Sleep Body Position Research Articles

Neurobiological Staging with Special Reference to Sleep Apnoea Syndrome: An Update

Abstract: Sleep apnea (SA) or Obstructive sleep apnoea (OSA) is a widely spread sleep disorder marked by repetitions of a complete or partial collapse of the upper airways during sleep. The pathogenesis of OSA is due to the recurrent obstruction of the pharyngeal airway during sleep. The risk factors contributing to upper airway obstruction are obesity, cardiovascular diseases, craniofacial changes, alcohol and smoking. The condition is associated with significant morbidity and mortality. The diagnosis is established with polysomnography (PSG). Lifestyle changes such as weight loss, keeping away from alcohol, tobacco, and sedatives and altering the usual sleeping body position help out in decreasing apnoea symptoms. Various treatments are available for the successful management of this disease, such as continuous positive airway pressure (CPAP) is mainly used in patients with severe SA and oral appliances are widely used in mild to moderate SA and for patients intolerant to CPAP therapy. There are many options available for surgical therapy, with the UPPP (Uvulopalato-pharyngoplasty) being the most widely employed. Also, a number of medications such as tricyclic antidepressants (TCA’s), decongestants, nasal steroids, antihypertensive agents, CNS stimulants and supplementary oxygen are used for treating patients with OSA.

Compact Wideband Double-Slot Microstrip Feed Engraved TEM Horn Strip Antennas on a Multilayer Substrate Board for in Bed Resting Body Positions Determination Based on Artificial Intelligence

In this paper, a horn-shaped strip antenna exponentially tapered carved on a multilayer dielectric substrate for an indoor body position tracking system is proposed. The performance of the proposed antenna was verified by testing it as a tracking state of an indoor resting body position. Among different feeding techniques, the uniplanar T-junction power divider approach is used. The performance verification of the proposed antenna is explained through its compact size and 3D shape, along with a performance comparison of the return loss radiation pattern and the realized gain. The suggested antenna has an 88.88% fractional bandwidth and a return loss between 6 and 15.6 GHz, with a maximum gain of 9.46 dBi in the 9.5 GHz region. Within the intended band, the radiation pattern had an excellent directivity characteristics. The proposed antenna was connected to an NVA-R661 module of Xethru Inc. for sleeping body position tracking. The performance of the antenna is measured through microwave imagining of the state of the resting body in various sleeping positions on the bed using a Recurrent Neural Network (RNN). The predicted outcomes clearly define the antenna's performance and could be used for sensing and prediction purposes.

Sleep body position correlates with cognitive performance in middle age obstructive sleep apnea subjects.

Sleep body position correlates with cognitive performance in middle age obstructive sleep apnea subjects.

Self-Reported Onset of Paroxysmal Atrial Fibrillation Is Related to Sleeping Body Position.

Background: Because stretch of the atrial myocardium is proarrhythmic for atrial fibrillation (AF) and a left lateral body position increases atrial dimensions in humans, we hypothesized that left lateral recumbence is a frequent AF-triggering body position in AF patients.Methods: We performed a questionnaire study of symptomatic paroxysmal AF (episodes of AF < 1 week) patients scheduled for a first AF ablation therapy at Catharina Hospital, Eindhoven, the Netherlands and at University Hospital, Bordeaux, France.Results: Ninety-four symptomatic paroxysmal AF patients were included [mean age 61 ± 11 years, median AF history of 29(48) months, 31% were females]. Twenty-two percent of patients reported a specific body position as a trigger of their AF symptoms. The triggering body position was left lateral position in 57% of cases, supine position in 33%, right lateral position in 10%, and prone position in 5% (p = 0.003 overall difference in prevalence). Patients with positional AF had a higher body mass index compared to patients without nocturnal/positional AF [28.7(4.2) and 25.4(5.2) kg/m2, respectively, p = 0.025], but otherwise resembled these patients.Conclusion: Body position, and the left lateral position, in particular, is a common trigger of AF in symptomatic AF patients. Moreover, positional AF is associated with overweight. Understanding of the underlying mechanisms of positional AF can contribute to AF treatment and prevention.

