Assessment of a neck-based treatment and monitoring device for positional obstructive sleep apnea

Abstract

Study objectives: A majority of patients diagnosed with obstructive sleep apnea are position dependent whereby they are at least twice as severe when sleeping supine (POSA). This study evaluated the accuracy and efficacy of a neck-worn device designed to limit supine sleep. The study included nightly measurements of snoring, sleep/wake, time supine, and the frequency and duration of feedback to monitor compliance.

Methods: Thirty patients between ages 18 and 75 years, BMI ≤ 35 with an overall apnea-hypopnea index (AHI) ≥ 5 and an overall AHI ≥ 1.5 times the non-supine AHI, and an Epworth score ≥ 5 were prospectively studied. Subjective reports and polysomnography were used to assess efficacy resulting from 4 weeks of in-home supine-avoidance therapy and to measure device accuracy. From 363 polysomnography reports, 209 provided sufficient positional data to estimate one site's prevalence of positional OSA.

Results: In 83% of participants exhibiting > 50% reduction in overall AHI, the mean and median reductions were 69% and 79%. Significant reductions in the overall and supine AHI, apnea index, percent time SpO2 < 90%, and snoring contributed to significant improvements in stage N1 and N2 sleep, reductions in cortical arousals and awakenings, and improved depression scores. Supine position was under-detected by > 5% in 3% of cases. Sleep efficiency by neck actigraphy was within 10% of polysomnography in 87% of the studies when position feedback was delivered. The prevalence of POSA was consistently > 70% when the overall AHI was < 60.

Conclusions: The neck position therapy device is accurate and effective in restricting supine sleep, improving AHI, sleep architecture and continuity, and monitoring treatment outcomes.

Keywords: obstructive sleep apnea; positional therapy; prevalence; snoring; supine sleep.

Figure 1. Photograph of neck device from (A) back and (B) front.

Figure 2. Comparison of cortical arousals and supine attempts per hour during the follow-up PSG.

Figure 3. Bland Altman Plot comparing the percent of time supine as scored by as scored by video editing of the chest sensor to the percent of time supine determined with the NPTD.

Figure 4. Bland-Altman plots comparing PSG to NPTD for: (A) total sleep time (TST), (B) sleep efficiency (SE), (C) sleep onset (SO), and (D) wake after sleep onset (WASO).