Objectives: Positional obstructive sleep apnea (POSA) is common and affects sleep quality. This study was to identify the efficacy of using a Thai traditional triangle cushion as a position device for therapy in POSA. Methods: This open-label, self-control, prospective intervention study enrolled adult patients with POSA. The 8-weeks positional advice was performed, followed by 8-weeks using a Thai triangle cushion. Study outcomes were to measure changes in Epworth sleepiness scale (ESS) scores

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... and 36-Item Short Form Health Survey (SF-36) and problems/complaints during the study. Results: There were 10 patients enrolled in total, with a mean age of 55.8 years old (SD 11.3), with an average apnea-hypopnea index (AHI) of 26.1, a supine AHI of 35.3, a non-supine AHI of 8.6 and the average baseline ESS was 10 (SD3.5). The positional advice did not improve the ESS score from baseline [the mean difference in ESS score of +0.20 (95%CI-2.01 to 2.41, p-value 0.84)]. Using cushion intervention significantly reduced the ESS score from baseline [-3.6 (95%CI-5.00 to-2.20), p-value<0.001]. The period of using a cushion (intervention) also significantly reduced the ESS score when compared with the period of positional advice (control), with an ESS reduction of -3.8 (95%CI-6.47 to-1.13), p-value 0.011. The quality of life is improved only during the period of using a cushion. There were no complaints from the patients related to positional advice or using the intervention cushion. Conclusions: The Thai traditional triangle cushion, as a positional device in treating patients with positional obstructive sleep apnea, is effective and comfortable.