1. The effect of sleep position on the severity of OSA has been well established.
2. Positional OSA is defined as OSA with AHI in the supine position that is at least double the AHI in a nonsupine position.
3. The first reported attempt at positional therapy came from the wife of a patient who “sewed a pocket into the back of a T-shirt and inserted a hollow light-weight plastic ball” into the pocket which resulted in the resolution of her husband’s snoring and daytime sleepiness within about 2 days of it use.
4. Positional therapy has been used with vests filled with a half-cylindrical piece of hard foam in the back and showed significant reduction in the AHI index.  Long term, discomfort has been reported to be the reason for poor compliance.
5. The tennis ball technique (TBT) has been used for positional OSA with improved daytime alertness, decreased snoring loudness, improved oxygenation, and over a 50% decrease in the AHI.  Long-term, however, discomfort limits compliance.
6. Battery-operating vibrating devices have been used with success in treating positional OSA.
7. The Apnea Sleep Position Trailer, which records the sleep position, causes the phone to vibrate if the supine position is detected, and sounds an alarm if the person does not respond by changing position.  This is available as an Android phone application.
8. With the advent of smarter devices, the bulky positional devices will likely be replaced by more comfortable treatments.  Smart phone applications bypass the lengthy FDA approval and regulatory bureaucracy and will allow market innovations in this form of therapy
9. Positional therapy should be the part of any treatment for OSA, as it will reduce the severity of OSA.  It may sometimes be just counseling patients to avoid the supine position, as much as possible during sleep.