SleepPOSAtive Trial: Positional Therapy for the Treatment of Positional Obstructive Sleep Apnea in Children

Dr. Lena Xiao, MD, MSc is a Pediatric Respirologist and Sleep Physician at British Columbia Children’s Hospital and Clinical Assistant Professor at the University of British Columbia. She received the IMPaCT and Michael Smith Health Research BC 2025 Training Award for early career researchers to develop a pan-Canadian multicenter clinical trial protocol evaluating positional therapy for the treatment of obstructive sleep apnea in children.  

Obstructive sleep apnea causes recurrent upper airway blockage during sleep leading to low oxygen levels and unrefreshing sleep. Sleep apnea affects 1-5% of children and impacts physical, mental and psychosocial health. The main treatment is a surgery to remove the adenoids and tonsils, which are glands that block the nose and throat when swollen. However, many children still have sleep apnea after this surgery and will need to use a breathing machine called positive airway pressure therapy. The problem is that half of all children find breathing machines uncomfortable and cannot use them regularly. Other therapies called hypoglossal nerve stimulation, drug-induced sleep endoscopy directed surgery, and heated high flow are promising sleep apnea treatments but are expensive and hard to access. We need to identify cost-effective, simple, and comfortable alternative treatments that can help children with sleep apnea throughout Canada.  

Many children with sleep apnea have more severe airway blockage when they sleep on their back called positional obstructive sleep apnea. A simple treatment could be a positional sleep belt, which is a chest-worn belt with cushions on the back to prevent a child from sleeping on their back. We are planning a randomized controlled trial across Canda evaluating whether positional therapy is more effective than beathing machines for treating positional obstructive sleep apnea in the home environment for children. This trial will provide important information about alternative therapies for sleep apnea in children.