New research suggests that a side-sleeping device can lead to permanent behavioral changes, providing an alternative for patients who struggle with CPAP adherence.
RT’s Three Key Takeaways:
- Long-Term Conditioning: Researchers found that positional therapy creates a behavioral change that allows patients to maintain side-sleeping for up to a year after treatment ends.
- CPAP Alternative: The therapy provides an effective option for the 40% of patients who struggle with continuous positive airway pressure adherence.
- Broad Clinical Utility: Since up to 75% of patients have positional obstructive sleep apnea, this approach could serve as a first-line treatment option.
Positional therapy can be a long-lasting and effective treatment for patients with positional obstructive sleep apnea (OSA), according to research presented at ATS 2026.
In a new study, titled “Pavlov,” 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 continuous positive airway pressure (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,” said Irene Cano-Pumarega, MD, PhD, a pneumologist and head of the sleep unit at Ramón y Cajal Hospital in Madrid.
While CPAP is considered the gold-standard treatment for OSA, its real-world effectiveness is limited by poor adherence, with up to 40% of patients failing to use it enough to see clinical benefits. Positional OSA is a specific type of sleep apnea triggered by sleeping on the back, affecting up to 75% of all patients with the condition.
Positional therapy works through a device that monitors body position and delivers a gentle vibration when a patient turns onto their back during sleep. This feedback prompts the patient to shift to their side without fully waking up. The Pavlov study aimed to determine if this repeated feedback conditioned patients to avoid back-sleeping on their own without the device.
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 remained consistent even one year after stopping the therapy.
“This represents a fundamental shift from device-dependent therapy to a potentially self-maintained therapeutic effect,” said Cano-Pumarega.
The study noted that while CPAP only works while the device is in use, the behavioral change prompted by positional therapy could allow patients to manage their condition without ongoing treatment. For healthcare systems, this approach could reduce costs associated with the long-term use of CPAP devices.
Researchers were surprised by both the magnitude and the duration of the benefits. While previous studies confirmed that positional therapy was effective and well-tolerated, this trial 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,” said Cano-Pumarega.
Future research will focus on how long these benefits continue after treatment and which patient populations respond best to positional therapy. The ultimate goal is to incorporate these findings into clinical guidelines and move toward personalized treatment strategies for obstructive sleep apnea.
More information
Session/Presentation: D97
When Treatment Meets Reality: Outcomes, Adherence, and Policy in Sleep Apnea Management
Long-Term Conditioning Response After Positional Therapy Withdrawal in Obstructive Sleep Apnea: The Pavlov Randomized Controlled Trial
Date and Time: May 20, 2026, at 12:24 pm ET
Location: W312 (Level III, OCCC West Concourse)
