Supplementary Material for: Head-up Tilt Sleeping to Treat Orthostatic Intolerance in a Patient with Advanced Parkinson’s Disease: A Case Report

Introduction: Orthostatic hypotension is common in people with Parkinson’s disease due to autonomic dysfunction and medication use, and can have a significant negative impact on quality of life. Pharmacological treatment is often complicated due to complex blood pressure regulation problems. This case report presents a patient whose symptoms of orthostatic intolerance were successfully treated with the non-pharmacological method of Head-Up Tilt Sleeping (HUTS).
Case presentation: A 69-year-old man with Parkinson’s disease and prominent autonomic failure received recommendation from the neurologist to use HUTS to battle orthostatic intolerance, of which complaints were worst in the early morning. The patient noted a marked improvement of the orthostatic intolerance after a period in which he slowly step-by-step inclined the bed to an angle just over 10°. When ceasing HUTS for a brief period, complaints of orthostatic intolerance immediately returned and the patient returned to tilted sleeping right away. After a follow-up of three months the patient did not report orthostatic intolerance during a standing test.
Conclusion: This case illuminates that, despite difficulties intrinsic to this method, whole-body head-up tilt sleeping can ameliorate orthostatic intolerance and improve the daily life of people with advanced movement disorders.

引言：直立性低血压（orthostatic hypotension）在帕金森病（Parkinson’s disease）患者中较为高发，其主要诱因包括自主神经功能障碍（autonomic dysfunction）与药物干预，且会对患者生活质量造成显著负面影响。由于血压调控机制存在复杂异常，药物治疗往往面临诸多挑战。本病例报告介绍了一例直立不耐受（orthostatic intolerance）症状经非药物疗法——头高位倾斜睡眠（Head-Up Tilt Sleeping, HUTS）——成功缓解的患者。

病例报告：一名69岁男性帕金森病患者伴随显著自主神经衰竭，神经内科医师建议其采用头高位倾斜睡眠疗法以改善直立不耐受症状，该症状在清晨最为突出。患者逐步将床头调整至略高于10°的角度，坚持一段时间后，直立不耐受症状得到明显改善。当短暂停止头高位倾斜睡眠后，直立不耐受症状即刻复发，患者随即恢复倾斜睡眠。为期三个月的随访期间，患者在直立试验中未报告直立不耐受症状。

结论：尽管该疗法本身存在固有难度，但全身头高位倾斜睡眠可有效改善直立不耐受症状，并提升晚期运动障碍患者的日常生活质量。