Sleep Position Research Articles

How religion affects sleep health: exploring the perspectives of religious Muslims and Jews in Israel.

Few empirical studies have explored the links between sleep and religion and no research has examined how religious individuals view these links. This article contributes to the literature by drawing on in-depth interviews with 31 midlife Israeli Muslims and Jews who describe themselves as religious or very religious. Findings indicate that respondents shared the view that sleep is important for health and wellbeing, as well as for religious practice and the proper worship of God. Their accounts clarified that religious observance entails a set of social rules and prescriptions as well as beliefs that may affect sleep behaviour and sleep outcomes. Traditional prayer times affected sleep duration for observant Muslims and Jews because respondents woke up early for prayer but could not always retire early enough so as to obtain a sufficient amount of sleep. Religion also dictated a preferred sleep position, to which participants became accustomed and found to be helpful. Respondents maintained that their deep faith in God and the practice of praying helped reduce stress, which contributed to sleep quality. However, among Muslims, missing prayers could arouse feelings of guilt and unease, thus affecting sleep quality. The article concludes that religion affects the sleep of both Muslims and Jews, but these effects vary by how individuals practice their religion and by how religiosity intersects with other social categories, such as gender. Future studies could enrich understanding of the social determinants of sleep by designing research inspired by lay persons' insights into the association between religion and sleep.

Influence of Nasal Cavity Dimension and Sleep Posture on the Severity of Obstructive Sleep Apnea

Background and Objectives The aim of this study was to evaluate the effect of sleep position and nasal cavity dimension according to minimal cross-sectional area (MCA) on the severity of obstructive sleep apnea (OSA).Subjects and Method This study enrolled 528 consecutive patients who completed overnight polysomnography (PSG) and acoustic rhinometry. Positional sleep time and apnea-hypopnea index (AHI) were compared between the right and left lateral sleep positions (RLSP vs. LLSP), and between the wide and narrow lateral side sleep position (WLSP vs. NLSP) according to MCA.Results The sleep time was longer for LSP than for WLSP (20.35%±19.69% and 15.92%±16.35%, respectively) with a statistically significant difference (<i>p</i>=0.001). However, the AHI was not significantly different between the two groups. The sleep time was longer for RLSP than for LLSP (20.65%±19.31% and 15.39%±16.05%, respectively) with a statistically significant difference (<i>p</i><0.001). In the RLSP-dominant group, there were fewer left nasal cavity narrowed patients than right nasal cavity narrowed patients (91 vs. 129, respectively). Furthermore, in the LLSP-dominant group, there were fewer right nasal cavity narrowed patients than left nasal cavity narrowed patients (60 vs. 85, respectively, <i>p</i>=0.001). However, we found that the AHI value was not significantly different according to sleep posture and nasal cavity dimension.Conclusion Snoring patients preferred RLSP to LLSP, and preferred to sleep on the lateral side of the narrow nasal cavity. The OSA severity was not different according to sleep position and nasal cavity dimension.

Associations between demographic and parental factors and infant sleep characteristics.

Although sleep problems are highly prevalent in infants, the intrinsic and extrinsic factors that influence sleep consolidation and regulation in this age group are not well understood. This study aimed to examine the cross-sectional associations of demographic and parental factors with infant sleep characteristics. Participants were 97 Canadian mother-infant dyads primarily from Edmonton, Alberta. Demographic factors (e.g., infant age), parenting practices (e.g., sleep position, sleep initiation methods), and infants sleep characteristics (e.g., the frequency of nighttime awakenings) were assessed using the Brief Infant Sleep Questionnaire. Maternal sleep characteristics (e.g., nighttime sleep duration) were assessed using Actigraph accelerometers. Infant age (mean = 4.24 ± 2.90) was associated with most infant sleep characteristics. In multiple regression models for infant nighttime sleep duration, after removing influential observations, a negative association for side (vs. prone) sleep position was, respectively, observed. In multiple regression models for the frequency of nighttime awakenings in infants, positive associations for infants falling asleep while feeding (vs. in bed alone) and side (vs. prone) sleep position were consistently observed after removing influential observations. Lower nighttime sleep efficiency (B = - 0.08, 95%CI: -0.13, -0.02) and longer nighttime wake after sleep onset (B = 1.03, 95%CI: 0.41, 1.65) in mothers were associated with more frequent nighttime awakenings in infants. After removing influential observations, more frequent nighttime awakenings (B = 0.35; 95%CI: 0.09, 0.61) and longer total sleep duration (B = 0.33, 95%CI: 0.11, 0.55) in mothers were also associated with more frequent nighttime awakenings in infants. Sleep initiation methods with less parental involvement, and more continuous and efficient maternal nighttime sleep, tended to be associated with less interrupted infant sleep.

