2008 Dec;18(6):318-24. Epub 2008 Oct 15.
Head-up sleeping improves orthostatic tolerance in patients with syncope.
Cooper VL, Hainsworth R.
Cardiorespiratory Unit, St James's University Hospital, Leeds, UK.
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.
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