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Background & Aims: The aim of the study was to evaluate the effect of an electronic positional therapy wearable device on nocturnal gastroesophageal reflux measured by pH‐impedance reflux monitoring. Methods: We performed a single‐center, prospective, interventional study in 30 patients with nocturnal reflux symptoms and a nocturnal esophageal acid exposure time (AET) ≥1.5% measured off acid‐suppressive medication by ambulatory pH‐impedance reflux monitoring. Patients were treated with an electronic positional therapy wearable device for 2 weeks. The device vibrates in the right lateral decubitus position so it conditions patients to avoid that sleep position. After 2 weeks treatment, the pH‐impedance study was repeated. Primary outcome was the change in nocturnal AET. Secondary outcomes include change in number of reflux episodes and reflux symptoms. Results: Complete data were available for 27 patients (13 females, mean age 49.8 years). The median nocturnal AET decreased from 6.0% (IQR, 2.3–15.3) to 3.1% (0.1–10.8) after 2 weeks of treatment (p = 0.079). The number of reflux episodes was significantly reduced after 2 weeks of treatment (baseline: 8.0 (3.0–12.3) vs. end: 3.0 (1.0–8.0); p = 0.041). Treatment led to a statistically significant decrease in time spent in right lateral decubitus position (baseline: mean 36.9% ± 15.2% vs. end: 2.7% ± 8.2%; p = <0.001) and an increase in the left lateral decubitus position (baseline 29.2% ± 14.8% vs. end: 63.3% ± 21.9%; p = <0.001). Symptom improvement was reported by 70.4% of the patients. Conclusions: Sleep positional therapy using an electronic wearable device promotes sleeping in the left lateral decubitus position and improves reflux parameters measured by pH‐impedance reflux monitoring. [ABSTRACT FROM AUTHOR]

Objectives This prospective, population-based cohort study aimed to investigate the development of facial asymmetry up to 6 years of age using a three-dimensional (3D) soft tissue imaging method in a normal population. In addition, the study sought to identify potential predisposing factors to facial asymmetry. Methods A total of 102 newborns were enrolled in the study at birth. 3D stereophotogrammetric images of the head and face were analysed at the ages of 12 months (T1), 3 years (T2), and 6 years (T3). The surface-based analysis involved the calculation of the average distance (mm) and the symmetry percentage (%) between the original and mirrored surfaces. For landmark-based analysis, the distance of facial landmarks to the facial midline was examined. Results The final analysis included 70 (68.6%) subjects. Surface-based analysis showed a significant improvement of facial symmetry from T1 to T3 in all facial areas. Landmark-based analysis showed that upper facial landmarks were located, on average, slightly on the left and lower facial landmarks slightly on the right in relation to the facial midline (P < 0.001). Limitations The size of the study population was limited. Facial posture may affect the reliability of the results, especially in younger children. Conclusion Facial asymmetry is detectable in early childhood and tends to reduce with age in young children. The lower face deviates slightly to the right, and the upper face to the left in relation to the facial midline. Possible predisposing factors for facial asymmetry at the age of 6 years include deformational plagiocephaly, sleeping position, and previous facial asymmetry. [ABSTRACT FROM AUTHOR]

Instantaneous heart rate (IHR) has been investigated for sleep applications, such as sleep apnea detection and sleep staging. To ensure the comfort of the patient during sleep, it is desirable for IHR to be measured in a contact-free fashion. In this work, we use speckle vibrometry (SV) to perform on-skin and on-textile IHR monitoring in a sleep setting. Minute motions on the laser-illuminated surface can be captured by a defocused camera, enabling the detection of cardiac motions even on textiles. We investigate supine, lateral, and prone sleeping positions. Based on Bland–Altman analysis between SV cardiac measurements and electrocardiogram (ECG), with respect to each position, we achieve the best limits of agreement with ECG values of [−8.65, 7.79] bpm, [−9.79, 9.25] bpm, and [−10.81, 10.23] bpm, respectively. The results indicate the potential of using speckle vibrometry as a contact-free monitoring method for instantaneous heart rate in a setting where the participant is allowed to rest in a spontaneous position while covered by textile layers. [ABSTRACT FROM AUTHOR]

The goal was to perform a 10-year retrospective study on the correlation between sleep disordered breathing (SDB) and upper airway dimensions, as well as the relation between SDB status and TMJ position. The study also examined links between airway dimensions and TMJ position. Patients were categorized into Control (n = 28) or SDB (n = 45). Cone beam (CBCT) data was analyzed using InVivo5™. Although there were distinctive features within the SDB group, these did not show a correlation of significance with airway dimensions. SDB patients were more likely to have their condyles posteriorly seated. Other factors, such as presence of TMD, limited mouth opening, and pain upon palpation of masticatory muscles also significantly affected the TMJ position. Volumetric airway analysis showed links to TMJ position. SDB patients have a smaller airway volume and have a significant relationship between airway volume and TMJ position with their condyles seated more posteriorly. [ABSTRACT FROM AUTHOR]

