Sleeping Positions Research Summary (24 Studies)
Warning. Most natural and often medical websites claim that the human body repairs itself during sleep. However, dozens of medical studies, as well as clinical observations, testify that sick people are most likely to die from 4 to 7 am due to heart attacks, strokes, seizures, exacerbations of asthma and COPD, and many other conditions (see the summary of these studies here: Sleep Heavy Breathing Effect). It is also true that over 90% of people have lowest body oxygen levels during early morning hours. Therefore, do not get fooled by those people who advice to sleep more and feel better about sleep. Your health will get worse and worse if your body oxygen drops during sleep.
While most internet sources, including official medical websites, recommend sleeping on one's back
(as a best sleep position), medical evidence (all 24 published studies) revealed worsening of the following health problems due to sleeping on
one's back (supine sleep):
Asthma (Ballard et al, 1991)
Asthma and allergies
in wheezing children (Ponsonby et al, 2004)
Asthma (nocturnal) (D'Alonzo & Ciccolella,
1996)
Back pain in pregnancy (Fast & Hertz,
1992)*
Bruxism and swallowing (Miyawaki et
al, 2003)
Bruxism,
clenching episodes and gastroesophageal reflux (Miyawaki et al, 2004)
Chronic respiratory
insufficiency patients (Ambrogio et al, 2009)
Cough (nocturnal) and
coughing attacks (Bonnet et al, 1995)
GERD (gastroesophageal
reflux disease) (Khoury et al, 1999; Wang et al, 1999)
Geriatric inpatients (Hjalmarsen &
Hykkerud, 2008)*
Heart failure patients with central sleep apnea/Cheyne-Stokes (irregular)
respiration (Joho et al, 2010; Szollosi et al, 2006*)
Irregular or periodic breathing
(Hudgel et al, 1993)
Pregnancy (Trakada et al, 2003)*
Sleep apnea (Ingman et al, 2004; Yoshida, 2000;
Matsuzawa et al, 1995; Miura e tal, 1992; Kavey et al, 1985)
Sleep paralysis
and terrifying hallucinations (Kompanje, 2008; Cheyne, 2002)
Snoring, hypopneas and apneas
(Jan et al, 1994)
Stroke patients with sleep
apnea (Brown et al, 1998)
Stroke (elderly patients)
(Schubert & Héraud, 1994)
Tuberculosis
(pulmonary) treated by thoracoplasty (Brander et al, 1993)*
Press Release: World's Leading Health Media Promotes Disinformation on Best Sleeping Positions (22 Sept 2010)
Criteria for best sleep positions
What are the criteria for choosing best sleep positions? Epidemiological studies found that early morning hours have highest
mortality rates and chances of exacerbations in the sick and severely sick
patients. (Sick people are most likely to die during sleep!) That relates to asthma, COPD, coronary spasms and cardiac arrest,
angina pectoris, stroke, cerebral ischemia and stroke, diabetes, seizures,
inflammatory conditions, inflammation in the amnesic patients, and morning
sickness (for references and quotes visit
Sleep Heavy Breathing Effect). Blood gases abnormalities is the
most common clinical findings in the severely sick just before the death (see
Heavy
Breathing Pattern). Hence, sleep is a deadly poison for the severely
sick and critically ill people.
Even in normal subjects, variety of adverse effects
is normal, and most people can testify that mornings are the time of their health
misery. Blood gases (arterial CO2 and O2 saturation) depend on our automatic
breathing patterns. In several above studies the researchers measured blood oxygen saturation.
These studies are marked
with "*" sign above. It was found in all of them that the supine sleeping position produced the
worst blood oxygenation in comparison with any other body postures (Fast & Hertz, 1992; Hjalmarsen & Hykkerud, 2008; Szollosi et al, 2006; Trakada et al, 2003; Brander et al, 1993).
Best sleeping positions must be
chosen on the basis of the higher body oxygen content.
Hence, light slow inaudible and strictly nasal diaphragmatic breathing is the key
criteria of good sleep and best sleeping positions. It is, indeed, easy to
confirm that, when we are in a state of better health, our breathing during
sleep is lighter and slower so that others cannot hear and see it. Breathing
of sick people, on the other hand is fast and noisy or loud due to elevated
minute ventilation.
You can easily observe this effect, if you regularly pay attention to breathing of your spouse, children and/or relatives and friends during sleep. When they are healthy, their breathing is quiet and relaxed. When they are sick, you can easily hear them.
Which medical professionals consider sleep as a crucial factor for health?
Official mainstream medicine continue to
ignore devastating effects of sleep on health. In my view, there is only one
medical therapy that addresses sleep and sleeping positions, as necessary
parameters to optimize. The name of the technique is the Buteyko breathing method. Each Buteyko
student starts the day with the morning CP test (measuring body oxygen levels
immediately after waking up), while morning CP remains
the main criteria of health for the Buteyko method. This is reflected in
Buteyko Table of Health Zones.
In relation to best sleep positions, Russian doctors and me, while testing own students, found that there is the following approximate relationship between sleeping postures and the body oxygen level:
Prone position: lying with the front or face downward. Supine position: lying down with the face up.
Note that these approximate results do not reflect many other parameters that influence breathing during sleep. For example, sleeping too long in the same position generally leads to reduced body oxygenation. More physical exercise improves one's ability to sleep longer in the same position. Sleeping on hard beds results in more movements and better body oxygenation provided that sleeping on one's back is avoided.
Sitting posture
for sleep (as in an armchair or bus/plane) is the ideal
sleeping posture for breathing and body oxygenation. Russian Buteyko doctors
have the same opinion (e.g., Chief Physician of the Moscow Buteyko Clinic
Andrey Novozhilov, private communication). Honorable Physician and
doctor-therapist of the Moscow Buteyko Clinic Tatiana Alexandrovna Kulik in
her book "Buteyko Method for All" (ISBN: 978-5-9731-0213-5; Moscow,
ASS-Centre; 2010, 124 pages, in Russian) also states that sitting is the
ideal posture for sleep.
Unfortunately, since modern people do not learn it from early childhood, most people find it uncomfortable to use. However, it is very efficient for speedy breathing normalization and can be applied in special circumstances provided that the angle of body inclination remains high. (Motivated patients with strong will power are also able to use it for their better health.)
Conclusions. Based on these findings, it is suggested to avoid sleeping on your back and alternate between 2 best sleep positions: sleeping on your stomach (or chest) and the left side. Note that there are many intermediate positions between chest and left or right side. Indeed, if you prop one of your shoulders with a pillow, you can sleep half-way on your chest and this position is also good for maintaining light and slow breathing and good body oxygenation.
