Compression stockings may improve obstructive sleep apnea

This article reviews a recent study showing that compression stockings may improve obstructive sleep apnea. I discussed this more during a previous post.

This is the theory behind why the stockings may help. Fluid can accumulate in the lower legs during the day because for much of the day, the legs are lower than the heart, and gravity pulls the fluid down into the legs. This fluid usually gets resorbed back into the blood stream when the patient lays down at night, as the legs are at the level of the heart. But this fluid expands the blood volume and it can leak out at other locations, such as the back of the throat. This causes swelling and worsens the narrowing seen in OSA. The stockings can prevent the fluid accumulation in the legs to begin with, thus limiting swelling in the back of the throat when the patient lays down.

Compression Stockings and Sleep Apnea

Chronic venous insufficency is a disorder of the leg veins that can result in fluid accumulation in the legs and ankle swelling. When patients with chronic venous insufficiency lay down at night to sleep, some of the fluid is redistributed to the other parts of the body, including the head and neck. This can cause swelling in the neck, which can increase risk of sleep apnea. In fact, one research group in Italy has shown that in patients with chronic venous insufficiency, OSA severity was linked to the amount of fluid being redistributed from the legs to the neck region overnight.

Compression stockings can be used to treat chronic venous insufficiency. Now, that same Italian research group has just completed another study about using compression stockings to treat OSA. Twelve non-obese patients with OSA and chronic venous insufficiency were randomly assigned to either wear compression stockings for one week or not (the control period). After the week, each patient did the opposite for another week - a.k.a. crossover trial design. The results showed that at the end of the compression stocking-wearing period, there was a 62% reduction in leg fluid volume compared to the control period. There was a 60% reduction in neck circumference. Finally, there was a 36% reduction in the severity of OSA, from 48.4 to 31.3.

These findings are exciting, as chronic venous insufficiency is common with OSA. The results raise some important questions as well. Does the effect persist if compression stockings are worn for longer periods of time? Will other treatments for chronic venous insufficiency also reduce OSA severity? Will the compression stockings work in obese patients, in contrast to the non-obese and relatively healthy patients in this study? Finally, will the use of compression stockings also reduce the clinical signs of OSA like daytime sleepiness?