Sleep is extremely important for physical and mental health. Although polysomnography is an established approach in sleep analysis, it is quite intrusive and expensive. Consequently, developing a non-invasive and non-intrusive home sleep monitoring system with minimal influence on patients, that can reliably and accurately measure cardiorespiratory parameters, is of great interest. The aim of this study is to validate a non-invasive and unobtrusive cardiorespiratory parameter monitoring system based on an accelerometer sensor. This system includes a special holder to install the system under the bed mattress. The additional aim is to determine the optimum relative system position (in relation to the subject) at which the most accurate and precise values of measured parameters could be achieved. The data were collected from 23 subjects (13 males and 10 females). The obtained ballistocardiogram signal was sequentially processed using a sixth-order Butterworth bandpass filter and a moving average filter. As a result, an average error (compared to reference values) of 2.24 beats per minute for heart rate and 1.52 breaths per minute for respiratory rate was achieved, regardless of the subject's sleep position. For males and females, the errors were 2.28 bpm and 2.19 bpm for heart rate and 1.41 rpm and 1.30 rpm for respiratory rate. We determined that placing the sensor and system at chest level is the preferred configuration for cardiorespiratory measurement. Further studies of the system's performance in larger groups of subjects are required, despite the promising results of the current tests in healthy subjects. [ABSTRACT FROM AUTHOR]

Objective: This research has been carried out to investigate the factors affecting the sleep of babies between 0-2 years of age. Materials and Method: The participants of the study are composed of 60 mothers with babies between the ages of 0-2 years who applied to a family health center in the Beykoz district of Istanbul Provincial Health Directorate to have their children or themselves examined or treated. The research is a descriptive study that uses the convenience sampling technique. The researcher and advisor prepared two forms for use in the study. The questions on the Parent-Baby Information Form are intended for learning the parents' and babies' sociodemographic information, and the Mother Interview Form contains qualitative and quantitative questions that were prepared to collect information about the factors affecting their babies' sleep patterns. The research findings were obtained using mixed methods and analyzed using the program SPSS. Frequency analyses and chi-squared tests were also used to analyze the data. The analysis results consider p values less than 0.05 (p = 0.05) to be statistically significant. Results: The mothers were mostly determined to simultaneously regulate the environmental sounds and lights in their babies' sleep environment, with the majority of them putting their babies in their cribs in the same room as them. The study learned that the majority of mothers accompany their babies when they go to sleep, and most of the babies have difficulty falling asleep at night. Most of the babies were determined to fall asleep at night by suckling on their mother's breast and to prefer a pacifier as a sleeping aid after falling asleep at night. According to the research results, when comparing the babies' sleeping positions at monthly intervals, a statistically significant difference was seen to occur between them (p=0.025). Conclusion: The study results reflect the perceptions of the mothers in the sample group regarding their babies' sleep patterns, sleep routines, sleep environments, and sleep hygiene. In addition, the chi-squared results showed the monthly intervals to affect the babies' sleep positions. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the involvement of the mesencephalic superior colliculus (SC) in the pathogenetic mechanism of SIDS, a syndrome frequently ascribed to arousal failure from sleep. We analyzed the brains of 44 infants who died suddenly within the first 7 months of life, among which were 26 infants with SIDS and 18 controls. In-depth neuropathological investigations of serial sections of the midbrain showed the SC layered cytoarchitectural organization already well known in animals, as made up of seven distinct layers, but so far never highlighted in humans, albeit with some differences. In 69% of SIDS cases but never in the controls, we observed alterations of the laminar arrangement of the SC deep layers (precisely, an increased number of polygonal cells invading the superficial layers and an increased presence of intensely stained myelinated fibers). Since it has been demonstrated in experimental studies that the deep layers of the SC exert motor control including that of the head, their developmental disorder could lead to the failure of newborns who are in a prone position to resume regular breathing by moving their heads in the sleep-arousal phase. The SC anomalies highlighted here represent a new step in understanding the pathogenetic process that leads to SIDS. [ABSTRACT FROM AUTHOR]