Dr. KP Buteyko suggested that severely sick people should sleep on their stomach or chest, "If patients lie down, then they must lie on their tummy. This compresses the rib cage, abdominal muscles, and the walls of the tummy, thus decreasing respiration." (Dr. Buteyko's lecture at the Moscow State University, 1972)
You can measure the effects of sleeping positions on your body oxygen
If you are uncertain about the suggested best sleep positions, you can measure your CP (body oxygen level) after sleeping in different positions for 10 or more minutes. (Just keep an illuminated electronic clock or ticking clock nearby for counting your CP at night. Then you do not need to turn the light on.) If you find that your CP remains the same or even gets higher after sleeping in certain positions, it is smart to use them for your better health and ignore these and any other statistical findings.
Resources
- How
to Prevent Sleeping on One's back - Simple technique for people with low body oxygen levels
- Internet
Deception
About Ideal Sleep Positions
- Good Sleep Hygiene - Detailed summary
of lifestyle factors for good sleep
References: CO2 Effects Web Pages
Vasodilation: CO2 expands arteries and arterioles facilitating perfusion
(or blood
supply) to all vital organs
The Bohr effect
How and why oxygen is released by red blood cells in tissues
Cell Oxygen Levels and oxygen transport are controlled by
alveolar CO2 and breathing
Oxygen Transport depends on
breathing and these two effects (Vasoconstriction-Vasodilation and the Bohr
effect) are parts of two diagrams that summarize influences of hypocapnia (low CO2
content in the blood and cells) on circulation and O2 delivery
Free Radical Generation takes
place due to anaerobic cell respiration caused by cell hypoxia. Hence,
antioxidant defenses of the human body are also regulated by CO2 and breathing
Inflammatory Response is controlled by
breathing since hypoxia leads to or intensifies chronic inflammation through over-expression
of the hypoxia-inducible factor 1, while normal
breathing reduces these processes
Nerve stabilization takes place due to calmative or
sedative effects of carbon dioxide in neurons or nerve cells
Muscle relaxation or relaxation of muscle cells
is normal at high CO2, while hypocapnia causes muscular tension, poor posture
and, sometimes, aggression and violence
Brochodilation - dilation of
airways (bronchi and bronchioles) by carbon dioxide, and their constriction due
to hypocapnia
CO2: Best Natural Cough Suppressant
and "home remedy" since it calms urge-to-cough nerve receptors located in the
tracheobronchial tree and larynx
Blood
pH regulation and regulation of other bodily fluids
CO2: Lung Damage Healer: Elevated carbon
dioxide prevents injury and promotes healing of lung tissues
CO2: Skin and Tissue Healer
Synthesis of Glutamine
in the Brain, CO2 fixation, and other chemical reactions
CO2 myth
"CO2 is a toxic waste gas" myth
Breathing control
How is our breathing regulated? Why hypocapnia makes breathing uneven and erratic?
Reference Web Pages: Breathing norms, Medical Graphs and Tables about Breathing Rates (Minute Ventilation) and
Body Oxygen in Healthy, Normal and Sick People
Breathing
norms Parameters, graph, and description of the normal
breathing pattern
6 breathing myths 6
myths about breathing and body oxygenation (prevalence: over 90%)
Hyperventilation Definitions of
hyperventilation: their advantages and weak points
Hyperventilation Syndrome in the
Sick. Table
1. Western scientific evidence about prevalence of CHV
(chronic hyperventilation) in patients with various chronic conditions
(34 medical studies)
Normal Minute Ventilation in
Healthy Subjects: Easy and Light Breathing (14 Studies)
Hyperventilation Prevalence Present in Over 90% of
Normal People (24 medical publications)
HV and hypoxia
How and why deep breathing reduces oxygenation of cells and tissues of
all vital organs
Body oxygen test
How to measure your own breathing and body oxygenation (a simple DIY test)
Body oxygen in healthy
Table 4. CP (body oxygen level) in healthy people (27 medical
studies)
Body oxygen in sick Table 5.
CP (body oxygen level) in sick people (14 medical studies)
Buteyko
Table of Health Zones with clinical description of most common zones
Morning HV Morning
hyperventilation effect or how and why critically ill people are most
likely to die during early morning hours
References
Asthma
Am Rev Respir Dis. 1991 Sep;144(3 Pt 1):499-503.
Influence of posture and sustained loss of lung volume on pulmonary function
in awake asthmatic subjects.
Ballard RD, Pak J, White DP.
Departments of Medicine, Denver Veterans Administration Medical Center, CO
80220.
Abstract
Nocturnal worsening occurs commonly in the asthmatic patient population and
contributes substantially to the morbidity and even mortality of asthma.
However, no physiologic process has yet been identified as the major
contributor to this pattern. Sleep is typically associated with both the
supine posture and substantial decrements in lung volume, and both have been
proposed to have a role in the pattern of nocturnal worsening. To assess the
effects of posture and sleep-associated reductions in functional residual
capacity on pulmonary function, eight asthmatic patients were first
monitored overnight in a horizontal volume-displacement body plethysmograph
to determine mean FRC during sleep for each subject. We then compared,
during wakefulness, the effects on FEV1 and methacholine responsiveness from
chest wall and abdomen strapping (to maintain FRC at mean sleep levels) for
6 h in the supine and upright postures. FEV1 was significantly decreased
after strapping in the supine posture (2.54 +/- 0.36 versus 3.38 +/- 0.29 L
on control day, p = 0.0001) but was not affected by strapping in the upright
posture (3.07 +/- 0.30 versus 3.34 +/- 0.31 L on control day, not
significant, NS). Bronchial responsiveness to methacholine was not altered
after strapping in either posture. These observations suggest that the
supine posture, in conjunction with the reduction in lung volume associated
with sleep, may contribute to the nocturnal worsening of asthma.
Asthma and allergies in wheezing children
Pediatrics. 2004 May;113(5):1216-22.
The bedding environment, sleep position, and frequent wheeze in childhood.
Ponsonby AL, Dwyer T, Trevillian L, Kemp A, Cochrane J, Couper D, Carmichael
A.
National Centre for Epidemiology and Population Health, Australian National
University, Canberra ACT, Australia. anne-louise.ponsonby@anu.edu.au
Abstract
OBJECTIVE: Synthetic quilt use has been associated with increased childhood
wheeze in previous studies. Our aim was to examine whether the adverse
effect of synthetic quilt use on frequent wheeze differed by usual sleep
position.
DESIGN, SETTING, AND PARTICIPANTS: A population-based cross-sectional study
of 6378 (92% of those eligible) 7-year-olds in Tasmania, Australia, was
conducted in 1995. Exercise-challenge lung function was obtained on a subset
of 414 children from randomly selected schools. EXPOSURE
MEASURES: Child bedding including pillow and overbedding composition and
usual sleep position by parental questionnaire.
OUTCOME MEASURES: Frequent wheeze (>12 wheeze episodes over the past year),
using the International Study of Asthma and Allergies in Childhood parental
questionnaire, and baseline and postexercise forced expiratory volume in 1
second lung-function measures.
