Poor long-term patient compliance with the tennis ball technique for treating positional obstructive sleep apnea

J Clin Sleep Med. 2009 Oct 15;5(5):428-30.


Study objectives: Little is known regarding long-term patient compliance with the tennis ball technique (TBT), one of the original simple methods of positional therapy (i.e., avoiding the supine posture during sleep) for posture-dependent obstructive sleep apnea patients. The purpose of this study was to investigate long-term patient compliance with TBT.

Methods: A follow-up questionnaire was mailed to all patients prescribed TBT at the Adelaide Institute for Sleep Health between July 2004 and March 2008 (n = 108).

Results: Sixty-seven patients replied to the questionnaire. Baseline demographic/clinical characteristics were not significantly different from non-respondents. Among the respondents, follow-up time was (mean +/- SD) 2.5 +/- 1.0 years. Four (6.0%) reported they were still using TBT (group A); 9 (13.4%) were no longer using TBT, claiming to have learned to avoid the supine position during sleep (group B); and 54 (80.6%) were neither using TBT nor avoiding the supine posture (group C). The main reason for ceasing TBT use in group C was that TBT was too uncomfortable (34/54 patients).

Conclusions: Long-term patient compliance with TBT appears to be very poor, with less than 10% of patients reporting continued use (group A) approximately 30 months after prescription. With most TBT non-compliers reporting it to be too uncomfortable, alternative forms of positional therapy appear to be needed.

MeSH terms

  • Equipment and Supplies / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Patient Compliance / statistics & numerical data*
  • Posture*
  • Sleep Apnea, Obstructive / therapy*
  • Surveys and Questionnaires
  • Treatment Outcome