Head-Of-Bed Elevation (HOBE) for improving positional obstructive sleep apnea (POSA): an experimental study

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 sleepapnea (OSA) patients. A prospective trial simultaneously performing drug-induced sleep endoscopy(DISE) and polysomnography (PSG) tests was performed. Methods: Forty-five patients were includedin the prospective study protocol. All patients enrolled in the study and underwent the followingevaluations: (1) a drug-induced sleep endoscopy, with an evaluation of obstructions and collapseof the upper airways at 0◦ and in a HOBE position, with head and trunk elevation of 30◦; (2) anovernight PSG assessment in the hospital with head and trunk elevation from 0◦to 30◦ during thenight; (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 epiglottisbetween the 0◦ position and the 30◦ up position (p > 0.05). The average AHI score changed from23.8 ± 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 to44 ± 25.8 (p = 0.05). Conclusions: By adopting the HOBE position with 30◦elevation of the headand trunk, it is possible to obtain a reduction of upper airways collapses and an improvement ofapnea/hypopnea events and nightly respiratory outcomes.