RESULTS: Frequent wheeze (n = 117) was positively associated with synthetic
quilts, synthetic pillows, electric blankets, and sleeping in a bottom bunk
bed but did not vary by sleep position. In a nested case-control analysis,
the association between synthetic quilt use and frequent wheeze differed by
sleep position. Among children who slept supine, synthetic (versus
feather) quilt use was associated with frequent wheeze (adjusted odds ratio:
2.37 [1.08, 5.23]). However, among nonsupine sleepers, overlying
synthetic quilt use was not associated with frequent wheeze (adjusted odds
ratio: 1.06 [0.60, 1.88]). This difference in quilt effect by sleep position
was highly significant. Similarly, synthetic quilt use was associated with
lower postexercise forced expiratory volume in 1 second measures among
supine but not nonsupine sleeping children.
CONCLUSION: An increasing focus on the bedding environment immediately
adjacent to the nose and mouth is required for respiratory disorders
provoked by bedding, such as child asthma characterized by frequent wheeze.
Asthma (nocturnal)
Curr Opin Pulm Med. 1996 Jan;2(1):48-59.
Nocturnal asthma: physiologic determinants and current therapeutic
approaches.
D'Alonzo GE, Ciccolella DE.
Temple University Health Sciences Center, Philadelphia, PA 19140, USA.
Abstract
Asthma has a tendency to destabilize at night in patients that are diurnaly
active and try to sleep at night. As asthma worsens, the expression of this
disease seems to increase at night. Additionally, nocturnal asthmatics have
increased airway hyperresponsiveness and likely more active inflammation at
night as compared with the daytime. Although the cause of nocturnal
asthma cannot be completely explained, there do appear to be a variety of
internal body circadian rhythms that play a role in this disease. Also,
noncircadian rhythmic influences such as sleep, supine posture, snoring, and
gastroesophageal reflux cannot be dismissed. Directing therapy, perhaps
in unique ways, may be essential for the control of nocturnal asthma.
Patients on inhaled corticosteroid therapy or nonsteroidal anti-inflammatory
agents often persist in asthmatic disease expression at night. Long-acting
bronchodilator therapy, either by inhalation or with sustained-release
tablets, is often added to inhaled anti-inflammatory therapy for more
complete 24-hour disease control. Using existing therapies but employing
chronotherapeutic strategies is likely to improve the overall asthma
management. By focusing on nocturnal asthma, we may be able to improve our
understanding of this disease and more effectively control it over each
24-hour period.
Back pain in pregnancy
Am J Reprod Immunol. 1992 Oct-Dec;28(3-4):251-3.
Nocturnal low back pain in pregnancy: polysomnographic correlates.
Fast A, Hertz G.
Department of Physical Medicine and Rehabilitation, St. Vincent's Hospital
and Medical Center, New York, NY 10011.
Abstract
Thirteen women in late stages of pregnancy underwent a polysomnographic
study. Eight women (61%) complained of mild nocturnal back pain or back
discomfort. Five women (39%) did not complain of nocturnal back pain. The
two groups did not differ in total bed time, total sleep time, sleep
latency, and wake after sleep onset (WASO). A significant decrease in rapid
eye movement (REM) sleep and an increase in stage 2 were observed in the
pain group. The same group had a statistically significant decrease in the
basal O2 saturation level. The pain group also spent a longer time
sleeping in the supine position. We hypothesize that a prolonged stay in the
supine position leads to obstruction of the vena cava. In the presence of
inadequate collateral circulation, increased pressure and venostasis in
combination with a decrease in basal oxygen saturation may lead to
hypoxemia, compromise the metabolic supply of the neural structures, and
result in pain. It appears, therefore, that the vascular system plays an
important role in the pathogenesis of pain. The role played by the disturbed
sleep architecture in the production of pain remains to be established. It
is possible that the changes observed in sleep architecture result from pain
rather than contribute to pain production.
Bruxism and swallowing
Sleep. 2003 Jun 15;26(4):461-5.
Association between sleep bruxism, swallowing-related laryngeal movement,
and sleep positions.
Miyawaki S, Lavigne GJ, Pierre M, Guitard F, Montplaisir JY, Kato T.
Facultés de médecine et de médecine dentaire, Université de Montréal,
Québec, Canada.
Abstract
STUDY OBJECTIVE: To describe the relationships of sleep bruxism to
swallowing and sleep positions.
DESIGN: Controlled descriptive study.
SETTING: Polysomnography and audio-video recordings were done in a hospital
sleep laboratory.
PARTICIPANTS: Nine patients with sleep bruxism and 7 normal subjects were
matched for age and sex. Interventions: n/a.
MEASUREMENTS AND RESULTS: During sleep, patients with sleep bruxism showed a
higher frequency of rhythmic masticatory muscle activity episodes (6.8 +/-
1.0 [SEM]/h) than did normals (0.5 +/- 0.1/h, p < 0.01). Swallowing-related
laryngeal movements occurred more frequently in sleep of patients with sleep
bruxism (6.8 +/- 0.8/h) than in normals (3.7 +/- 0.3/h, p < 0.01). In both
groups, during sleep, close to 60% of rhythmic masticatory muscle activity
episodes were associated with swallowing. In sleep bruxism patients, 68% of
swallowing events occurred during rhythmic masticatory muscle activity
episodes, while only 10% of swallowing events were associated with rhythmic
masticatory muscle activity in normal subjects. Sleep bruxism patients and
normals spent 95.5% and 87.3% of sleeping time in the supine and lateral
decubitus positions, respectively. In both groups, up to 96% of rhythmic
masticatory muscle activity and swallowing were observed in the supine and
lateral decubitus position. In sleep bruxism patients, although sleeping
time did not differ between the 2 sleeping body positions, 74% of rhythmic
masticatory muscle activity and swallowing events were scored in the supine
position compared to 23% in the lateral decubitus position.
CONCLUSIONS: During sleep, rhythmic masticatory muscle activity is often
associated with swallowing. In sleep bruxism patients, most of these
oromotor events are observed in the supine position. The physiologic link
between rhythmic masticatory muscle activity and swallowing and the clinical
relevance of sleep position in sleep bruxism management need to be
investigated.
Bruxism, clenching episodes and gastroesophageal reflux
Am J Orthod Dentofacial Orthop. 2004 Nov;126(5):615-9.
Relationships among nocturnal jaw muscle activities, decreased esophageal
pH, and sleep positions.
Miyawaki S, Tanimoto Y, Araki Y, Katayama A, Imai M, Takano-Yamamoto T.
Department of Orthodontics and Dentofacial Orthopedics, Okayama University
Graduate School of Medicine and Dentistry, Okayama, Japan.