Effects of Body Pillow Use on Sleeping Posture and Sleep Architecture in Healthy Young Adults

Background and Objective Patients with position-dependent obstructive sleep apnea have a > 2-fold higher apnea-hypopnea index when sleeping in a supine position compared with a non-supine position. We investigated the effect of body pillow use on sleeping body position and sleep architecture in healthy young adults. Methods In experiment 1, we evaluated the body pressure distribution with or without body pillow use in 8 healthy young adults [age, 36.5 ± 13.0 years; body mass index (BMI); 20.6 ± 1.2 kg/m2]. In experiment 2, we performed a randomized-crossover intervention study to evaluate the effects of body pillow use on sleeping position and sleep architecture in 10 healthy young adults (age, 24.3 ± 7.8 years; BMI, 21.4 ± 1.7 kg/m2). Sleep architecture was characterized by polysomnography, and body positions were monitored using a sensor. Subjective sleep quality was evaluated with the Oguri-Shirakawa-Azumi sleep inventory, middle age and aged version. Results In experiment 1, body pillow use significantly reduced mean body pressure on the shoulder, hip, and whole body. In experiment 2, mean time spent in the supine, lateral, and prone body positions did not differ significantly between the 2 trials. Body pillow use, however, significantly extended the sustained time spent in the lateral body position compared with the control trial. Subjective sleep quality and sleep architecture did not differ significantly between the 2 trials, but body pillow use decreased the number of short (30 s) slow-wave sleep episodes. Conclusions Sleeping with a body pillow effectively extends sustained time in a lateral sleeping position and prevents segmentation of slow-wave sleep episodes. Key words: Body pillow, Sleeping body position, Lateral position, Sleep architecture, Energy expenditure

Joint Apnea and Body Position Analysis for Home Sleep Studies Using a Wireless Audio and Motion Sensor

This study aims to evaluate the accuracy of a wireless tracheal audio sensor including the sleep body position measurement, as a possible tool to screen for obstructive sleep apnea (OSA) and also to distinguish among “positional” and “non-positional” sleep apnea patients. 30 adult subjects were asked to sleep naturally for a single night in the sleep laboratory, having simultaneous polysomnography (PSG) as a reference. The results were compared using, e.g., Pearson's and Lin's correlation coefficients, Bland-Altman plots, mean absolute error, intercept of the fitted linear model etc. We found the thresholding approach performed on normalized audio energy data achieved mean absolute error of 5.7, and average difference was -2.0. Pearson's and Lin's R coefficients were 0.92 and 0.70, respectively. The qualitative approach reached 86% accuracy (sensitivity of 96%, and specificity of 76%) when setting a binary border at the level of AHI = 15 (combined normal + mild versus combined moderate + severe cases). We also checked the distribution of apneas depending on the body position. Our sensor showed a mean = SE difference between supine apnea index and non-supine apnea index of 8.3 ± 3.2, while PSG reference of 11.2 ± 3.8. The proposed sensor might be a good complement for home sleep studies, being less disturbing and allowing for longitudinal observations and reliably showing positional OSA. PSG is the gold standard in diagnosing OSA; however, it requires to spend a night in a lab with medical staff, it provides short observation, the cost of the study is very high, and it is less suitable for children. This is why a reliable screening method is needed in sleep medicine.

Effects of sleep body posture on subjective sleepiness in patients with OSAHS

Objective:To observe the effects of sleep body posture on subjective sleepiness in patients with OSAHS.Method: We assessed the sleeping body position, the sleep structure, position specific AHI and the Epworth Sleepiness Scale (ESS) in a total of 90 patients with OSAHS. The patients were grouped according to AHI: mild OSAHS (5≤AHI<15), moderate (15≤AHI<30) and severe (AHI≥30). The polysomnography data and clinical characteristics were compared between each group.Result: There was statistically significant difference in arousal index，MinSpO2，REM% and NREM% among three groups (F value was 12.10,43.67,15.81,13.17，respectively，P<0.05). Compared with supine，the severe OSAHS group had significantly bigger changes in MinSpO2， REM% and NREM%（t value was 3.02,2.41,2.90，respectively，P<0.05）. For mild-to-moderate groups，there was no correlation between the ESS and the AHI at any position（P>0.05）. For severe group，the ESS was significantly correlated with L-AHI（r=0.454，P<0.01)；the REM L-AHI and NREM L-AHI was also significantly correlated with ESS of severe group (r=0.522 and 0.425，P<0.01). Conclusion:The sleep body posture had significant effects on sleep structure and respiratory events in severe OSAHS group. The L-AHI was found to have a closer association with daytime sleepiness in severe OSAHS than other groups.