Background: There is very little information on the beliefs and perceptions of mothers about SIDS and its related risk factors in Africa. To better understand parental decisions about infant sleep practices and other risk factors for SIDS, we conducted focus group discussions (FGDs) with mothers of infants in Lusaka, Zambia. Methods: FGDs involved 35 purposively sampled mothers aged 18–49 years. FGDs were conducted using a semi-structured interview guide in the local language, Nyanja. These were translated, transcribed verbatim into English, and then coded and analyzed using thematic analysis in NVivo 12. Results: Six FGDs were conducted with 35 mothers in April-May 2021 across two study sites. FGD Participants were generally aware of sudden unexplained infant deaths, with several describing stories of apparent SIDS in the community. The side sleeping position was preferred and perceived to be safer for the infant with most believing the supine position posed an aspiration or choking risk to the infant. Bedsharing was also preferred and perceived to be convenient for breastfeeding and monitoring of the infant. Experienced family members such as grandmothers and mothers-in-law, and health care workers were frequently cited as sources of information on infant sleep position. A heightened awareness of the infant's sleeping environment was suggested as a mechanism to prevent SIDS and smothering. Conclusions: Decisions about bedsharing and infant sleep position were guided by maternal beliefs and perceptions about what is convenient for breastfeeding and safer for the infant. These concerns are vital to designing tailored interventions to address sleep-related sudden infant losses in Zambia. Public health campaigns with tailored messages that address these concerns are likely to be effective at ensuring optimal uptake of safe sleep recommendations. [ABSTRACT FROM AUTHOR]

The field of circadian research on Restless Legs Syndrome (RLS) and periodic limb movements (PLMs) is reviewed in general. RLS has five obligatory criteria for diagnosis: (1) an urge to move the legs often accompanied by uncomfortable leg sensations; (2) symptoms are worse at rest, i.e., lying or sitting; (3) there is a least partial and temporary relief of symptoms by activity, e.g., walking or stretching or bending the legs; (4) symptoms are worse later in the day or at night; and (5) mimics of RLS such as leg cramps and positional discomfort should be excluded by history and physical. In addition, RLS is frequently accompanied by PLMs, either periodic limb movements of sleep (PLMS) as determined by polysomnography or periodic limb movements while awake (PLMW) as determined by the suggested immobilization test (SIT). Since the criteria for RLS were based upon clinical experience only, an early question after the development of the criteria was whether criteria 2 and 4 were the same or different phenomena. In other words, were RLS patients worse at night only because they were lying down, and were RLS patients worse lying down only because it was night? Early circadian studies performed during recumbency at different times of the day suggest that the uncomfortable sensations, PLMS, and PLMW as well as voluntary movement in response to leg discomfort follow a similar circadian pattern with worsening at night independent of body position and independent of sleep timing or duration. Other studies demonstrated that RLS patients get worse when sitting or lying down independent of the time of day. These studies as a whole suggest that the worsening at rest and the worsening at night criteria for RLS are related but separate phenomena and that criteria 2 and 4 for RLS should be kept separate based upon the circadian studies, as had been the case previously based upon clinical grounds alone. Tomore fully prove the circadian rhythmicity of RLS, studies should be conducted to see if bright light shifts the signs and symptoms of RLS to a different circadian time in concert with circadian markers. [ABSTRACT FROM AUTHOR]

Keratoconus is a complex and multifactorial disease and its exact aetiology remains unknown. This current study examined the important environmental risk factors and their association with keratoconus. This study was registered in the PROSPERO International Prospective Register of systematic reviews under registration number CRD42021256792 in 2021. Scopus, Web of Science, PubMed, and Cochrane CENTRAL databases were searched for all relevant articles published from 1 January 1900 to 31 July 2021. National Institutes of Health Quality Assessment Tool was used to assess the methodological quality of the studies. The assessment for statistical heterogeneity was assessed using the Z-statistics on RevMan v5.4. P-value of <0.05 was considered as statistically significant and I2 < 25% as homogenous. Thirty studies were included in this meta-analysis. Pooled odds ratio was calculated with 95% CI. The pooled odds ratio (OR) of eye rubbing, atopy, asthma, and eczema was 3.64 (95% CI, 2.02, 6.57), 1.90 (95% CI, 1.22, 2.94), 1.36 (95% CI, 1.15, 1.61) and 1.90 (95% CI, 1.22, 2.94), respectively. The OR for diabetes was 0.86 (95% CI 0.73, 1.02), and use of sunglasses, contact lens, allergic conjunctivitis, side sleep position and prone sleep position was 0.40 (95% CI, 0.16, 0.99), 1.68 (0.70, 4.00), 2.24 (95% CI, 0.68, 7.36), 3.81 (95% CI, 0.31, 46.23), 12.76 (95% CI, 0.27, 598.58), respectively. Twenty studies were considered to be of high quality, nine to be moderate and one to be low. Environmental risk factors have been identified to play a role in the susceptibility of keratoconus. However, further large-scale longitudinal studies are needed to understand the mechanisms between environmental risk factors and keratoconus. [ABSTRACT FROM AUTHOR]

