Cervical Positioning for Reduction of Sleep-Disordered Breathing in Mild-to-Moderate OSAS
Stanford University Sleep Disorders Clinic, Stanford, California 94305-5730, USA. Sleep And Breathing
(Impact Factor: 2.48).
07/2001; 5(2):71-8. DOI: 10.1007/s11325-001-0071-z
The objective of this study was to assess whether cervical positioning could improve mild to moderate cases of the obstructive sleep apnea syndrome (OSAS). Eighteen subjects recruited from a tertiary sleep disorders clinic population with mild to moderate cases of OSAS were evaluated using a custom-fitted cervical pillow designed to increase upper airway caliber by promoting head extension. The subjects used their usual pillows during two consecutive recorded baseline nights in our laboratory. They then used the cervical pillow for 5 days at home and returned for 2 consecutive recorded nights at our laboratory to use the cervical pillow. During the nights in our laboratory, the subjects completed questionnaires, were videotaped to record head and body position, and had full polysomnography. The subjects had a significant trend toward improvement in their respiratory disturbance indices with use of the cervical pillow, despite spending more time in the supine position and having similar amounts of REM sleep in the baseline and experimental conditions. They also had nonsignificant trends toward improvements in their sleep efficiency and subjective depth of their sleep as well as significantly fewer arousals and awakenings in the experimental compared with the baseline condition. We propose that cervical positioning (i.e., head extension) with a custom-fitted cervical pillow provides a simple, noninvasive, and comfortable means of reducing sleep-disordered breathing in patients with mild to moderate OSAS.
Available from: Marco Carotenuto
- "We can postulate that the prevertebral and antero-lumbar MCs could be oversolicited during the apnoic events, and the assumption of abnormal posture could be interpreted as a way to relax or diminish the strain or muscular stress caused by the apneas. In this perspective, during sleep the supine position promotes gravity's effect on the genioglossus muscles leading to increased upper airway collapse and obstructive respiratory events increase in frequency particularly during REM sleep . In fact, in certain patients with OSAS, respiratory events occur with increased frequency during sleep in the supine posture   and during REM sleep  although the latter has been disputed . "
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ABSTRACT: Sleep-related breathing disorders (SRBD) are disorders of breathing during sleep characterized by prolonged partial upper airway obstruction, intermittent complete or partial obstruction (obstructive apnea or hypopnea), or both prolonged and intermittent obstruction that disrupts normal ventilation during sleep, normal sleep patterns, or both. Children with OSAS may sleep in unusual positions, such as seated or with neck hyperextended, even if the neck position is not the only unusual posture or the special sleeping positions that is possible to detect in children with SRBD. We have hypothesized that the assumption of unusual posture during sleep, in particular legs retracting or crossing during sleep, could be a way to enlarge the diaphragmatic excursion and promoting the alveolar gas exchanges avoiding the stress of the antero-lumbar and prevertebral muscular chains in SRBD subjects. We have hypothesized that the assumption of unusual posture during sleep, in particular legs retracting or crossing during sleep, could be a way to enlarge the diaphragmatic excursion and promoting the alveolar gas exchanges avoiding the stress of the antero-lumbar and prevertebral muscular chains in SRBD subjects. We can postulate that the prevertebral and antero-lumbar muscular chains could be oversolicited during the apnoic events, and the assumption of abnormal posture could be interpreted as a way to relax or diminish the strain or muscular stress caused by the apneas. The consequence of this hypothesis could be summarized in the concept that a specific rehabilitation or muscular program to improve the tone of this kinetic chain, could be useful to limit the effect nocturnal or diurnal of this so impacting syndrome.
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- "Based on a literature search (Cartwright, 1984; Jokic et al., 1999; Kushida et al., 2001; Mador et al., 2005; Oksenberg et al., 2006) and a previous pilot study, several determinants of sleep positions to reduce snoring and apnea were selected. These determinants included CVS-HT, SS, and LP. "
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ABSTRACT: A lateral position (LP) during sleep is effective in reducing sleep disorder symptoms in mild or moderate sleep apnea patients. However, the effect of head and shoulder posture in LP on reducing sleep disorders has not been reported. In this study, effective sleeping positions and a combination of sleep position determinants were evaluated with respect to their ability to reduce snoring and apnea. The positions evaluated included the following: cervical vertebrae support with head tilting (CVS-HT), scapula support (SS), and LP. A central composite design was applied for response surface analysis (RSA). Sixteen patients with mild or moderate positional sleep apnea and snoring who underwent polysomnography for two nights were evaluated. Based on an estimated RSA equation, LP (with a rotation of at least 30 degrees) had the most dominant effect [P = 0.0057 for snoring rate, P = 0.0319 for apnea-hypopnea index (AHI)]. In addition, the LP was found to interact with CVS-HT (P = 0.0423) for snoring rate and CVS-HT (P = 0.0310) and SS (P = 0.0265) for AHI. The optimal sleep position reduced mild snoring by more than 80% (i.e. snoring rate in the supine position was <20%) and the snoring rate was approximately zero with a 40 degrees rotation. To achieve at least 80% reduction of AHI, LP and SS should be >30 degrees and/or 20 mm respectively. To determine an effective sleep position, CVS-HT and SS, as well as the degree of the LP, should be concurrently considered in patients with positional sleep apnea or snoring.
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ABSTRACT: We discuss feasibility of temperafure determination with an integrated sensor in ulfrasound (US) interstirial heating. The sensor, a 230-p diameter microthermisor, is epoxied at the tip of the 1..22-mm diameter antenna of the US applicator. Acoustic scans show fhat the acousfic output of the applicator with the integrated sensor is about 10% lower. While the temperatures read with the integrated sensor were much higher compared to microthermistors around the antenna, the shape of the heating curves was very similar. Measurements show that the volume temperatwe can be inferred from the readings of the integrated sensor using, e.g. short interruptions in delivered US power.
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