Tolerability and efficacy of full-body head-up tilt sleeping in Parkinson’s disease and multiple system atrophy

Orthostatic hypotension (OH) and the co-existence with supine hypertension (SH) are debilitating consequences of autonomic failure in Parkinson’s disease (PD) and multiple system atrophy (MSA). Head-up tilt sleeping (HUTS) has the potential to treat both simultaneously. Within the Heads-Up trial, 20 persons with PD or MSA and both SH and OH were assigned randomly to two HUTS schemes with gradually increasing angles: 1° (placebo), 6° and 12°; or 6°, 12° and 18°. The effect of increasing the head of the bed (per cm) was analyzed with linear mixed models. HUTS did not reduce nocturnal SBP but improved other indicators of blood pressure control, including early morning supine SBP, nocturnal dipping profile, diurnal SBP and SBP fall upon standing, coinciding with improved orthostatic tolerance. Adherence was 100% at 6°, 80% at 12°, and 60% at 18°. Higher angles were more effective, but at the cost of lower tolerability. The trial is registered at ClinicalTrials.gov (NCT05551377, 19-09-2022).