Risk Factors for Suffocation and Unexplained Causes of Infant Deaths.

Observational studies have improved our understanding of the risk factors for sudden infant death syndrome, but separate examination of risk for sleep-related suffocation and unexplained infant deaths has been limited. We examined the association between unsafe infant sleep practices and sudden infant deaths (sleep-related suffocation and unexplained causes including sudden infant death syndrome). We conducted a population-based case-control study using 2016 to 2017 Centers for Disease Control and Prevention data. Controls were liveborn infants from the Pregnancy Risk Assessment Monitoring System; cases were from the Sudden Unexpected Infant Death Case Registry. We calculated risk factor prevalence among cases and controls and crude and adjusted odds ratios. We included 112 sleep-related suffocation cases with 448 age-matched controls and 300 unexplained infant death cases with 1200 age-matched controls. Adjusted odds for sleep-related suffocation ranged from 18.7 (95% confidence interval [CI]: 6.8-51.3) among infants not sharing a room with their mother or caregiver to 1.9 (95% CI: 0.9-4.1) among infants with nonsupine sleep positioning. Adjusted odds for unexplained death ranged from 7.6 (95% CI: 4.7-12.2) among infants not sharing a room with their mother or caregiver to 1.6 (95% CI: 1.1-2.4) among nonsupine positioned infants. We confirmed previously identified risk factors for unexplained infant death and independently estimated risk factors for sleep-related suffocation. Significance of associations for suffocation followed similar patterns but was of larger magnitude. This information can be used to improve messaging about safe infant sleep.

Sleep Disturbance and Common Interventions Used for Sleep Management in Individuals with Hypermobile Ehlers-Danlos Syndrome

<h3>Research Objectives</h3> To investigate common problems associated with sleep disturbances in individuals with hypermobile Ehlers-Danlos Syndrome (hEDS) and interventions commonly utilized to facilitate sleep. <h3>Design</h3> Survey of individuals with hypermobile Ehlers-Danlos syndrome. <h3>Setting</h3> Data set from a 2022 survey distributed worldwide through the Ehlers-Danlos Society website. <h3>Participants</h3> 768 adult (18+ years) participants with hEDS. <h3>Interventions</h3> Presence or absence of sleep disturbances; presence or absence of sleep deficits (under 7 hours per 24 hour period); presence or absence of anxiety; and the most common sleep disturbances reported and inventions utilized. <h3>Main Outcome Measures</h3> Survey data was collected on sociodemographic characteristics (e.g., age, sex, employment status), sleep disturbances (pain, body temperature regulation, insomnia, anxiety, etc.) and common interventions utilized (positioning, sleep routines, medications, etc.). The National Institutes of Health (NIH) Patient Reported Outcomes Measurement Information System (PROMIS) sleep scale was also used to compare individuals with hEDS to normative data. A measure of mental and physical health-related quality of life (HRQOL) from the SF-36 was also utilized. <h3>Results</h3> The majority of individuals with hEDS reported having problems with their sleep not being restful (92.2%). The majority of this population got less than the recommended number of hours of sleep (7) per night (66.4%). Pain was reported as interfering with sleep by 97.4% of subjects with 37.75% causing them to have trouble with sleep daily. The most common sleep interventions used by participants were maintaining a routine sleep schedule (64.6%), use of prescription (41.5%)and over the counter medications (35.0%), positioning, pillows, or wedges (20.1%), and room temperature (17.3%). Comparison of individuals with hEDS to PROMIS normative data found significantly worse sleep in this population (p < 0.01). Both mental and physical HRQOL were impacted by poor sleep (p < 0.01). <h3>Conclusions</h3> Individuals with hEDS had significant sleep disturbances due to pain, temperature regulation, and anxiety. Many participants use medications, sleep positioning, and sleep routines to combat these sleep difficulties. More research is needed to determine optimal interventions to improve the overall quality of sleep in individuals with hEDS. <h3>Author(s) Disclosures</h3> None.

