8 cohort studies and 10 RCTs.

The authors reported the following findings:

• The use of vibrotactile PT significantly reduced the AHI at follow-up compared with baseline (mean difference −9.19 events/hour).
• The mean %Tsupine was also significantly reduced (mean difference −32.79%).
• The percentage changes in the AHI and %Tsupine were 43% and 70%, respectively.
• Secondary outcomes were daytime sleepiness, quality of life and sleep indices. These showed minimal change, although follow-up was short.

"We found evidence that vibrotactile PT decreases the time spent in the supine position and the severity of OSA, however, the effect on self-reported daytime sleepiness does not reach clinical significance and there is a lack of evidence on the longer-term effect of PT," the researchers wrote.

"Other, more targeted outcomes for OSA, such as vitality, have limited data and follow-up periods were often short. Therefore, there is a need for well-designed clinical trials to fill these evidence gaps," they concluded.

Reference:

ALQarni AS, Turnbull CD, Morrell MJ, et alEfficacy of vibrotactile positional therapy devices on patients with positional obstructive sleep apnoea: a systematic review and meta-analysisThorax Published Online First: 21 June 2023. doi: 10.1136/thorax-2021-218402