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Sleep Breath. 2017 Dec;21(4):815-820. doi: 10.1007/s11325-017-1524-3. Epub 2017 Jun 24.

The influence of head-of-bed elevation in patients with obstructive sleep apnea.

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Pulmonary Division - Hospital São José, Pulmonar Sleep Laboratory and Universidade do Extremo Sul Catarinense, Antônio de Lucca 91, 4th floor, Pio Correa, Criciúma, Santa Catarina, Brazil.
Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
Pulmonary Division, Hospital São José and Pulmonar Sleep Laboratory, Criciúma, Santa Catarina, Brazil.
Division of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.



The purpose of this study is to test the effects of a mild degree of head-of-bed elevation (HOBE) (7.5°) on obstructive sleep apnea (OSA) severity and sleep quality.


OSA patients were recruited from a single sleep clinic (Criciúma, Santa Catarina, Brazil). Following a baseline polysomnography (PSG), all patients underwent a PSG with HOBE (within 2 weeks). In addition, a subset of patients performed a third PSG without HOBE.


Fifty-two patients were included in the study (age 53.2 ± 9.1 years; BMI 29.6 ± 4.8 kg/m2, neck circumference 38.9 ± 3.8 cm, and Epworth Sleepiness Scale 15 ± 7). Compared to baseline, HOBE significantly decreased the apnea-hypopnea index (AHI) from 15.7 [11.3-22.5] to 10.7 [6.6-16.5] events/h; p < 0.001 and increased minimum oxygen saturation from 83.5 [77.5-87] to 87 [81-90]%; p = 0.003. The sleep architecture at baseline and HOBE were similar. However, sleep efficiency increased slightly but significantly with HOBE (87.2 [76.7-90.7] vs 88.8 [81.6-93.3]; p = 0.005). The AHI obtained at the third PSG without HOBE (n = 7) returned to baseline values.


Mild HOBE significantly improves OSA severity without interfering in sleep architecture and therefore is a simple alternative treatment to ameliorate OSA.


Obstructive sleep apnea; Patient positioning; Polysomnography; Therapy

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