Influence of the right- versus left-sided sleeping position on the apnea-hypopnea index in patients with sleep apnea

Sleep and sleep position have a significant impact on physical, cardiac and mental health, and have been evaluated in numerous studies particularly in terms of lateral sleeping positions and their association with diseases. We retrospectively examined the relationship between the sleeping position and position-specific apnea-hypopnea index (AHI) in obstructive sleep apnea-hypopnea (OSA) patients. We assessed the sleeping body position and the body position-specific AHI score in patients who were referred for suspected OSA and underwent diagnostic nocturnal polysomnography. In order to eliminate inter-individual differences, only those who had a similar percentage of time spent in the LSSP and RSSP for each patient were enrolled. To provide this validity, only subjects that had a similar percentage of left and right lateral sleep time (±10%) were included in the analysis. A total of 864 patients had nocturnal diagnostic PSG. Of them, 131 patients met the inclusion criteria. The percent rate spent in the supine sleeping position (SSP) was 31.3 ± 18.7%, in the LSSP was 31.8 ± 10% and in the RSSP was 32.6 ± 10.8%. Whereas the SSP-specific AHI score was the highest with 60.4 ± 36.2/h among all the sleeping position-specific AHI scores (p < 0.001), the LSSP-specific AHI score was statistically higher than that for RSSP (30.2 ± 32.6/h vs. 23.6 ± 30.1/h; p < 0.001). When comparing individuals sub-grouped based on OSA severity, there was a statistically significant difference between the LSSP-specific AHI score and RSSP-specific AHI score in patients with severe (p = 0.002) and moderate (p = 0.026), but not mild (p = 0.130) OSA. We found that the sleeping position had a significant influence on apneic events and RSSP decreased the frequency of obstructive respiratory events in patients with moderate and severe disease.

Relationship between the Body Position-Specific Apnea-Hypopnea Index and Subjective Sleepiness

Background: It is well known that the sleeping position influences the rate of apnea-hypopnea events; however, whether events in one position may have more influence on daytime sleepiness than events in another position has not been thoroughly investigated. Objectives: We retrospectively examined the relationship between the body position-specific apnea-hypopnea index (AHI) and daily sleepiness. Methods: We assessed the sleeping body position, the body position-specific AHI and the Epworth Sleepiness Scale (ESS) in a total of 699 patients who were referred for suspected obstructive sleep apnea-hypopnea syndrome (OSAHS) and underwent diagnostic polysomnography. Results: For all subjects, only the lateral position-specific AHI (L-AHI) showed a weak but significant correlation with the ESS (r = 0.102; p < 0.05). For mild-to-moderate OSAHS patients, there was no correlation between the ESS and the AHI at any position. For severe OSAHS patients, the ESS showed a closer correlation with the L-AHI (r = 0.266; p < 0.001) than with the supine position-specific AHI (S-AHI; r = 0.141; p < 0.05). In a subgroup analysis, divided into positional and non-positional severe OSAHS patients, the correlation coefficients also identified a link between the L-AHI and the ESS. Finally, a multiple linear regression analysis indicated that the ESS was better explained by the L-AHI than by the S-AHI in severe OSAHS patients. Conclusion: The L-AHI is considered to have a stronger influence on daytime sleepiness than the S-AHI in Japanese patients with severe OSAHS.

