Head-Of-Bed Elevation (HOBE) for Improving Positional Obstructive Sleep Apnea (POSA): An Experimental Study
Maysoon Abu Assab, Joelle Sansour
Rosary Sisters’ High School
13/5/2023
Abstract
The study evaluates the efficacy of the head-of-bed
elevation position (HOBE) in relieving upper
airway obstruction in obstructive sleep apnea (OSA)
patients. The protocol involved 45 patients. In the
30° up position, velum (V) and oropharynx lateral
wall (O) collapses were reduced. 0° and 30°
locations did not vary in tongue base and epiglottis
obstruction. By adopting the HOBE posture with
30° head and trunk elevation, upper airway
collapses and apnea/hypopnea events may be
reduced.
Introduction
One of the most frequent sleep-disorder breathing
(SDB) disorders is obstructive sleep apnea (OSA). It
is characterized by a decrease (hypopnea) or full
cessation (apnea) of upper airway airflow during the
night. Head-of-bed elevation (HOBE) is a
semi-sitting posture that facilitates blood
oxygenation and allows for greater patient chest
expansion and breathing. It is a valid decubitus
alternative used to aid breathing in a variety of
conditions. A 30 degree elevation of the head and
trunk may be regarded as a fair compromise between
the potential impact of upper airway stabilization
and patient acceptability to sleep in the HOBE
posture.
Results
Limited physiological and clinical studies have
tested the impact of HOBE on OSA, mucous
membrane collapsibility, and upper airway area.
Anteroposterior and concentric velum
collapse decreased significantly. Compared to
moderate and severe OSA, mild individuals had less
velum obstruction. Our prospective experiment
evaluated the HOBE posture (30◦ elevation) in
reducing upper airway obstruction and
apnea/hypopnea events in OSA patients. During
DISE assessment, total velum collapse decreased
from 82.3% in the 0◦ supine position to 57.7% in the
HOBE position , and total oropharynx lateral wall
Table 1:DISE results according to 0◦ supine position and head-of-bed elevation (30◦ position).
obstruction decreased from 60% to 33.3%. All
individuals who demonstrated a shift in the HOBE
position were overweight or obese, suggesting a
greater BMI is linked to worse lung expansion due
to the diaphragm's upward push and increased
abdominal pressure.
Conclusion
Methods
• All OSA patients referred to the Morgagni
Pierantoni hospital in Forli, Italy, from January
2021 to January 2022.
• All patients' medical histories were collected.
• All study participants were
evaluated: 1. drug-induced sleep endoscopy
(DISE) with upper airway blockage and collapse
examination at 0° and 30° head and trunk
elevation. 2. Overnight PSG with head and trunk
elevated from 0° to 30°. 3. Questions to analyze
patients' HOBE input.
Discussion
Table 2; Differences in PSG outcomes between the 0◦ position and 30◦ up position.
Adopting the HOBE position with a 30° elevation
of the head and trunk (based on average SpO2,
lower Spo2) can reduce upper airway collapses
and improve apnea/hypopnea events. The
manuscript has been read and approved by all
authors; external funding was not used for this
study.
References
Table 3: Feedback of patients to sleeping with head-of-bed elevation.
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