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°, 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.
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Cooper, V.L., Hainsworth, R. Head-up sleeping improves orthostatic tolerance in patients with syncope. Clin Auton Res 18, 318–324 (2008). https://doi.org/10.1007/s10286-008-0494-8
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DOI: https://doi.org/10.1007/s10286-008-0494-8