Abstract
The purpose of this study was to examine the relationships among nocturnal
jaw muscle activities, decreased esophageal pH, and sleep positions. Twelve
adult volunteers, including 4 bruxism patients, participated in this study.
Portable pH monitoring, electromyography of the temporal muscle, and
audio-video recordings were conducted during the night in the subjects'
homes. Rhythmic masticatory muscle activity (RMMA) episodes were observed
most frequently, with single short-burst episodes the second most frequent.
The frequencies of RMMA, single short-burst, and clenching episodes were
significantly higher during decreased esophageal pH episodes than those
during other times. Both the electromyography and the decreased esophageal
pH episodes were most frequently observed in the supine position. These
results suggest that most jaw muscle activities, ie, RMMA, single
short-burst, and clenching episodes, occur in relation to gastroesophageal
reflux mainly in the supine position.
Chronic respiratory insufficiency patients
Intensive Care Med. 2009 Feb;35(2):306-13. Epub 2008 Sep 16.
Sleep and non-invasive ventilation in patients with chronic respiratory
insufficiency.
Ambrogio C, Lowman X, Kuo M, Malo J, Prasad AR, Parthasarathy S.
University of Torino, Turin, Italy.
Abstract
OBJECTIVE: Noninvasive ventilation with pressure support (NIV-PS) therapy
can augment ventilation; however, such therapy is fixed and may not adapt to
varied patient needs. We tested the hypothesis that in patients with chronic
respiratory insufficiency, a newer mode of ventilation [averaged volume
assured pressure support (AVAPS)] and lateral decubitus position were
associated with better sleep efficiency than NIV-PS and supine position. Our
secondary aim was to assess the effect of mode of ventilation, body
position, and sleep-wakefulness state on minute ventilation (V(E)) in the
same patients.
DESIGN: Single-blind, randomized, cross-over, prospective study.
SETTING: Academic institution.
PATIENTS AND PARTICIPANTS: Twenty-eight patients.
INTERVENTIONS: NIV-PS or AVAPS therapy.
MEASUREMENTS AND RESULTS: Three sleep studies were performed in each
patient; prescription validation night, AVAPS or NIV-PS, and crossover to
alternate mode. Sleep was not different between AVAPS and NIV-PS. Supine
body position was associated with worse sleep efficiency than lateral
decubitus position (77.9 +/- 22.9 and 85.2 +/- 10.5%; P = 0.04). V(E) was
lower during stage 2 NREM and REM sleep than during wakefulness (P <
0.0001); was lower during NIV-PS than AVAPS (P = 0.029); tended to be lower
with greater body mass index (P = 0.07), but was not influenced by body
position.
CONCLUSIONS: In patients with chronic respiratory insufficiency, supine
position was associated with worse sleep efficiency than the lateral decubitus position. AVAPS was comparable to NIV-PS therapy with regard to
sleep, but statistically greater V(E) during AVAPS than NIV-PS of unclear
significance was observed. V(E) was determined by sleep-wakefulness state,
body mass index, and mode of therapy.
Cough (nocturnal) and coughing attacks
Chest. 1995 Aug;108(2):581-5.
Intractable cough associated with the supine body position. Effective
therapy with nasal CPAP.
Bonnet R, Jörres R, Downey R, Hein H, Magnussen H.
Loma Linda University, Division of Pulmonary and Critical Care Medicine, CA
92354, USA.
Abstract
We describe five patients with severe nocturnal cough and daytime
somnolence in whom the coughing attacks are triggered by assuming the supine
body position. Quantity and quality of the nocturnal cough were
evaluated in the sleep laboratory with and without nasal continuous positive
airway pressure (N-CPAP). Air flow characteristics were assessed using flow
volume and airway resistance loops. Airway anatomy was evaluated
bronchoscopically. In all five patients, the cough had a barking quality.
Flow-volume loops showed an expiratory collapse phenomenon in two of the
patients. Endoscopically, all five patients had signs of airway collapse.
All patients had difficulty falling asleep because of coughing and were
awakened by it frequently. Sleep times ranged from 2.5 to 4.5 h per night.
With N-CPAP pressures ranging from 5 to 13 cm H2O, all five patients had
clinically significant improvement in their symptoms. Their sleep times
increased to a range of 5 to 7.5 h per night and the daytime somnolence
markedly improved or resolved. All five patients requested a N-CPAP unit for
home use. We conclude that a cough that is predominantly associated with or
exacerbated by the supine body position may be treated effectively with
N-CPAP.
GERD (gastroesophageal reflux disease)
Am J Gastroenterol. 1999 Aug;94(8):2069-73.
Influence of spontaneous sleep positions on nighttime recumbent reflux in
patients with gastroesophageal reflux disease.
Khoury RM, Camacho-Lobato L, Katz PO, Mohiuddin MA, Castell DO.
Department of Medicine, Graduate Hospital, Philadelphia, Pennsylvania 19146,
USA.
OBJECTIVE: Body position has been shown to influence postprandial and
fasting gastroesophageal reflux (GER) in patients and normal volunteers when
they are assigned to lie in a prescribed position. No published studies have
evaluated the effect of spontaneous sleeping positions on recumbent reflux
in patients with GER.
METHODS: Ten patients, three female and seven male (mean age 47.6 yr, range
30-67 yr) with abnormal recumbent esophageal pH <4 on 24-h pH-metry
participated. A standardized high fat dinner (6 PM) and a bedtime snack (10
PM) were administered to all patients. GER during spontaneous sleep
positions was assessed with a single channel pH probe placed 5 cm above the
lower esophageal sphincter (LES) and with a position sensor taped to the
sternum. Data were recorded with a portable digital data logger (Microdigitrapper-S,
Synectics Medical) and analyzed for recumbent percent time pH <4 and
esophageal acid clearance time in each of four sleeping positions. Time
elapsed between change in sleeping position and GER episodes was also
calculated.
RESULTS: Right lateral decubitus was associated with greater percent time pH
<4 (p < 0.003) and longer esophageal acid clearance (p < 0.05) compared to
the left, supine, and prone. GER episodes were more frequent in the supine
position (p < 0.04) and occurred within 1 min after change in sleeping
position 28% of the time.
CONCLUSIONS: The left lateral decubitus position is preferred in patients
with nocturnal GER. Measures to aid patients in sleeping in this position
should be developed.
Zhonghua Wai Ke Za Zhi. 1999 Feb;37(2):71-3, 3.
[Can esophagogastric anastomosis prevent gastroesophageal reflux]
[Article in Chinese]
Wang Q, Liu J, Zhao X, Lei J, Cong Q, Li W, Li B, Wang F, Cao F, Zhang X,
Zhang H, Zhang H.
Depatment of Thoracic Surgery, Fourth Hospital of Hebei Medical University,
Shijiazhuang 050011.
Abstract
OBJECTIVE: To investigate the possible anti-reflux function of
esophagogastric anastomosis in the patients after receiving resection of
cardiac cancer.
