A.CHIEW1, C.SAW1, A.CHIA1, I.LIM1, C.M.KUMAR1, E. SEET1
Khoo Teck Puat Hospital1
Overnight rostral fluid shift has been implicated in the pathophysiology of OSA, particularly in fluid overload states. Nocturnal fluid distribution from legs to the neck contributes to the increase in neck circumference and may worsen OSA. Compression stockings (CS) reduces dependent lower limb fluid accumulation and may decrease overnight rostral fluid shift and alter OSA pathophysiology.
The objective of this systematic review is to determine the effect of CS on overnight rostral fluid shift in OSA patients.
A qualitative literature search from January 1970 to March 2021 was performed in PubMed, Embase, Google Scholar and Cochrane databases using several keywords including “apnoea-hypopnoea index,” “oxygen desaturation index,” “obstructive sleep apnoea,” “overnight rostral fluid shift,” “sleep-disordered breathing,” and “snoring” combined with “compression stockings”. A qualitative analysis was performed.
Four studies (n=77 patients; mean age 56years, mean BMI 28 kg/m2, gender: 47 male / 30 female) included 3 randomized controlled trials and 1 observational study. The protocols involved the use of either thigh-length or below-the-knee CS applied at a pressure of ≥20 mmHg for range of 1 day to 2 weeks. Three studies showed significant reduction (15–62%) in fluid shift as well as apnoea-hypopnoea index (19–36%) with CS application. The usage of CS was also associated with a reduction in the increase in neck circumference.
CS is effective in altering OSA pathophysiology by decreasing overnight rostral fluid shift. Further study is desirable in Asian population evaluating beneficial potential of CS in altering pathophysiology which may reduce OSA severity.