Remote patient monitoring service for sleeping human postures in a WBAN

Wireless Body Area Networks (WBANs) provide wireless remote patient monitoring services where doctors get patients' health records without physically visiting them. In WBANs, biosensors are placed on the patient's body that sense and transmit physiological data to the paired medical personnel. Such medical setups are appropriate for COVID-19 patient monitoring, where the patient remains isolated for an extended period. Sometimes, human body parts impede the signals transmitted by biosensors to the coordinator and this type of occlusion lasts for a longer duration during sleeping human postures. In such circumstances, an intermediate biosensor forwards the signals of the occluded biosensor node. The forwarding of messages results in quick depletion of energy resources at the intermediate biosensor, affecting the overall WBAN services. To resolve this, first, we propose an adaptive Relay-Node Centric (RNC) relay-based communication protocol for WBANs, which reduces energy used in relaying and improves the stability period of the network. Second, we design a novel simulation model using an existing real-life experimental dataset to simulate a WBAN placed on the sleeping patient's body. We derive a Discrete Markov Chain (DTMC) model from real-life data and use human biomechanisms to simulate biosensors' connectivity status in four human sleeping positions. Lastly, we evaluate the performance of RNC against the existing cost-function-based and Analytical Hierarchical Process (AHP) based relay selection protocols. Results obtained on the real-life dataset and designed simulation model show that RNC outperforms the existing methods in terms of network stability period and packet success ratio.

Obstructive sleep apnea in young infants: Sleep position dependence and spontaneous improvement.

The natural evolution of obstructive sleep apnea (OSA) in young infants is not established. We re-evaluated 10-year pediatric sleep center infant polysomnography (PSG) data, excluding infants with syndromes, genetic defects, structural anomalies or periodic breathing > 5% of sleep time. Obstructive events > 1 h-1 were evident in 255 infants, of which 91 were eligible for the study. Of the 38 infants in a follow-up study, 30 (79%) were male, 15 (40%) were born prematurely, 25 (66%) had observed apneas, and 13 (33%) had experienced a brief, unexplained event or had a sibling of the infant died suddenly. The first PSG was performed at a median corrected age of 4 weeks (interquartile range [IQR] 2-7) and the second at 11 weeks (IQR 9-14). The obstructive apnea and hypopnea index (OAHI) was greater in the supine compared to side-sleeping position in both recordings (p < 0.001), whereas OAHI dropped from 10 h-1 (IQR 6-24) in the first PSG to 3 h-1 (IQR 1-9) in the second PSG (p < 0.001). OSA alleviation was also observable as a decrease in the number of oxygen desaturations (p < 0.001), as a decrease in transcutaneous (p = 0.001) and end-tidal carbon dioxide (p = 0.01) 95th percentile levels, and work of breathing (p = 0.002). Seven infants had a third PSG to verify a satisfactory improvement of OSA. OSA in young infants without a clear syndrome or structural anomaly is sleep position dependent and shows improvement during the following few months.

Survey of Korean daycare personnel on safe sleep practices related to sudden unexplained infant death: a cross-sectional exploratory study.