METHODS: One hundred and ninety-two patients were studied by video-assisted
gastroscopy, manometry, 24-h pH esophageal monitoring, radioscintigraphy and
scanning electron microscopy.
RESULTS: Abnormalities were found in 90.2% of patients through endoscopy.
Resting pressure in esophageal body was higher than that in normal controls,
and in the stomach, lower. Twenty-four hour pH monitoring demonstrated that
gastroesophageal reflux (GER) did not occur when the patients slept in
semi-reclining position, and occurred in all patients when slept in supine
position. Scintigraphic study showed that 2/3 of the patients had
reflux, occurrence of which was not affected by the length of postoperative
period. Scanning electron microscopic examination showed that degeneration,
exfoliation of esophageal mucosal epithelial cell, and derangement of
micro-fold and inflammatory oedema of cytomembrane may be directly caused by
reflux.
CONCLUSIONS: GER exists in the majority of the patients after
esophagogastrectomy and esophagogastrostomy for cardiac cancer. The
occurrence of GER is not affected by the length of postoperative period.
Some detecting methods fail to show the existence of GER, and 24-h pH
monitoring is the most reliable method for detecting GER. Sleep in
semireclining position is an effective method of preventing GER in
postoperative patients.
Geriatric inpatients
Age Ageing. 2008 Sep;37(5):526-9. Epub 2008 May 16.
Severe nocturnal hypoxaemia in geriatric inpatients.
Hjalmarsen A, Hykkerud DL.
Department of Medicine, Pulmonary Division, University Hospital of North
Norway, N 9038 Tromsø, Norway. audhild.hjalmarsen@unn.no
Abstract
BACKGROUND: Oxygen levels are decreased in older people especially in the
supine position, and during sleep. Geriatric inpatients often suffer
from stroke and heart disease. Respiratory control may be substantially
affected.
OBJECTIVE: the aim of this study was to examine oxygen levels during night
in inpatients on geriatric medical wards to find out if they needed
nocturnal oxygen therapy.
DESIGN: prospective observational study. Setting/Participants: we
consecutively examined 133 patients with SpO(2) >or=92% in sitting position
by an overnight -8-h pulse oximetry. Patients with severe obesity, dementia
or pulmonary disease were excluded. The test was performed at least 4 days
after the event in stroke cases. Outcome Variables: ninety two patients, m/f
43/49, with mean age 78.3 +/- 6.9 SD completed the test. Sixty six patients
suffered from stroke; 34 left-sided and 19 right-sided stroke. Nine patients
suffered from a heart disease only, and 17 patients suffered from other
diseases.
RESULTS: according to the guidelines for long-term oxygen therapy
recommendations for nocturnal oxygen therapy, we found that 26% of the
patients fulfilled the criteria of SpO(2) <or=90% for >or=30% of the time.
There was a significant positive correlation between age and the amount of
time with SpO(2) between 80 and 84% (0.215, P < 0.05). Diagnosis or
severeness of disease did not significantly affect nocturnal SpO(2) %. The
1-year survival rate was 75% in group I (hypoxaemic) versus 84% in group II
(normoxaemic) (NS).
CONCLUSION: nearly 30% of the inpatients in geriatric medical wards suffered
from severe oxygen-requiring nocturnal hypoxaemia irrespective of diagnosis.
Heart failure patients with central sleep apnea/Cheyne-Stokes (irregular) respiration
Sleep Med. 2010 Feb;11(2):143-8. Epub 2010 Jan 21.
Impact of sleeping position on central sleep apnea/Cheyne-Stokes respiration
in patients with heart failure.
Joho S, Oda Y, Hirai T, Inoue H.
Second Department of Internal Medicine, Toyama University Hospital, Toyama,
Japan. sjoho@med.u-toyama.ac.jp
Abstract
BACKGROUND: The present study determines the influence of sleeping position
on central sleep apnea (CSA) in patients with heart failure (HF).
METHODS: The apnea/hypopnea index (AHI) during different body positions
while asleep was examined by cardiorespiratory polygraphy in 71 patients
with HF (ejection fraction <45%).
RESULTS: Twenty-five of the patients having predominantly CSA (central apnea
index 10/h) with a lower obstructive apnea index (<5/h) were assigned to
groups with positional (lateral to supine ratio of AHI <50%, n=12) or
non-positional (ratio > or = 50%, n=13) CSA. In the non-positional group the
BNP level was higher, the ejection fraction was lower and the
trans-tricuspid pressure gradient was higher than in the positional group.
Multiple regression analysis revealed more advanced age (p=0.006),
log(10)BNP (p=0.017) and lung-to-finger circulation time (p=0.020) as
independent factors of the degree of positional CSA. Intensive treatment for
HF changed CSA from non-positional to positional in all eight patients
tested. Single night of positional therapy reduced CSA (p<0.05) and BNP
level (p=0.07) in seven positional patients.
CONCLUSION: As cardiac dysfunction progresses, severity of CSA also
increases and positional CSA becomes position-independent. Positional
therapy could decrease CSA, thereby having a valuable effect on HF.
Sleep.2006 Aug 1;29(8):1045-51.
Lateral sleeping position reduces severity of central sleep apnea / Cheyne-Stokes
respiration.
Szollosi I, Roebuck T, Thompson B, Naughton MT.
Department of Allergy Immunology and Respiratory Medicine, Alfred Hospital,
Melbourne, Australia.
Abstract
INTRODUCTION: The influence of sleeping position on obstructive sleep apnea
severity is well established. However, in central sleep apnea with Cheyne
Stokes respiration (CSA-CSR) in which respiratory-control instability plays
a major pathophysiologic role, the effect of position is less clear.
STUDY OBJECTIVES: To examine the influence of position on CSA-CSR severity
as well as central and mixed apnea frequency.
METHODS: Polysomnograms with digitized video surveillance of 20 consecutive
patients with heart failure and CSA-CSR were analyzed for total apnea-hypopnea
index, mean event duration, and mean oxygen desaturation according to sleep
stage and position. Position effects on mixed and central apnea index, mean
apnea duration, and mean desaturation were also examined in non-rapid eye
movement sleep.
RESULTS: Data are presented as mean +/- SEM unless otherwise indicated.
