Research presented at ATS 2026 reveals that positional therapy conditions patients to avoid back-sleeping, maintaining obstructive sleep apnea control for up to a year after device withdrawal.
Key takeaways:
- Positional therapy conditioned more than two-thirds of patients to continue side-sleeping and control their OSA without active treatment a year after stopping device use.
- The self-maintained effect presents a financial and clinical alternative for patients with positional OSA who struggle with CPAP adherence.
- Researchers were surprised by the magnitude and duration of the benefits, suggesting positional therapy could become a first-line treatment for positional OSA.
Positional therapy can be a long-lasting and effective treatment for patients with positional obstructive sleep apnea (OSA), according to research presented at the 2026 ATS International Conference.
In the Pavlov study, researchers found that positional therapy, which uses a device to encourage patients to sleep on their side, leads to long-term behavior changes and improvement for patients, even after active treatment is stopped. The finding supports the use of positional therapy as an alternative for patients who find CPAP therapy difficult to tolerate.
“We observed that positional therapy was not only effective—comparable to CPAP—but also better tolerated, supporting its role as a valuable alternative for patients who struggle with CPAP adherence,” says first author Irene Cano-Pumarega, MD, PhD, a pneumologist and head of the sleep unit at Ramón y Cajal Hospital in Madrid, in a release.
Positional OSA is a type of sleep apnea triggered by sleeping on the back. For these patients, side-sleeping can improve symptoms. Positional therapy works by having patients wear a device that monitors body position and delivers a gentle vibration when they turn onto their backs during sleep, prompting them to shift to their side without fully waking up.
Researchers wanted to learn if this repeated feedback conditioned patients to avoid back-sleeping on their own, even without the device in place. After six months of using a positional therapy device, more than two-thirds of patients continued the side-sleeping behavior and were able to control their OSA without any active treatment. This effect continued even a year after stopping therapy.
While CPAP only works while the device is in use, the behavioral change caused by positional therapy could allow patients to control their sleep apnea without ongoing treatment.
“This represents a fundamental shift from device-dependent therapy to a potentially self-maintained therapeutic effect,” says Cano in a release.
For healthcare systems, this approach could have significant financial implications by reducing costs associated with the long-term use of CPAP devices. Cano notes that researchers were surprised not just by the magnitude of the benefits but also by how long those benefits lasted. Previous studies have shown that positional therapy was effective and well-tolerated, but this is the first to demonstrate that its benefits endure long term.
“Our findings suggest that positional therapy could represent a first-line treatment option for a substantial proportion of patients with positional OSA,” says Cano in a release.
Next, researchers plan to study how long these benefits continue after treatment and to evaluate which patients respond best to positional therapy.
“Ultimately, our goal is to incorporate these findings into clinical guidelines and move toward a more personalized treatment strategy for obstructive sleep apnea,” says Cano in a release.