Safe sleep practices (SSP) are among the main strategies to reduce sleep-related sudden unexplained infant death (SUID). Daycare personnel must be knowledgeable and trained in SSP related to SUID. This study explored the experience, knowledge, and confidence regarding SSP associated with SUID of daycare personnel. A cross-sectional survey was conducted with 395 staff members at 61 daycare centers to measure their experience related to SSP (10 items), related to sleep position and location, bedding materials, and other topics; knowledge of SSP (18 items); and confidence in SSP (1 item) related to SUID. A substantial proportion (23.6%) of respondents used the lateral or prone positions for infant sleep. On average, 4.5 bedding materials were used for infant sleep. Participants showed a lack of knowledge about SSP as indicated by a 56.6% knowledge of SSP related to SUID correct answer rate. Personnel who received SUID education were more knowledgeable and had more confidence regarding SSP than those who did not. More knowledge and confidence related to SSP were associated with better adherence to SSP. Standard SSP guidelines should be developed based on South Korea's culture of childcare for educating both childcare professionals and parents at home.

Investigation of the frequency of obstructive sleep apnoea syndrome in patients with subclinical hypothyroidism.

BackgroundThe aim of this study is to determine the frequency of obstructive sleep apnoea syndrome (OSAS) in a study group with the diagnosis of subclinical hypothyroidism and in a control group without the diagnosis of subclinical hypothyroidism. This study compares these two groups in terms of demographic characteristics, chronic diseases and especially polysomnographic data.MethodsA total of 120 patients were included in this study. They consisted of 60 patients with newly diagnosed subclinical hypothyroidism and a control group of 60 patients with normal thyroid functions. Demographic, anthropometric, polysomnography data and Epworth Sleepiness Scale scores of the patients were recorded and compared.ResultsAny significant difference in the frequency and severity of OSAS was not detected. A significant difference was found in the oxygen desaturation index (ODI), the apnoea–hypopnoea index (AHI) in rapid eye movement sleep, the AHI in supine sleep position and the arousal index of the group experiencing subclinical hypothyroidism with OSAS.ConclusionThis study showed that there was no increase in OSAS frequency in patients with subclinical hypothyroidism, but it demonstrated that the ODI and the arousal index were significantly increased in OSAS patients diagnosed with subclinical hypothyroidism. It is thought that the diagnosis and treatment of OSAS in these patients may be important in preventing cardiovascular complications.

O68 - Addressing Caregiver Challenges with Inconsistent and Unrealistic Safe Sleep Messaging: a Safer Sleep Guideline informed by Risk Minimisation

Safe sleep messaging varies considerably in clinical practice and guidelines within and between Australian states and territories. Risk elimination approaches which attempt to enforce idealistic expectations of where and how a baby sleeps have been demonstrated to alienate parents. Risk minimisation approaches which support ‘safer sleep’ offer flexibility and practical strategies that are more likely to engage families in risk reduction and infant health promoting behaviours. This analysis aims to share safe sleep messages that parents identified as most challenging to implement and introduce the Safer Infant Sleep clinical guideline designed to address common barriers encountered. A cross-sectional survey of 3341 Queensland families with infants aged approximately 3-months, birthed April-May 2017. Data included family characteristics, infant care practices used and engagement with safe sleep recommendations. Qualitative free-text items explored challenges with current safe sleep recommendations. Of caregivers, 1033 (31%) reported difficulty with at least one recommendation. Infant sleep position and avoiding a shared-sleep surface presented the greatest challenges. Families experiencing challenges were significantly less likely to employ advice compared to those not reporting difficulty (sleep position: 198/473, 42% vs 2548/2837, 90%[p<0.0001]; own sleep space: (269/344, 78% vs 1331/2884, 46%[ p <0.0001]). Parenting strategies believed to be unsupported weren’t disclosed, reducing opportunities between family and health professionals to share information and inform safer strategies. A tiered approach to tailor interventions for priority families based on identified vulnerabilities has been designed to develop safer sleep plans for every sleep. Structured support such as the Pēpi-Pod® Program is included. Many families encounter difficulties in implementing safe sleep advice; these challenges negatively impact infant care practices. The Safer Sleep guideline provides families a voice for collaborative and informed decision-making and provides professionals a tiered approach to manage risk whilst recognising their clinical judgement and reasoning to meet the needs of families.

