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SYSTEMATIC REVIEW article

Front. Med.
Sec. Pulmonary Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1517274
This article is part of the Research Topic Novel approaches for treating obstructive sleep apnea View all articles

Comparative Efficacy of Sleep Positional Therapy, Oral Appliance Therapy, and CPAP in Obstructive Sleep Apnea: A Meta-Analysis of Mean Changes in Key Outcomes

Provisionally accepted
Gao Yunjun Gao Yunjun *Sixiang Zhu Sixiang Zhu Wenjun Li Wenjun Li Youqing Lai Youqing Lai
  • Department of Otorhinolaryngology, Beijing jishuitan Hospital, Capital Medical University, China, Beijing, China

The final, formatted version of the article will be published soon.

    Background: Obstructive sleep apnea (OSA) is commonly treated with continuous positive airway pressure (CPAP), though many patients struggle with adherence. Sleep positional therapy (SPT) offers a potential alternative, especially for positional OSA (POSA). This study aimed to compare the efficacy and safety of SPT with CPAP, oral appliance therapy (OAT), and placebo.Methods: Nineteen randomized controlled trials (RCTs) with 1,231 participants were included. Data extraction focused on changes in key outcomes such as apnea-hypopnea index (AHI), total sleep time (TST), oxygen desaturation index (ODI), and sleep architecture from pre- to post-intervention. Random-effects meta-analyses were conducted to compare mean changes between SPT and control groups (placebo, OAT, CPAP), with sensitivity analyses to assess heterogeneity.Results: SPT showed a significant reduction in AHI in the supine position compared to placebo (MD= -7.46, 95%CI: -11.42, -3.49), although no difference was observed in overall AHI between SPT and placebo or OAT. Compared to CPAP, SPT was less effective in reducing AHI, with a trend toward greater reductions in AHI favoring CPAP. SPT demonstrated a significant improvement in arousal index compared to OAT (MD= -7.11, 95%CI: -10.52, -3.71) and a lower risk of device-related complications compared to both OAT (OR=0.54, 95%CI: 0.31, 0.95) and CPAP (OR=0.29, 95%CI: 0.12, 0.72). However, SPT did not lead to significant improvements in TST or oxygen saturation parameters across comparisons.Conclusions: SPT is a safe alternative for managing positional OSA, particularly for patients intolerant to CPAP, though it remains less effective than CPAP in reducing overall AHI and improving oxygenation.

    Keywords: obstructive sleep apnea, sleep positional therapy, Continuous Positive Airway Pressure, Oral appliance therapy, Systematic review

    Received: 25 Oct 2024; Accepted: 20 Jan 2025.

    Copyright: © 2025 Yunjun, Zhu, Li and Lai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Gao Yunjun, Department of Otorhinolaryngology, Beijing jishuitan Hospital, Capital Medical University, China, Beijing, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.