Characteristics of Japanese Patients with Complex Sleep Apnea Syndrome: A Retrospective Comparison with Obstructive Sleep Apnea Syndrome

The prevalence of complex sleep apnea syndrome (CompSAS) among Asian patients with obstructive sleep apnea syndrome (OSAS) has not yet been reported. Distinguishing CompSAS from pure OSAS is difficult using only diagnostic polysomnography (PSG). We examined the prevalence of CompSAS in Japanese patients with OSAS and the possibility to distinguish CompSAS from pure OSAS by analyzing the severity of respiratory events based on either sleep body position or sleep stage using a diagnostic PSG. A retrospective chart review of 297 consecutive Japanese patients who were 15 years of age or older with a primary diagnosis of OSAS who were referred for CPAP titration (AHI> or =20 events/hr). Seventeen patients (5.7%) out of the 297 patients who had an obstructive apnea hypopnea index (AHI) of 20 or higher showed adverse increases in central apnea index (CAI) by the treatment with CPAP whereas obstructive apnea index (OAI) and mixed apnea index (MAI) were significantly decreased. In the results, the AHI on the PSG for CPAP titration reached only approximately half of the values on the diagnostic PSG. In these CompSAS patients, both the total CAI and the CAI in the supine position during NREM sleep on the diagnostic PSG were significantly higher than those in the OSAS group. The sleep body position did not so strongly affect the AHI, OAI and MAI in the CompSAS group. Multiple, stepwise, and logistic regression analyses revealed that the CAI in the supine position during NREM (p=0.026) was a significant variable to distinguish CompSAS from OSAS statistically although the variables were within the normal range. The prevalence of CompSAS in Japanese OSAS patients may be lower when compared with Caucasian patients. The increase of CAI in the supine position during NREM sleep on diagnostic PSG may be a characteristic feature in CompSAS.

Nocturnal body position in sleeping children with and without obstructive sleep apnea

To assess whether body position during sleep differs among children with obstructive sleep apnea (OSAS) and controls, and to assess the effects of body position, obesity, and tonsillar size on respiratory disturbance. Four hundred and thirty consecutive children with polysomnographically demonstrated OSAS. And 185 age-, gender-, and ethnically matched children (Controls) were compared. The effect of sleep body position on respiratory disturbance was examined in OSAS, and also in relation to obesity and tonsillar size. Children with OSAS spent more time in the supine position than Controls (P<0.01), with less time spent in the side position (P<0.005). Obstructive apnea and hypopnea index (AHI) was similar in the three sleep-related positions, but apnea index (AI) was significantly greater (4.6 +/- 0.7/hr TST) in the supine position than in the side position (2.7 +/- 0.3/hr TST; P<0.001) or prone position (3.3 +/- 0.5/hr TST; P<0.01). Tonsillar size was not a contributing factor to positional differences in AI or AHI. Obese OSAS children had increased prone position (20.4 +/- 2.0%TST vs. non-obese: 10.9 +/- 2.5%TST; P<0.05), and displayed increased AHI and AI while supine. Non-obese OSAS increased AHI in prone or side positions compared to supine (P<0.01), with no significant differences in position-dependent AI. Children with OSAS spend more time sleeping supine and less time on the side. Obese children with OSAS are more likely to sleep prone, suggesting that this position may promote upper airway patency in the presence of obesity. Although tonsillar size is not associated with positional differences in breathing, the presence or absence of obesity markedly modifies the effect of body position on respiratory disturbance.

Sociodemographic factors associated with sleeping position and location.

Recent research has implicated infant sleeping body position and bed sharing as risk factors in the sudden infant death syndrome. The sociodemographic associations of infant sleeping body position and location were examined in this study. This showed that the majority (86.4%) of New Zealand parents now place their infants to sleep on their sides. The remainder place their infants supine (1.3%), prone (4.8%), or no particular way (7.5%). In the waking position, 57.9% were usually found on their sides, 18.2% supine, and 6.1% prone. Infant sleeping position showed marked sociodemographic variability. These findings are a marked contrast to previous New Zealand studies which showed a reversed pattern, with most infants put to sleep prone. There were also highly significant sociodemographic differences in the place of sleeping. Overall 12.2% of infants shared a bed, with infants of younger less well educated mothers who were of non-European origin, with a parity of five or more, or unmarried significantly more likely to do so. Infants of unemployed and lower socioeconomic group (Elley-Irving groups 5 and 6) fathers were also more likely to share a parental bed.