Development of a Risk Score to Predict Sudden Infant Death Syndrome.

Sudden Infant Death Syndrome (SIDS) is the third leading cause of death among infants younger than one year of age. Effective SIDS prediction models have yet to be developed. Hence, we developed a risk score for SIDS, testing contemporary factors including infant exposure to passive smoke, circumcision, and sleep position along with known risk factors based on 291 SIDS and 242 healthy control infants. The data were retrieved from death certificates, parent interviews, and medical records collected between 1989–1992, prior to the Back to Sleep Campaign. Multivariable logistic regression models were performed to develop a risk score model. Our finalized risk score model included: (i) breastfeeding duration (OR = 13.85, p < 0.001); (ii) family history of SIDS (OR = 4.31, p < 0.001); (iii) low birth weight (OR = 2.74, p = 0.003); (iv) exposure to passive smoking (OR = 2.64, p < 0.001); (v) maternal anemia during pregnancy (OR = 2.07, p = 0.03); and (vi) maternal age <25 years (OR = 1.77, p = 0.01). The area under the curve for the overall model was 0.79, and the sensitivity and specificity were 79% and 63%, respectively. Once this risk score is further validated it could ultimately help physicians identify the high risk infants and counsel parents about modifiable risk factors that are most predictive of SIDS.

Effect of Sleep Position on Sleep-Disordered Breathing in Young Children With Unrepaired Incomplete Cleft Palates.

Children with cleft lip/palate are usually faced with upper airway problems after surgical repair. The severity of upper airway obstruction is more likely associated with the age and preoperative diagnosis of obstructive sleep apnea (OSA). This study aimed to investigate the severity of OSA in toddlers before palatoplasty from the perspective of polysomnography. In this retrospective cohort study, 97 children with unrepaired cleft palate and habitual prone sleeping were identified with a mean age of 1.6 years (SD 0.6) and divided into 2 age groups (1.5 year or younger and older than 1.5 year). Detailed information was collected including demographics, sleep parameters, and respiratory disturbances. Polysomnography results showed these children were at high risks of OSA with averagely moderate severity at night during their early childhood [apnea-hypopnea index 7.2±3.2 events/hour; obstructive apnea index (OAI) 6.5±2.8 events/hour]. Positional OAI was greatly lower in prone than that in laterals or in supine. Far more sleep time was spent in prone than in supine (42.9%±42.2% versus 8.5%±15.7%), which were consistent with parental reporting of prone sleeping habits. There were no significant differences found between the 2 age groups in respiratory disturbances such as apnea-hypopnea index, OAI, mean oxygen saturation, and nadir oxygen saturation ( P =0.097-0.988). Thus, prone sleeping with a history of snoring might be indicators for early screening for OSA in the cleft population. Adequate attention should be paid to their upper airway and, if available, overnight polysomnography should be performed to ascertain their potential respiratory problems before repair surgery.