Emerging data suggest that determination of physiologic endotypic traits (eg, loop gain) may enable precision medicine in OSA. Does a single-night assessment of polysomnography-derived endotypic traits provide reliable estimates in moderate to severe OSA? Two consecutive in-lab polysomnography tests from a clinical trial (n = 67; male, 69%; mean ± SD age, 61 ± 10 years; apnea-hypopnea index [AHI] 53 ± 22 events/h) were used for the reliability analysis. Endotypic traits, reflecting upper airway collapsibility (ventilation at eupneic drive [V passive ]), upper airway dilator muscle tone (ventilation at the arousal threshold [V active ]), loop gain (stability of ventilatory control, LG1), and arousal threshold (ArTh) were determined. Reliability was expressed as an intraclass correlation coefficient (ICC). Minimal detectable differences (MDDs) were computed to provide an estimate of maximum spontaneous variability. Further assessment across four repeated polysomnography tests was performed in a subcohort (n = 22). Reliability of endotypic traits between the two consecutive nights was moderate to good (ICC: V passive = 0.82, V active = 0.76, LG1 = 0.72, ArTh = 0.83). Variability in AHI, but not in body position or in sleep stages, was associated with fluctuations in V passive and V active (r = –0.49 and r = –0.41, respectively; P <.001 for both). MDDs for single-night assessments were: V passive = 22, V active = 34, LG1 = 0.17, and ArTh = 21. Multiple assessments (mean of two nights, n = 22) further reduced MDDs by approximately 20% to 30%. Endotypic trait analysis using a single standard polysomnography shows acceptable reliability and reproducibility in patients with moderate to severe OSA. The reported MDDs of endotypic traits may facilitate the quantification of relevant changes and may guide future evaluation of interventions in OSA. [ABSTRACT FROM AUTHOR]

Introduction: Twin pregnancies have significantly higher rates of perinatal morbidity and mortality compared to singleton pregnancies; current attempts to reduce perinatal mortality have been less successful in twin pregnancies. The paucity of information about modifiable risk factors for adverse neonatal outcomes in twin pregnancies, as well as independent effects of chorionicity may have contributed to this outcome. This study aimed to explore the feasibility of an observational study to identify modifiable factors associated with adverse neonatal outcomes in twin pregnancies. Material and methods: Patients pregnant with twins at six UK hospitals between December 2019–March 2021 completed researcher‐administered questionnaires at approximately 20‐, 28‐ and 36‐weeks' gestation, recording a wide range of self‐reported social, lifestyle and demographic factors, alongside prospectively recorded clinical data from maternity records. Descriptive statistics were used to describe frequencies of exposures; logistic regression was used to determine whether factors were associated with a composite measure of adverse neonatal outcome. Results: Data were collected from 65% (181/277) of eligible participants. A total of 98% (175) of participants had positive views about their participation. Some exposures, including cigarette smoking, supine sleep position and reduced fetal movements were less frequent in twin pregnancies compared to singletons, whereas fertility treatment was more common. Furthermore, different patterns of exposure were seen between monochorionic and dichorionic twins. This pilot study found some associations with adverse neonatal outcomes including: low BMI (OR 8.36, 95% CI: 1.02–68.87), maternal age ≥41 years (OR 9.0 95% CI: 1.07–75.84), maternally perceived high‐stress levels (OR 1.96, 95% CI: 1.03–3.75) and inadequate antenatal screening (OR 1.44, 95% CI: 1.01–2.06). Sleep duration ≥9 h and right‐sided going to sleep position were more frequent among pregnancies with adverse outcomes. Participants who reported receiving no information on fetal movement and reduced maternal perception of movements were more likely to have an adverse outcome, but sample size prohibited analysis based upon chorionicity. Conclusions: An observational study of modifiable factors in twin pregnancy is feasible. Differences in the frequencies of exposures between twin and singleton pregnancies highlight the need for twin‐specific studies to identify modifiable factors and develop preventative strategies for morbidity and mortality in twin pregnancies. [ABSTRACT FROM AUTHOR]

Sleep disorders can impact daily life, affecting physical, emotional, and cognitive well-being. Due to the time-consuming, highly obtrusive, and expensive nature of using the standard approaches such as polysomnography, it is of great interest to develop a noninvasive and unobtrusive in-home sleep monitoring system that can reliably and accurately measure cardiorespiratory parameters while causing minimal discomfort to the user's sleep. We developed a low-cost Out of Center Sleep Testing (OCST) system with low complexity to measure cardiorespiratory parameters. We tested and validated two force-sensitive resistor strip sensors under the bed mattress covering the thoracic and abdominal regions. Twenty subjects were recruited, including 12 males and 8 females. The ballistocardiogram signal was processed using the 4th smooth level of the discrete wavelet transform and the 2nd order of the Butterworth bandpass filter to measure the heart rate and respiration rate, respectively. We reached a total error (concerning the reference sensors) of 3.24 beats per minute and 2.32 rates for heart rate and respiration rate, respectively. For males and females, heart rate errors were 3.47 and 2.68, and respiration rate errors were 2.32 and 2.33, respectively. We developed and verified the reliability and applicability of the system. It showed a minor dependency on sleeping positions, one of the major cumbersome sleep measurements. We identified the sensor under the thoracic region as the optimal configuration for cardiorespiratory measurement. Although testing the system with healthy subjects and regular patterns of cardiorespiratory parameters showed promising results, further investigation is required with the bandwidth frequency and validation of the system with larger groups of subjects, including patients. [ABSTRACT FROM AUTHOR]

