Efficacy of the 'tennis ball technique' versus nCPAP in the management of position-dependent obstructive sleep apnoea syndrome

Background and objective: Avoidance of sleep in the supine position is recommended in the management of position-dependent OSA hypopnoea syndrome (OSAHS). Our aim was to evaluate the efficacy of a thoracic anti-supine band (TASB), designed to mimic the so-called 'tennis ball technique', compared with nasal CPAP (nCPAP). Methods: Twenty adults with mild to moderately severe position-dependent OSAHS (mean AHI +/- SD) 22.7 +/- 12.0/H (range 6.0-51.2); AHI supine, 59.6 +/- 27.5/H, were included in a randomized cross-over trial. Portable sleep studies were undertaken at baseline and after 1 month on each treatment. A successful treatment outcome was defined as AHI <= 10/H. Results: Mean AHI was 12.0 +/- 14.5/H with the TASB and 4.9 +/- 3.9/H with nCPAP (P = 0.02; 95% confidence interval for the difference: -13.1 to -1.0). With the TASB, treatment 'success' was achieved in 13/18 subjects, whereas 'success' was achieved in 16/18 subjects using nCPAP (P = 0.004). In the two subjects with baseline AHI < 10/H, AHI remained below 10 for both therapies. The TASB successfully reduced time spent in the supine position. Mean percentage supine sleep time was 6.3 +/- 5.9% with the TASB, and 35.4 +/- 34.1% with nCPAP (P < 0.001). No significant differences in sleep efficiency or subjective responses were observed between treatments. Conclusions: Control of body position during sleep using an anti-supine device mimicking the so-called 'tennis ball technique' provides benefit in the management of position-dependent OSAHS in subjects who meet strict inclusion criteria. The overall improvement is, however, less than for nCPAP.