Obstructive sleep apnea is position dependent in young infants

BackgroundObstructive sleep apnea in infants with Pierre Robin sequence is sleep-position dependent. The influence of sleep position on obstructive events is not established in other infants.MethodsWe re-evaluated ten-year pediatric sleep center data in infants aged less than six months, with polysomnography performed in different sleep positions. We excluded infants with syndromes, genetic defects, or structural anomalies.ResultsComparison of breathing between supine and side sleeping positions was performed for 72 infants at the median corrected age of 4 weeks (interquartile range (IQR) 2-8 weeks). Of the infants, 74% were male, 35% were born prematurely, and 35% underwent study because of a life-threatening event or for being a SIDS sibling. Upper airway obstruction was more frequent (obstructive apnea-hypopnea index (OAHI), p < 0.001), 95th-percentile end-tidal carbon dioxide levels were higher (p = 0.004), and the work of breathing was heavier (p = 0.002) in the supine than in the side position. Median OAHI in the supine position was 8 h−1 (IQR 4–20 h−1), and in the side position was 4 h−1 (IQR 0-10 h−1).ConclusionsObstructive upper airway events in young infants are more frequent when supine than when sleeping on the side.ImpactThe effect of sleep position on obstructive sleep apnea is not well established in infants other than in those with Pierre Robin sequence.A tendency for upper airway obstruction is position dependent in most infants aged less than 6 months. Upper airway obstruction is more common, end-tidal carbon dioxide 95th-percentile values higher, and breathing more laborious in the supine than in the side-sleeping position.Upper airway obstruction and obstructive events have high REM sleep predominance.As part of obstructive sleep apnea treatment in young infants, side-sleeping positioning may prove useful.

Relationship between gastroesophageal reflux disease and objective sleep quality.

To objectively characterize (1) the relationship between gastroesophageal reflux disease (GERD) and sleep quality, and (2) the influence of sleep position on this relationship, using in-laboratory polysomnography. We retrospectively analyzed first-night diagnostic in-laboratory polysomnography data for 3411 patients (median age 55 years; 48% male). Medication use and medical condition data were obtained through self-reported questionnaires. Associations between sleep quality and the presence of GERD, and the influence of sleep position on these associations, were analyzed using multivariable linear regression models. After adjusting for age, sex, body mass index, and relevant comorbidities, GERD was associated with a 3.0% decrease in sleep efficiency, 8.8-minute increase in wake after sleep onset, 24.4-minute increase in rapid eye movement (REM) latency, 13.4-minute decrease in total sleep time, 1.4% decrease in %REM sleep, and 1.5% increase in %N3 sleep. Having both GERD and the majority of sleep on the right side was associated with an 8.6% decrease in sleep efficiency, 27.5-minute increase in wake after sleep onset, 35.6-minute decrease in total sleep time, 2.1% decrease in %REM sleep, and 3.5% increase in %N3 sleep. Having both GERD and the majority of sleep on the left side was associated with an 8.7-minute increase in sleep onset latency. GERD is associated with an impairment in objective sleep quality. These associations were more pronounced in right-sided sleep and mostly ameliorated in left-sided sleep. Physicians should recognize the potential for poor sleep quality in patients with GERD and the effect of body position on this relationship. Gurges P, Murray BJ, Boulos MI. Relationship between gastroesophageal reflux disease and objective sleep quality. J Clin Sleep Med. 2022;18(12):2731-2738.

Prospective association of short sleep duration in newborns with bruxism behavior in children: The Japan Environment and Children's Study (JECS)

BackgroundBruxism is defined as a repetitive masticatory muscle activity, characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Although the bruxism etiology can be bidirectionally described with sleep disorders, there are few studies available to understand the association of sleep duration with bruxism behavior in early childhood. MethodsA dataset of children (n = 90,148) from the Japan Environment and Children's Study (JECS) — an ongoing nationwide, prospective birth cohort study — was used to investigate the prospective association of the infant's sleep duration with bruxism behavior, which were acquired using self-reported questionnaire. After multiple imputation of data, the association between sleep duration and bruxism behavior in early childhood was examined using a binomial logistic regression analysis. It was conducted with adjustments for several maternal (e.g., age at delivery and sleep duration) and child-related (e.g., sex and sleep position) variables. ResultsThe prevalence of bruxism behavior at the ages of two and four were 16.2% and 22.5%, respectively. Using the shortest sleep duration group's participants (≤13 h) as the reference, the odds ratio (95% confidence interval) for prevalence of bruxism behavior decreased with longer sleep duration at one month of age, but not at 36 months of age, after covariate adjustments. Furthermore, in comparison with the impacts between daytime and nighttime sleep, nighttime sleep with longer duration were dominantly associated with bruxism behavior. ConclusionThe sleep duration in infant stage, especially during newborn stage was associated with the prevalence of bruxism behavior in children.

