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A vibrating device may help some patients with a form of obstructive sleep apnea (OSA), even after stopping use, according to a new study presented at the American Thoracic Society (ATS) 2026 International Conference in Orlando, Fla.

Positional OSA (POSA) primarily occurs in the supine position. After 6 months of positional therapy, approximately one third of patients maintained disease control 3 months after stopping the device, suggesting behavior adaptation can persist over time, researchers said.

“Instead of treating all patients according to the same model, we should identify the mechanism or phenotype driving the disease and select the most appropriate therapy,” said Irene Cano Pumarega, MD, PhD, pulmonologist and head of the Sleep Unit at Ramón y Cajal Hospital in Madrid, Spain, who led the research. “Positional therapy may offer an effective, better-tolerated, and potentially self-maintained therapeutic strategy.”

An estimated 83.7 million US adults in 2024 had OSA. In patients studied in sleep laboratories, a little over one half had OSA that only occurred while on their backs. Continuous positive airway pressure (CPAP) devices are considered the gold standard for treatment of OSA, but adherence can pose a challenge.

Alternative treatments include surgery, oral appliances, an implantable hypoglossal nerve stimulator, and the GLP-1 drug tirzepatide. The FDA has also cleared positional devices that increase vibration intensity until the user moves onto their side.

In 2023, an international body of experts said positional therapy can be an effective treatment but noted research was limited, mostly consisting of small, short-term studies.

Cano Pumarega and colleagues conducted a randomized controlled trial that included 184 patients with POSA, half of whom were assigned to receive CPAP, whereas the remaining participants received a positional device for a 6-month period. Of those in the CPAP group, 31 people discontinued due mostly to intolerance to the machine, whereas 15 people in the positional group dropped out due to a range of reasons including intolerance or surgery for OSA.

To assess whether participants who initially responded to the positional device continued to benefit after the treatment was taken away — possibly because they had developed a Pavlovian response — investigators conducted follow-up respiratory polygraphy in responders at 1 week, 1 month, 3 months, and 1 year after stopping treatment.

Responders were defined as having a residual apnea-hypopnea index (AHI) of less than 15 breathing interruptions per hour and at least a 50% reduction from baseline AHI.

After initial treatment completion, 56 (91%) of 61 CPAP participants who finished treatment and 47 (61%) of 77 positional device participants who finished treatment were still classified as responders and continued on with assessments.

After 1 week of no treatment, 19 (33%) of the 56 CPAP participants were still responders compared with 37 (79%) of 47 patients with the positional device.

By 3 months, 38% (18 out of the original 47) in the positional group were considered responders compared with none in the CPAP group.

At the year mark, 13 participants in the positional group (about 27% of the 47 who had initially responded to the treatment) maintained their response.

Cano Pumarega and her colleagues plan to study which patients are most likely to respond and maintain the response after treatment withdrawal.

“Based on current knowledge, the best candidates are likely to be patients with clearly positional OSA, especially those with lower BMI, mild-to-moderate disease,” and a low non-supine AHI, she said.

Positional therapy is not frequently prescribed for OSA because of a lack of data on its long-term effectiveness, said Vishesh Kapur, MD, MPH, professor of medicine and director of the sleep medicine program at the University of Washington in Seattle.

He said the question of whether positional devices can be used for a short time and have a durable effect was not answered by the current study, in part because of a lack of follow-up with the participants who dropped out.

“It is reasonable to expect that those that don’t follow up may not have had the same success as those that did,” Kapur said. “This becomes a bigger problem when a great proportion of subjects do not complete the outcome assessment as seen in this study.”

He said whether positional devices are ready to be recommended in clinical practice is still unanswered.

“In future guidelines, it might be worthy of seeing if the level of evidence gets to the point that you would be recommending these devices,” he said.

Philips provided the positional device for the study. Cano Pumarega and Kapur reported having no financial conflicts of interest.

Brenda Sandburg is a freelance journalist for Medscape Medical News. She has written about the biopharmaceutical industry and legal issues for the Pink Sheet and American Lawyer Media.