Journal of Clinical Medicine (Sep 2022)

Head-Of-Bed Elevation (HOBE) for Improving Positional Obstructive Sleep Apnea (POSA): An Experimental Study

  • Giannicola Iannella,
  • Giovanni Cammaroto,
  • Giuseppe Meccariello,
  • Angelo Cannavicci,
  • Riccardo Gobbi,
  • Jerome Rene Lechien,
  • Christian Calvo-Henríquez,
  • Ahmed Bahgat,
  • Giuseppe Di Prinzio,
  • Luca Cerritelli,
  • Antonino Maniaci,
  • Salvatore Cocuzza,
  • Antonella Polimeni,
  • Giuseppe Magliulo,
  • Antonio Greco,
  • Marco de Vincentiis,
  • Massimo Ralli,
  • Annalisa Pace,
  • Roberta Polimeni,
  • Federica Lo Re,
  • Laura Morciano,
  • Antonio Moffa,
  • Manuele Casale,
  • Claudio Vicini

DOI
https://doi.org/10.3390/jcm11195620
Journal volume & issue
Vol. 11, no. 19
p. 5620

Abstract

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Purpose: Evaluate the effectiveness of the head-of-bed elevation position (HOBE) with a 30° elevation of the head and trunk, in improving obstruction of the upper airways in obstructive sleep apnea (OSA) patients. A prospective trial simultaneously performing drug-induced sleep endoscopy (DISE) and polysomnography (PSG) tests was performed. Methods: Forty-five patients were included in the prospective study protocol. All patients enrolled in the study and underwent the following evaluations: (1) a drug-induced sleep endoscopy, with an evaluation of obstructions and collapse of the upper airways at 0° and in a HOBE position, with head and trunk elevation of 30°; (2) an overnight PSG assessment in the hospital with head and trunk elevation from 0° to 30° during the night; (3) a questionnaire to evaluate the feedback of patients to sleeping with head-of-bed elevation. Results: Velum (V) and oropharynx lateral wall (O) collapses were reduced in the 30° up position. There were no statistical differences that emerged in the obstruction of the tongue base and epiglottis between the 0° position and the 30° up position (p > 0.05). The average AHI score changed from 23.8 ± 13.3 (0° supine position) to 17.7 ± 12.4 (HOBE position), with a statistical difference (p = 0.03); the same statistical difference emerged in the percentage of apneas that decreased from 55 ± 28.1 to 44 ± 25.8 (p = 0.05). Conclusions: By adopting the HOBE position with 30° elevation of the head and trunk, it is possible to obtain a reduction of upper airways collapses and an improvement of apnea/hypopnea events and nightly respiratory outcomes.

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