Analysis of Lateral Decubitus Position During Sleep in Patients With Obstructive Sleep Apnea Using WatchPAT Device

Background and Objectives: Measurement of sleep parameters in both supine and non-supine positions is important for the diagnosis of positional obstructive sleep apnea (OSA). However, the influence of right and left lateral decubitus positions (RLDP and LLDP, respectively) on sleep parameters is relatively unknown and has not been well investigated. This study was performed to verify the associations between sleep parameters and lateral decubitus sleep position.Methods: A retrospective study was performed on 38 patients who were diagnosed with OSA and underwent surgical interventions from January 2014 to December 2016. Preoperative sleep parameters were evaluated with WatchPAT, and patients who slept sufficiently in both RLDP and LLDP to accurately analyze sleep parameters were enrolled in the study. Basic clinical data including body mass index (BMI) and nasal endoscopic findings of patients were assessed.Results: The difference in peripheral arterial tonometry apnea-hypopnea index (pAHI) and PAT respiratory disturbance index (pRDI) between RLDP and LLDP showed no association with the side of deviated nasal septum. Patients with higher BMI showed higher pRDI in LLDP than RLDP (p=0.038). The difference in sleep position percentage between RLDP and LLDP was negatively correlated with the difference in pRDI (p=0.023).Conclusion: Higher BMI patients with OSA might benefit more from sleeping in RLDP than LLDP. Patients slept longer in the lateral decubitus position that produced lower pRDI. Not only supine and non-supine positions, but also RLDP and LLDP need to be evaluated in patients with OSA.

Sleep Position Detection for Closed-Loop Treatment of Sleep-Related Breathing Disorders.

Reliable detection of sleep positions is essential for the development of technical aids for patients with position-dependent sleep-related breathing disorders. We compare personalized and generalizable sleeping position classifiers using unobtrusive eight-channel pressure-sensing mats. Data of six male patients with confirmed position-dependent sleep apnea was recorded during three subsequent nights. Personalized position classifiers trained using leave-one-night-out cross-validation on average reached an F1-score of 61.3% for supine/non-supine and an F1-score of 46.2% for supine/lateral-left/lateral-right classification. The generalizable classifiers reached average F1-scores of 62.1% and 49.1% for supine/non-supine and supine/lateral-left/lateral-right classification, respectively. In-bed presence ("bed occupancy") could be detected with an average F1-score of 98.1%. This work shows that personalized sleep-position classifiers trained with data from two nights have comparable performance to classifiers trained with large interpatient datasets. Simple eight-channel sensor mattresses can be used to accurately detect in-bed presence required for closed-loop systems but their use to classify sleep-positions is limited.

Effect of sleep position in term healthy newborns on sudden infant death syndrome and other infant outcomes: A systematic review.