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Herein, moribund mud crab (Scylla serrata) samples were collected from various farming systems, brooders from wild and hatchery quarantine section, located in Tamil Nadu, Andhra Pradesh, and Odisha. The infected crabs showed clinical signs of lethargic movement with the sleeping position in the culture ponds, tanks, and wild-caught. In the wet mount study, massive numbers of viral giant cells were observed in the infected crab hepatopancreas and connective tissue. Mud crab reovirus (MCRV) inclusion bodies were noticed in the connective tissue of hepatopancreas, gill lamellae, muscle and gonads in histopathology analysis. Also, viral particles proliferated into the cytoplasm of the cells, but they did not affect the host nuclei. The infected crab samples were confirmed in the PCR using specific primers (ReoF and ReoR) and rDNA sequence analysis showed 99% similarity with mud crab reovirus and Scylla serrata reovirus (OL466868 and OL466869). The ultrastructural study (TEM) revealed that MCRV viral particles ranged between 70 and 75 nm in diameter, icosahedral shape, and non-enveloped with two capsid layers located in the cytoplasm of the cells. The prevalence of mud crab reovirus infection was recorded between 80 and 100% in cultured farms within 25 days and 19–33% in the wild from the collected samples. In the pathogenicity study, intramuscular injection bioassay reached 100% mortality and a co-habitation assay was 70% mortality on 14 days of MCRV post-infection. Thus, our results suggest that MCRV is highly pathogenic to mud crab culture. [ABSTRACT FROM AUTHOR]

Purpose: The assessment of sleep biomechanics (comprising movement and position during sleep) is of interest in a wide variety of clinical and research settings. However, there is no standard method by which sleep biomechanics are measured. This study aimed to (1) compare the intra- and inter-rater reliability of the current clinical standard, manually coded overnight videography, and (2) compare sleep position recorded using overnight videography to sleep position recorded using the XSENS DOT wearable sensor platform. Methods: Ten healthy adult volunteers slept for one night with XSENS DOT units in situ (on their chest, pelvis, and left and right thighs), with three infrared video cameras recording concurrently. Ten clips per participant were edited from the video. Sleeping position in each clip was coded by six experienced allied health professionals using the novel Body Orientation During Sleep (BODS) Framework, comprising 12 sections in a 360-degree circle. Intra-rater reliability was assessed by calculating the differences between the BODS ratings from repeated clips and the percentage who were rated with a maximum of one section of the XSENS DOT value; the same methodology was used to establish the level of agreement between the XSENS DOT and allied health professional ratings of overnight videography. Bennett's S-Score was used to assess inter-rater reliability. Results: High intra-rater reliability (90% of ratings with maximum difference of one section) and moderate inter-rater reliability (Bennett's S-Score 0.466 to 0.632) were demonstrated in the BODS ratings. The raters demonstrated high levels of agreement overall with the XSENS DOT platform, with 90% of ratings from allied health raters being within the range of at least 1 section of the BODS (as compared to the corresponding XSENS DOT produced rating). Conclusions: The current clinical standard for assessing sleep biomechanics, manually rated overnight videography (as rated using the BODS Framework) demonstrated acceptable intra- and inter-rater reliability. Further, the XSENS DOT platform demonstrated satisfactory levels of agreement as compared to the current clinical standard, providing confidence for its use in future studies of sleep biomechanics. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

