1309 Positional Therapy Augmented by Consumer Wearable Oximetry for Treatment of Positional Obstructive Sleep Apnea: A Case Report

Abstract Introduction Positional obstructive sleep apnea (OSA) is defined by a disproportionate burden of respiratory events and nocturnal hypoxemia during supine sleep. Although positive airway pressure (PAP) therapy remains the gold standard for OSA, a significant subset of patient’s decline or cannot tolerate PAP as a result of anxiety, discomfort, or interface related issues. Novel consumer wearable devices capable of monitoring nocturnal oxygenation and real time vibratory feedback during desaturation events may offer adjunctive, noninvasive approach to support behavioral interventions such as positional therapy. Report of case(s) We report the case of a 40-year-old male with hypertension, chronic insomnia, mood disorder, and anxiety who presented with longstanding snoring and non-restorative sleep. A home sleep apnea test (HSAT) demonstrated severe OSA with an REI of 30.5 events/hour with nadir SpO₂ 76% and SpO₂ < 88% for 13 minutes with a supine and non-supine REI of 54.2 and 22.0. Patient was reluctant of PAP therapy and MAD and decided to be treated with positional therapy. The patient initiated strict positional therapy, including side-sleeping and head-of-bed elevation and independently adopted a consumer smart-ring oximeter that delivers vibratory feedback during oxygen desaturations, prompting positional changes. Over several months, he demonstrated excellent adherence, a 5-lb weight loss, and marked reduction in supine snoring corroborated by bed partner report, and improvement in daytime sleepiness (Epworth Sleepiness Scale decreased from 11 to 5). Repeat HSAT showed objective improvement in the overall REI which was reduced to 14.6 events/hour and supine sleep time reduced from 25% to 2 % of the total recording time. Conclusion This case suggests that positional therapy augmented by real time vibratory feedback from a consumer wearable oximeter may provide meaningful clinical benefit for select patients with positional OSA who decline PAP therapy. Although such devices are not FDA-approved, they may serve as a complementary tool within individualized, conservative OSA management strategies. Further studies are needed to evaluate accuracy, benefit and long-term outcomes. Support (if any)