BackgroundThough recommended by numerous guidelines, adherence to supine sleep position during the first year of life is variable across the globe.MethodsThis systematic review of randomized trials and observational studies assessed the effect of the supine compared to non-supine (prone or side) sleep position on healthy newborns. Key outcomes were neonatal mortality, sudden infant death syndrome (SIDS), sudden unexpected death in infancy (SUDI), acute life-threatening event (ALTE), neurodevelopment, and positional plagiocephaly. We searched MEDLINE via PubMed, Cochrane CENTRAL, EMBASE, and CINAHL (updated till November 2021). Two authors separately evaluated the risk of bias, extracted data, and synthesised effect estimates using relative risk (RR) or odds ratio (OR). The GRADE approach was used to assess the certainty of evidence.ResultsWe included 54 studies (43 observational studies and 11 intervention trials) involving 474 672 participants. A single study meeting the inclusion criteria suggested that the supine sleep position might reduce the risk of SUDI (0-1 year; OR = 0.39, 95% confidence interval (CI) = 0.23-0.65; 384 infants), compared to non-supine position. Supine sleep position might reduce the risk of SIDS (0-1 year; OR = 0.51, 95% CI = 0.42-0.61; 26 studies, 59332 infants) and unexplained SIDS/severe ALTE (neonatal period; OR = 0.16, 95% CI = 0.03-0.82; 1 study, 119 newborns), but the evidence was very uncertain. Supine sleep position probably increased the odds of being 0.5 standard deviation (SD) below mean on Gross Motor Scale at 6 months (OR = 1.67, 95% CI = 1.22-2.27; 1 study, 2097 participants), but might have little to no effect at 18 months of age (OR = 1.16, 95% CI = 0.96, 1.43; 1 study, 1919 participants). An increase in positional plagiocephaly at 2-7 months of age with supine sleep position is possible (OR = 2.77, 95% CI = 2.06-3.72; 6 studies, 1774 participants).ConclusionsLow- to very low-certainty evidence suggests that supine sleep position may reduce the risk of SUDI (0-1 year) and SIDS (0-1 year). Limited evidence suggests that supine sleeping probably delays short-term ‘gross motor’ development at 6 months, but the effect on long-term neurodevelopment at 18 months may be negligible.

Sleep Posture Detection Using an Accelerometer Placed on the Neck.

Sleep position monitoring is key when attempting to address posture triggered sleep disorders. Many studies have explored sleep posture detection from a dedicated physical sensing channel exploiting optimum body locations, such as the torso; or alternatively non-contact approaches. But, little work has been done to try to detect sleep position from a body location which, whilst being suboptimal for that purpose, does however allow for better extraction of more critical biomarkers from other sensing modalities, making possible multi-modal monitoring in certain clinical applications. This work presents two different approaches, at varying levels of complexity, for detecting 4 main sleep positions (supine, prone, lateral right and lateral left) from accelerometry data obtained by a single wearable device placed on the neck. An ultra light-weight threshold-based model is presented in this work, in addition to an Extra-Trees classifier. The threshold-based model was able to achieve 95% average accuracy and 0.89 F1-score on out-of-sample data, showing that it is possible to obtain a moderately high classification performance using a simple rule-based model. The ExtraTrees classifier, on the other hand, was able to achieve 99 % average accuracy and 0.99 average F1-score using only 25 base estimators with maximum depth of 20. Both models show promise in detecting sleep posture with high accuracy when collecting the signals from a neck-worn accelerometer sensor.

Investigation of sleep position and triggered movement in patients with benign paroxysmal positional vertigo

Objective:To investigate the characteristics of habitual sleeping position and triggered movement in patients with benign paroxysmal positional vertigo（BPPV）. Methods:The patients with idiopathic tubulitic BPPV who the symptoms were relieved after repositioning were enrolled in this study. The relationship between the side, the tube of otolith detachment and habitual sleeping position and triggered movement was analyzed. Results:①Among the 446 patients, female gender predominated（319 cases, 71.5%）, 41-60 years old group accounted for the highest proportion（192 cases, 43.0%）, and posterior semicircular canal patients accounted for the highest proportion（289 cases, 64.8%）; ②The affected side was associated with habitual sleep postion（P<0.05, ES=0.392）, ipsilateral ear was more common in left or right decubitus; ③There were statistically significant differences in the triggered movement in different types of BPPV（P<0.05, ES=0.380）, BPPV of multiple semicircular canals. Horizontal semicircular canals and posterior semicircular canals were more likely to induce vertigo and nystagmus. Conclusion:Habitual sleeping position and triggered movement could be collected during the diagnosis of BPPV, to predict the affected side and tube. The combination of Roll test and Dix-Hallpike test is more conducive to accurately distinguish the location of otolith shedding.