To investigate the effect of frequently reported between-individual (viz., age, gender, body mass index [BMI], and apnea-hypopnea index [AHI]) and within-individual (viz., sleep stage and sleep position) snoring sound-related factors on snoring sound parameters in temporal, intensity, and frequency domains. This study included 83 adult snorers (mean ± SD age: 42.2 ± 11.3 yrs; male gender: 59%) who underwent an overnight polysomnography (PSG) and simultaneous sound recording, from which a total of 131,745 snoring events were extracted and analyzed. Data on both between-individual and within-individual factors were extracted from the participants' PSG reports. Gender did not have any significant effect on snoring sound parameters. The fundamental frequency (FF; coefficient = −0.31; P = 0.02) and dominant frequency (DF; coefficient = −12.43; P < 0.01) of snoring sounds decreased with the increase of age, and the second formant increased (coefficient = 22.91; P = 0.02) with the increase of BMI. Severe obstructive sleep apnea (OSA; AHI ≥30 events/hour), non-rapid eye movement sleep stage 3 (N3), and supine position were all associated with more, longer, and louder snoring events (P < 0.05). Supine position was associated with higher FF and DF, and lateral decubitus positions were associated with higher formants. Within the limitations of the current patient profile and included factors, AHI was found to have greater effects on snoring sound parameters than the other between-individual factors. The included within-individual factors were found to have greater effects on snoring sound parameters than the between-individual factors under study. • Sleep stage and sleep position have significant effects on snoring sound. • Gender did not have significant effect on snoring sound. • Severe OSA, N3 stage, and supine position relate to more and louder snoring sounds. • Positional therapy should be considered for all snorers. [ABSTRACT FROM AUTHOR]

Based on the pressure distributions in the head, neck, and upper body and the spine support values, this study aims to recommend the most suitable pillow for those with forward head posture (FHP) according to different sleeping positions. This descriptive cross-sectional study recruited thirty healthy 18- to 55-year-old men and women with body mass indexes of less than 30 kg/m2. Participants tried five different pillows (viscose, fiber, cotton, goose feather, and wool) on a medium-firm hybrid mattress at room temperature with a humidity of 45–55%. Participants tried the pillows first in the supine position, then side-lying, and finally in the prone position. A pressure-mapping system was utilized to measure the pressure distributions of the head and shoulder areas in millimeters of mercury (mmHg) and the amount of support provided by the pillow to these regions in square centimeters (cm2). When the comfort and support parameters of different pillow materials were compared among all participants, for the supine position, Pillow B and Pillow E provided higher head comfort (p < 0.001), while Pillow A and Pillow E provided higher shoulder support (p = 0.044). In the side-lying position, Pillow B provided higher head comfort (p < 0.001) and Pillow C (p = 0.003) higher shoulder comfort. In the prone position, Pillow B and Pillow E provided higher head comfort (p < 0.001), while Pillow E also provided higher shoulder support (p = 0.002). This study showed pillow materials affect the spine comfort and support of the participants, and these values may vary according to different spinal alignments, such as FHP. According to the preferred sleeping position, the pillow material that supports the spine and its comfort and support values may also change. [ABSTRACT FROM AUTHOR]

Sleep provides a positive effect for the development of the baby because it can stimulate the growth of the baby's brain. This study aims to identify the effect of baby massage toward baby sleep patterns. The researchquasy experiments with a sample number of 33 babies. The sampling technique used total sampling with data analysis t-dependent test and Mc Nemar test. The resultsin the sleeping position of babies before and after the massage where the time needed for the baby to fall asleep = 18.33 minutes (p value = 0.001), the total sleep for babies in 24 hours = 13.36 hours (p value = 0.008), the number of hours of sleep for infants at night = 9.78 hours (p value = 0.015), the frequency of babies waking at night = 3 times (p value = 0.008), and the majority of babies waking up did not cry (p value = 0.000). The results of this study prove that baby massage has an effect on baby's sleep patterns. Therefore it is important for midwifery officers to inform and teach baby massage techniques to the baby's parents so that it helps in overcoming the baby's sleep problems. [ABSTRACT FROM AUTHOR]

In the last 3 years, almost all medical resources have been reserved for the screening and treatment of patients with coronavirus disease (COVID-19). Due to a shortage of medical staff and equipment, diagnosing sleep disorders, such as obstructive sleep apnea (OSA), has become more difficult than ever. In addition to being diagnosed using polysomnography at a hospital, people seem to pay more attention to alternative at-home OSA detection solutions. This study aims to review state-of-the-art assessment techniques for out-of-center detection of the main characteristics of OSA, such as sleep, cardiovascular function, oxygen balance and consumption, sleep position, breathing effort, respiratory function, and audio, as well as recent progress in the implementation of data acquisition and processing and machine learning techniques that support early detection of severe OSA levels. [ABSTRACT FROM AUTHOR]