Group age was 59.9 +/- 2.3 years, and total apnea-hypopnea index was 26.4
+/- 3.0 events per hour. Compared with supine position, lateral position
reduced the apnea-hypopnea index in all sleep stages (Stage 1, 54.7 +/- 4.2
events per hour vs 27.2 +/- 4.1 events per hour [p < .001]; Stage 2, 43.3
+/- 6.1 events per hour vs 14.4 +/- 3.6 events per hour [p < .001];
slow-wave sleep, 15.9 +/- 6.4 events per hour vs 5.4 +/- 2.9 events per hour
[p < .01]; rapid eye movement sleep, 38.0 +/- 7.3 events per hour vs 11.0
+/- 3.0 events per hour [p < .001]). Lateral position attenuated apnea and
hypopnea associated desaturation (supine 4.7% +/- 0.3%, lateral 3.0% +/-
0.4%; p < .001) with no difference in event duration (supine 25.7 +/- 2.8
seconds, lateral 26.9 +/- 3.4 seconds; p = .921). Mixed apneas were longer
than central (29.1 +/- 2.1 seconds and 19.3 +/- 1.1 seconds; p < .001) and
produced greater desaturation (6.1% +/- 0.5% and 4.5% +/- 0.5%, p = .003).
Lateral position decreased desaturation independent of apnea type (supine
5.4% +/- 0.5%, lateral 3.9% < or = 0.4%; p = .003).
CONCLUSIONS: Lateral position attenuates severity of CSA-CSR. This effect
is independent of postural effects on the upper airway and is likely to be
due to changes in pulmonary oxygen stores. Further studies are required
to investigate mechanisms involved.
Irregular or periodic breathing
J Appl Physiol. 1993 May;74(5):2198-204.
Pattern of breathing and upper airway mechanics during wakefulness and sleep
in healthy elderly humans.
Hudgel DW, Devadatta P, Hamilton H.
Department of Medicine, Case Western Reserve University, Cleveland, Ohio
44109.
Abstract
Elderly subjects are known to be prone to periodic breathing in sleep.
Because periodic breathing may be associated with changes in upper airway
caliber, we hypothesized that oscillations in upper airway caliber
contribute to the increased prevalence of sleep-related periodic breathing
in the elderly. We tested this hypothesis by measuring upper airway
resistance, ventilatory variables, and the pattern of variation of these
variables in groups of body size-matched young and elderly healthy
individuals during wakefulness and stage 2 non-rapid-eye-movement sleep. No
major differences existed between the two groups during either wakefulness
or sleep in mean upper airway resistance or ventilation values. However,
ventilation was more variable during sleep in the elderly; this variability
was oscillatory in the majority of elderly subjects at an average rate of
0.04 breaths/cycle or one cycle approximately every 24 s. Oscillations in
upper airway resistance during sleep were associated with reciprocal
oscillations in tidal volume and/or minute ventilation at the same
frequency. Those subjects who had significant oscillations in upper airway
resistance had more apneas and hypopneas than those subjects without such
oscillations. Oscillations in resistance and ventilation occurred in the
supine but not in the lateral body position. We conclude that the wide
oscillations in upper airway resistance present during sleep in supine
healthy elderly subjects produce a fluctuating mechanical limitation of
ventilation, which may contribute to periodic breathing.
Pregnancy
Eur J Obstet Gynecol Reprod Biol. 2003 Aug 15;109(2):128-32.
Normal pregnancy and oxygenation during sleep.
Trakada G, Tsapanos V, Spiropoulos K.
Division of Obstretrics and Gynecology, University of Patras Medical School,
Patras 26 500, Greece.
Abstract
Pregnancy is associated with significant alterations in respiratory
function. Changes during pregnancy include reduced functional residual
capacity (FRC) and residual volume (RV), increased alveolar-arterial
difference for oxygen (A-alphaPO2) and in the supine position, reduced
cardiac output. In conjunction with sleep-related apneas or hypopneas,
these could lead to maternal oxygen desaturation during sleep. Because of
the conflicting data from sleep studies in late pregnancy, we performed
complete polysomnography on 11 pregnant women at 36 weeks of gestation and
again postpartum. We also measured the PaO2, every 2h. The frequency of
apneas and hypopneas was significantly lower during pregnancy compared with
that on the postpartum control night. PaO2 levels in the supine position,
during sleep, were also significantly lower during pregnancy compared to the
postpartum period. No correlation was observed between PaO2 levels and
apneas or hypopneas or percent of REM sleep.
Sleep apnea
Eur J Orthod. 2004 Jun;26(3):321-6.
Cephalometric comparison of pharyngeal changes in subjects with upper airway
resistance syndrome or obstructive sleep apnea in upright and supine
positions.
Ingman T, Nieminen T, Hurmerinta K.
Department of Pedodontics and Orthodontics, Institute of Dentistry,
Biomedicum Helsinki, University of Helsinki, Finland.
The aim of the present study was to cephalometrically compare pharyngeal
changes between upright and supine positions in patients with upper airway
resistance syndrome (UARS) or obstructive sleep apnea (OSA). Eighty-two OSA
patients, 70 men (mean age 49 +/- 11.8 years) and 12 women (45.9 +/- 8.3
years), underwent cephalometric sleep apnea analysis. One upright and one
supine radiograph were taken of each patient (a total of 164 cephalometric
radiographs). The results showed no significant changes either in naso- or
hypopharyngeal soft tissues between the two positions. In contrast, the
shortest distance from the soft palate (ve1-ve2) and the tip of the soft
palate (u1-u2) to the posterior oropharyngeal wall was significantly
narrower (P < 0.001) in the supine position. Furthermore, in the supine
position a slight thickening in the soft palate (sp1-sp2, P < 0.05) was
detected with no change in the length of the soft palate (PNS-u1). The form
of the tongue changed significantly: it was shorter (Tt-Tgo, P < 0.001;
Tt-va, P < 0.001) and thicker (Ts/Tt-Tgo, P < 0.05) in the supine position.
The present results suggest that OSA patients are prone to significant
narrowing of their oropharyngeal, but not of their naso- or hypopharyngeal,
airways in the supine position. Thus, treatment of OSA and UARS patients
should mainly be aimed at preventing further oropharyngeal airway narrowing
as a result of supine-dependent sleep.
Fortschr Neurol Psychiatr. 2000 Feb;68(2):93-6.
[The relationship between sleep position and therapeutic effect of the
Esmarch-Scheine appliance in sleep apnea syndromes]
[Article in German]
Yoshida K.
Department of Oral and Maxillofacial Surgery, Graduate School of Medicine,
Kyoto University, Japan.
Recently an oral appliance is being used increasingly for the treatment of
sleep apnea syndrome. But the success rate of oral appliance therapy shows
large interindividual difference, and which factors influence its efficiency
remain uncertain. To elucidate the influence of the sleep posture on the
therapeutic effect of the Esmarch device, 58 patients with sleep apnea
syndrome were investigated polysomnographically before and after insertion
of the device. The sleep position during each apnea was classified into
three types; supine, lateral and prone. The mean apnea index (25.6 +/- 18.7)
decreased significantly (p < 0.0001) after insertion of the device (11.5 +/-
12.6). The number of apneas (in the supine and prone) positions was
significantly reduced from 18.0 +/- 16.7 and 2.0 +/- 3.6 to 5.0 +/- 11.2, p
< 0.001, and 0.3 +/- 0.4, p < 0.005, respectively, but that in the lateral
position was slightly increased from 5.6 +/- 9.4 and 6.2 +/- 8.9. The
percent of apneas was 70.3% for supine, 21.9% for lateral, and 7.8% for
prone before therapy and 43.5%, 53.9% and 2.6%, respectively after
therapy. The results indicated that the effectiveness of oral appliance
therapy can differ greatly with the sleep posture. The sleep posture
recorded polysomnography may be important for choice of oral appliance
therapy and its prognosis.
