Head-up sleeping improves orthostatic tolerance in patients with syncope

Clin Auton Res. 2008 Dec;18(6):318-24. doi: 10.1007/s10286-008-0494-8. Epub 2008 Oct 15.

Abstract

Objectives: This study was designed to examine the effect of head-up sleeping as a treatment for vasovagal syncope in otherwise healthy patients. Treatment for syncope is difficult. Pharmacological treatments have potential side effects and, although other non-pharmacological treatments such as salt and fluid loading often help, in some cases they may be ineffective or unsuitable. Head-up sleeping may provide an alternative treatment.

Methods: Twelve patients had a diagnosis of vasovagal syncope based both on the history and on early pre-syncope during a test of head-up tilting and graded lower body suction. They then underwent a period of 3-4 months of sleeping with the head-end of their bed raised by 10 degrees , after which orthostatic tolerance (time to pre-syncope during tilt test) was reassessed.

Results: Eleven patients (92%) showed a significant improvement in orthostatic tolerance (time to pre-syncope increased by 2 minutes or more). Plasma volume was assessed in eight patients and was found to show a significant increase (P < 0.05, Wilcoxon signed-rank test). There was no significant change in either resting or tilted heart rate or blood pressure after head-up sleeping.

Interpretation: Head-up sleeping is a simple, non-pharmacological treatment which is effective in the majority of patients. However, it may not be tolerated by patients or bed-partners long term and whether the effects continue after cessation of treatment remains to be determined.

MeSH terms

  • Adolescent
  • Adult
  • Blood Pressure / physiology
  • Blood Volume / physiology
  • Female
  • Head*
  • Heart Rate / physiology
  • Humans
  • Hypotension, Orthostatic / physiopathology
  • Hypotension, Orthostatic / therapy*
  • Male
  • Middle Aged
  • Posture / physiology*
  • Sleep / physiology*
  • Syncope, Vasovagal / physiopathology
  • Syncope, Vasovagal / therapy*
  • Tilt-Table Test
  • Young Adult