Primary snoring impacts a significant portion of the adult population and has the potential to significantly impair quality of life. The purpose of these guidelines is to provide evidence‐based recommendations to assist Australasian practitioners in the management of adult patients who present with primary snoring without significant obstructive sleep apnoea. The Timetable, Methodology and Standards by which this Position Statement has been established is outlined in the Appendix S1. The main recommendations are:Weight loss, and reduced alcohol consumption should be recommended, where appropriateIf clinical judgement dictates, benzodiazepine and opioid reduction or avoidance may be advisedPositional therapy should be considered in supine dominant snorersIn dentate patients, Mandibular advancement devices (MAD) should be recommended as a first line treatment following assessment by both an appropriate Dentist and Sleep physicianContinuous positive airway pressure (CPAP) devices may be recommended in patients with primary snoring in those already committed to their use or willing to trySurgical treatment of primary snoring by an appropriately credentialled surgeon may be advised and includes nasal (adjunctive), palatal and other interventions This position statement has been designed based on the best available current evidence and our combined expert clinical experience to facilitate the management of patients who present with primary snoring. It provides clinicians with a series of both non‐surgical and surgical options with the aim of achieving optimal symptom control and patient outcomes. This is the first such set of recommendations to be established within Australasia and has also been reviewed and endorsed by the Australasian Sleep Association. [ABSTRACT FROM AUTHOR]

We explored whether a new combination of eye mask sleep position therapy (SPT) and oral appliance therapy (OAT) was more effective at treating positional obstructive sleep apnea (POSA) than was the use of either device alone. In this randomized controlled trial, 60 POSA subjects diagnosed by standard polysomnography (PSG) were divided into three groups (ratio 1:1:1): SPT, OAT, and SPT combined with OAT (SOT). Participants underwent hospital-based follow-ups during months 1 and 6 after beginning treatment. The primary outcome was the decline in the apnea hypopnea index (AHI) at month 6. The secondary outcomes were changes in oxygen-derived parameters and the curative effect at month 6. After 6 months of treatment, PSG showed that SPT, OAT, and SOT all improved the AHI and oxygen-derived parameters. The AHI decline was significantly better in the SOT group than in the OAT or SPT group (71.58% [50.56–84.84%] for SOT, 44.42% [21.23–67.52%] for OAT, and 33.24% [19.03–54.62%] for SPT at 6 months) (P = 0.018 and P < 0.001 for the comparisons of SOT with OAT and SOT with SPT, respectively). In terms of oxygen-derived parameters, only the sleep apnea-specific hypoxic burden (SASHB) improved more in the SOT group (76.89% [57.43–85.91%]) than in the other groups (44.73% [32.38–72.69%] for OAT and 41.82% [15.40–65.24%] for SPT, P = 0.002 and P < 0.001 for the comparisons of SOT with OAT and SOT with SPT, respectively). The efficacies of SPT, OAT, and SOT were 36.84%, 50%, and 80% at 6 months; the SOT group evidenced the highest value (rate ratio [95% confidence interval] 1.78 (1.05–3.03), P = 0.048 and 2.17 (1.16–4.07), P = 0.010, for the comparisons of SOT with OAT and SOT with SPT, respectively). The combination of SPT and OAT was better than either treatment alone and may represent a good option for the treatment of POSA. Chinese Clinical Trial Registry; URL: http://www.chictr.org.cn/showproj.aspx?proj=42,852 ; No. ChiCTR1900025584. • Novel sleep position therapy and oral appliance therapy were effective for positional obstructive sleep apnea. • The combination of these two devices was better than the use of either alone in improving AHI and SASHB. • The combination of the two methods may represent a good option for the treatment of positional obstructive sleep apnea. [ABSTRACT FROM AUTHOR]

The document is a correction notice for an article titled "Transitioning sleeping position detection in late pregnancy using computer vision from controlled to real-world settings: an observational study" published in Scientific Reports. The correction addresses an incomplete Acknowledgements section, providing details on the funding received from Mitacs and the Canadian Institutes of Health Research (CIHR) for the study conducted at the University of Toronto. The corrected article includes the names of the authors involved in the research. [Extracted from the article]

Summary: Continuous positive airway pressure is a common and effective treatment for obstructive sleep apnea, but adherence remains an issue. Both obstructive sleep apnea and oral diseases are associated with cardiovascular diseases, and as oral dryness contributes to treatment abandonment, oral health is of importance for this patient group. The aim was therefore to explore how persons with continuous positive airway pressure‐treated obstructive sleep apnea experience situations associated with their oral health, and which actions they take to manage these. An explorative and descriptive design was adopted using the critical incident technique. Based on a purposeful selection, 18 adults with long‐term experience of continuous positive airway pressure‐treatment were interviewed using a semi‐structured interview guide. Both negative and positive situations were described. Negative situations consisted of challenges with breathing, including mouth‐breathing, choking sensations, problems with night‐time and daytime oral dryness, changes in the saliva composition, and deteriorating oral health. Positive situations included experiences of reduced mouth‐breathing and oral dryness. The situations were often successfully managed by mimicking daytime movements, changing sleeping position, adjusting the CPAP‐device and mask, increasing oral hygiene efforts, drinking water, using a humidifier or chinstrap, or contacting their oral healthcare clinic. Long‐term experience of persons with continuous positive airway pressure‐treated obstructive sleep apnea regard situations and actions from everyday life. Successful management can contribute to long‐term adherence and decrease negative effects on oral health. More interdisciplinary collaborations could enable identification and adequate recommendations for persons who experience negative situations during their continuous positive airway pressure treatment. [ABSTRACT FROM AUTHOR]