Intern Med. 1995 Dec;34(12):1190-3.
Effect of prone position on apnea severity in obstructive sleep apnea.
Matsuzawa Y, Hayashi S, Yamaguchi S, Yoshikawa S, Okada K, Fujimoto K,
Sekiguchi M.
First Department of Internal Medicine, Shinshu University School of
Medicine, Matsumoto.
We describe a patient with obstructive sleep apnea (OSA) whose apnea-hypopnea
index (AHI) improved remarkably in the prone position accompanied by an
improved sleep quality, despite a higher AHI in the supine position and even
in the lateral position. Magnetic resonance imaging revealed the most
dilated upper airway in the prone position, which suggests the role of
anatomical narrowing of the upper airway as an important component in the
pathophysiology of positional apnea patients. Further studies are needed
to determine the therapeutic efficacy of a prone sleeping position in
patients with OSA.
Thorax. 1992 Jul;47(7):524-8.
Effects of posture on flow-volume curves during normocapnia and hypercapnia
in patients with obstructive sleep apnea.
Miura C, Hida W, Miki H, Kikuchi Y, Chonan T, Takishima T.
First Department of Internal Medicine, Tohoku University School of Medicine,
Sendai, Japan.
Abstract
BACKGROUND: A high ratio of forced expiratory to forced inspiratory maximal
flow at 50% of vital capacity (FEF50/FIF50) may identify upper airway
dysfunction. Since hypercapnia increases the motor activity of airway
dilating muscles its effects on the maximum expiratory and inspiratory
flow-volume curves (MEIFV) in patients with obstructive sleep apnea and in
normal subjects in different postures was studied.
METHODS: The effects of posture on the maximum expiratory and inspiratory
flow-volume curves during the breathing of air and 7% carbon dioxide in 11
patients with obstructive sleep apnea were compared with those in nine
normal subjects. Measurements were made in the sitting, supine, and right
lateral recumbent positions. Forced expiratory flow at 50% vital capacity
(FEF50), forced inspiratory flow at 50% vital capacity (FIF50) and
FEF50/FIF50 were determined.
RESULTS: In the normal subjects FEF50, FIF50, and FEF50/FIF50 were not
affected by change in posture or by breathing carbon dioxide. In the
patients there was a fall in FIF50 and an increase in FEF50/FIF50 when
breathing air in the supine position compared with values in the seated and
lateral position. While they were breathing carbon dioxide there was a
slight increase in FEF50 when patients were seated or in the lateral
position compared with values during air breathing. Hypercapnia abolished
the effects of posture on FEF50/FIF50. Values for FEF50/FIF50 in the supine
position while they were breathing air correlated with the apnoeic index but
not with other polysomnographic data.
CONCLUSION: In patients with obstructive sleep apnea the upper airway is
prone to collapse during inspiration when the patient is supine, even when
awake; this tendency can be reversed by breathing carbon dioxide.
Am J Otolaryngol. 1985 Sep-Oct;6(5):373-7.
Sleeping position and sleep apnea syndrome.
Kavey NB, Blitzer A, Gidro-Frank S, Korstanje K.
Four patients who were evaluated for hypersomnia-sleep apnea syndrome were
found in all-night sleep studies to have obstructive or mixed apneas related
to their sleeping positions. All four were available for comprehensive
follow-up and were subsequently restudied while avoiding the supine
position. Supine, prone, and lateral decubitus apnea indices were calculated
for each patient for each night. The supine sleeping position was
associated with significantly more apneas than the non-supine positions.
Keeping these patients off their backs when they slept was effective
treatment. Additionally, when results of surgical or pharmacologic
treatments of apnea are evaluated, positional apnea indices should be
considered.
Sleep paralysis and terrifying hallucinations
J Sleep Res. 2008 Dec;17(4):464-7. Epub 2008 Aug 5.
'The devil lay upon her and held her down'. Hypnagogic hallucinations and
sleep paralysis described by the Dutch physician Isbrand van Diemerbroeck
(1609-1674) in 1664.
Kompanje EJ.
Department of Intensive Care, Erasmus MC University Medical Center
Rotterdam, Rotterdam, The Netherlands. e.j.o.kompanje@erasmusmc.nl
Abstract
Hypnagogic and hypnopompic hallucinations are visual, tactile, auditory or
other sensory events, usually brief but sometimes prolonged, that occur at
the transition from wakefulness to sleep (hypnagogic) or from sleep to
wakefulness (hypnopompic). Hypnagogic and hypnopompic hallucinations are
often associated with sleep paralysis. Sleep paralysis occurs immediately
prior to falling asleep (hypnagogic paralysis) or upon waking (hypnopompic
paralysis). In 1664, the Dutch physician Isbrand Van Diemerbroeck
(1609-1674) published a collection of case histories. One history with the
title 'Of the Night-Mare' describes the nightly experiences of the
50-year-old woman. This case report is subject of this article. The
experiences in this case could without doubt be diagnosed as sleep paralysis
accompanied by hypnagogic hallucinations. This case from 1664 should be
cited as the earliest detailed account of sleep paralysis associated with
hypnagogic illusions and as the first observation that sleep paralysis and hypnagogic experiences occur more often in supine position of the body.
J Sleep Res. 2002 Jun;11(2):169-77.
Situational factors affecting sleep paralysis and associated hallucinations:
position and timing effects.
Cheyne JA.
Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.
Abstract
Sleep paralysis (SP) entails a period of paralysis upon waking or falling
asleep and is often accompanied by terrifying hallucinations. Two
situational conditions for sleep paralysis, body position (supine, prone,
and left or right lateral decubitus) and timing (beginning, middle, or end
of sleep), were investigated in two studies involving 6730 subjects,
including 4699 SP experients. A greater number of individuals reported SP
[with terrifying hallucinations] in the supine position than all other
positions combined. The supine position was also 3-4 times more common
during SP than when normally falling asleep. The supine position during
SP was reported to be more prevalent at the middle and end of sleep than at
the beginning suggesting that the SP episodes at the later times might arise
from brief microarousals during REM, possibly induced by apnea. Reported
frequency of SP was also greater among those consistently reporting episodes
at the beginning and middle of sleep than among those reporting episodes
when waking up at the end of sleep. The effects of position and timing of SP
on the nature of hallucinations that accompany SP were also examined. Modest
effects were found for SP timing, but not body position, and the reported
intensity of hallucinations and fear during SP. Thus, body position and
timing of SP episodes appear to affect both the incidence and, to a lesser
extent, the quality of the SP experience.
Snoring, hypopneas and apneas
Am J Respir Crit Care Med. 1994 Jan;149(1):145-8.
Effect of posture on upper airway dimensions in normal human.
Jan MA, Marshall I, Douglas NJ.
Respiratory Medicine Unit, University of Edinburgh, United Kingdom.
Abstract
Posture has a major effect on breathing during sleep. Snoring, hypopneas,
and apneas are all more common lying than sitting and more common supine
than in a lateral lying position. Because the effect of the lateral lying
position on upper airway caliber has not previously been studied, we
examined this in 20 normal awake subjects and also determined the effect of
neck position. The acoustic reflection technique was used. Pharyngeal
cross-sectional areas (CSA) fell significantly from the sitting to supine
position (oropharyngeal junction, from 1.65 +/- [SEM] 0.6 cm to 1.31 +/-
0.07 cm), but there was no difference in CSA between the supine and lateral
positions for oropharyngeal junction (1.36 +/- 0.06 cm), mean pharyngeal
area, maximal pharyngeal area, or pharyngeal volume. Neck hyper-extension
significantly increased pharyngeal CSA (e.g., oropharyngeal junction null
position 1.51 +/- 0.08, hyper-extension 1.94 +/- 0.11 cm), but there was no
significant effect of neck flexion on airway CSA. These results confirm that
in normal awake subjects, pharyngeal areas are smaller lying than sitting
but also showed no significant difference between CSA in the supine and
lateral lying positions. The study also demonstrates that the upper airway
caliber increases with neck extension in conscious adults.
Stroke patients with sleep apnea
Stroke. 2008 Sep;39(9):2511-4. Epub 2008 Jul 10.
High prevalence of supine sleep in ischemic stroke patients.
Brown DL, Lisabeth LD, Zupancic MJ, Concannon M, Martin C, Chervin RD.
Cardiovascular Center - Stroke Program, 1500 E. Medical Center Drive - SPC#5855,
Ann Arbor, MI 48109-5855, USA. devinb@umich.edu
BACKGROUND AND PURPOSE: Sleep apnea is very common after stroke and is
associated with poor outcome. Supine sleep is known to exacerbate apneas in
the general sleep apnea population. We therefore investigated the pattern of
sleep positions in the acute stroke period.
METHODS: Inpatients with acute ischemic stroke underwent full
polysomnography that included continuous monitoring of sleep positions.
Sleep apnea severity was measured using the apnea-hypopnea index (AHI).
Stroke severity was measured by the NIH Stroke Scale (NIHSS) at the time of
study enrollment by certified study personnel. Percent total sleep time
spent in the supine position was calculated and compared by stroke severity
based on a median split of NIHSS using a Wilcoxon rank-sum test.
RESULTS: Of the 30 patients, the median age was 67. The median AHI was 23 (IQR:
6, 47). Twenty-two patients (73%) had sleep apnea with an AHI >/=5. The
vast majority of sleep time among the stroke cases was spent supine, with a
median percent sleep time spent supine of 100 (IQR: 62, 100). The
majority (63%) of subjects spent no time asleep in any of the nonsupine
positions (prone, left, right). Median percent sleep time supine was 100 (IQR:
100, 100) in those with a higher NIHSS and 63 (IQR: 51, 100) in those with a
lower NIHSS (P<0.01).
CONCLUSIONS: Given the high prevalence of supine sleep identified,
research into positional therapy for stroke patients with sleep apnea seems
warranted.
Stroke (elderly patients)
Age Ageing. 1994 Sep;23(5):405-10.
The effects of pressure and shear on skin microcirculation in elderly stroke
patients lying in supine or semi-recumbent positions.
Schubert V, Héraud J.
Department of Geriatric Medicine, Huddinge University Hospital, Sweden.
Abstract
The effects of external pressure and shear on the skin microcirculation over
the sacral area, which is known as a high risk area for pressure sore
formation, were studied in 30 elderly patients. The skin blood cell flux (SBF)
was measured using the laser Doppler technique, with the patient first at
rest in lateral position, then lying for 30 minutes in supine or
semi-recumbent 45 degrees position, and finally in lateral position. Elderly
high-risk patients (G2), most of them more than two years post-stroke, had a
lower body mass index and a reduced sacral skin-fold compared with non-risk
patients (G1). The SBF in G2 decreased 28% in supine and 14% in 45 degrees
position, whereas the SBF in G1 increased 35% in supine and 13% in 45
degrees position. Spontaneous movements up to seven times per 30 minutes
were registered, even during sleep, and were evident by direct observation
of the recorded charts as a temporary SBF increase. The risk for skin
ischaemic damage over the sacral area of elderly risk patients was evident
in both positions, especially with the patients lying in supine position.
When increasing the upper body slope in G2 from horizontal to 45 degrees, an
inability to recover a satisfactory blood supply after the ischaemic insult
was found. Discomfort from compressive and shear forces initiates changes in
posture, even in elderly patients prone to tissue breakdown. Occasional
relief of pressure was in most patients followed by temporary increase in
skin blood flow with concomitant temperature increase. This most probably
protected them from developing skin lesions.
Tuberculosis (pulmonary) treated by thoracoplasty
Respiration. 1993;60(6):325-31.
Nocturnal oxygen saturation and sleep quality in long-term survivors of
thoracoplasty.
Brander PE, Salmi T, Partinen M, Sovijärvi AR.
Department of Pulmonary Medicine, University of Helsinki, Finland.
Abstract
The extent and the predictors of nocturnal hypoxemia were studied in 9 men
and 11 women treated for pulmonary tuberculosis by thoracoplasty 30-54 years
previously. The patients had a scoliotic (Cobb) angle of 4-53 degrees.
Median values for pulmonary function were: forced expiratory volume in 1 s
1.2 liters (49% of the predicted value), vital capacity 1.9 liters (54%),
total lung capacity 3.6 liters (62%), and supine waking partial pressure for
arterial oxygen 9.7 kPa. Four patients were hypercapnic. The patients' mean
nocturnal SaO2 ranged from 83 to 94% (median 91.8%), and the SaO2 level
below which the patients spent 10% of the total nocturnal recording time
ranged from 78 to 92% (median 89.4%). A multiple stepwise linear
regression analysis identified supine waking SaO2 as a significant predictor
of nocturnal O2 desaturation, accounting for about 80% of the variability in
nocturnal SaO2 levels; lung function values and Cobb angle were not
significant independent predictors. The sleep quality, assessed by EEG,
was good. It is concluded that in thoracoplasty patients with mild hypoxemia
during wakefulness, the degree of sleep-related oxygen desaturation was
modest and closely related to the waking level of SaO2.
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