Background: Having infants sleep with their parents and sleeping face down or on their sides are the two most proximate and modifiable risk factors for sudden infant death syndrome (SIDS). Little is known about the burden of SIDS or the prevalence of these risk factors in Africa. Our primary objective was to determine the prevalence of modifiable risk factors of SIDS in Lusaka, Zambia.Methods: We conducted cross-sectional surveys with recent mothers of infants aged < 1 year across two busy urban clinic sites in Lusaka, Zambia. We used log-binomial regression analysis to identify factors predictive of bedsharing and prone sleeping.Results: Surveys were conducted with 478 mothers between April-May 2021. The sleep-related risk factors, bedsharing and side sleeping, were widely prevalent. 89.5% of respondents indicated that they share a bed with the infant during sleep, 73.0% preferred putting their baby on its side, and 19.9% preferred the prone position. Only 6.7% of respondents described using the safer, supine position. Age of infant was the only factor which was predictive of prone sleeping. Infants > 2 months old were twice as likely to be put to sleep in a prone position compared to infants aged less than 2 months old. Mothers reported that they rarely (24.1%) received advice from medical caregivers to use the supine position. Maternal use of alcohol (12.0%) and tobacco (0.8%) during pregnancy were uncommon.Conclusions: Bedsharing and placing the infant to sleep on the side were commonly reported among the mothers we interviewed. Whether this represents an opportunity to reduce SIDS in Zambia is unclear since accurate data on the burden of SIDS in Zambia is not available. There is a need for increased awareness of SIDS and more prospective data collection on its burden and related risk factors in these African populations. [ABSTRACT FROM AUTHOR]

Capitalism today tries to take advantage of sleep while reducing its duration. The expansion of flexible work regimes into other fields of life spreads the effects of social acceleration. Acceleration is in line with deceleration. Sleep can be a limit to acceleration or can be a necessary deceleration of the body for further acceleration. On the one hand, due to the requirements and desires inside and outside work, sleep is more vulnerable to time pressure. On the other hand, lack of or unhealthy sleep is seen as an obstacle before enriched participation in waking life. The tension between the economic and cultural drivers of social acceleration is perpetuated by its structural motor, which generates an ambivalent position for the sleep of white-collar employees. This renders sleep both dispensable and indispensable at the same time. [ABSTRACT FROM AUTHOR]

The use of flexible wearable sensors to monitor the impact of sleeping position and turning frequency on sleep and to study sleep patterns can help bedridden patients heal and recover. The flexible wearable sleeping-position monitoring device was designed and developed using a flexible angle sensor and a six-axis motion sensor to measure the dynamic changes in body posture during sleep. Based on the changes in the output parameters of the flexible angle sensor and the six-axis motion sensor, we determined the change in the subject's lying position, verifying and analyzing the relationship between lying position preference, turning frequency, and sleep quality in healthy subjects. The sleeping-position monitoring device was worn by 13 subjects (7 males and 6 females) without sleep disorders before the sleep experiment. They performed more than 50 sleeping-position changes to ensure the accuracy of the monitoring device. Subjects slept in their beds for 8 h per night for 15 nights. During that time, they wore the sleeping-position monitoring device and a wristband sleep-monitoring bracelet on their left hand, and gathered the subjective sleep data using questionnaires. The results show that the most critical influencing factors are sleeping-position preference and frequency of turning. Data analysis reveals that subjects with a preference for right-sided lying and a lower frequency of turning had better sleep quality. [ABSTRACT FROM AUTHOR]

Scientific, public, and political discourse around the perennial changing of the clocks during the transitions into and out of daylight saving time (DST) is a touchstone issue for the translation of fundamental chronobiology into societal impacts. The Society for Research on Biological Rhythms, along with other sleep science bodies, has issued a position statement that advocates for the abolition of the biannual clock changes and the adoption of permanent standard time for the optimization of population circadian health. However, there is a paucity of data on preexisting public perceptions and preferences with regard to these issues. In this perspective, we examine 5 issues that we believe are pertinent for chronobiologists to consider to enable effective advocacy on these policies; in particular, we discuss public preference for permanent DST and steps that may need to be taken to understand this preference. We inform our discussion with reference to cross-sectional studies we undertook in Spring 2020 and Fall 2019, around the transition out of and into DST Ireland. We conclude that there appears to be a gap between existing public perceptions and preferences around the clock changes and chronobiological and sleep science-informed positions, and that the chronobiology community may benefit from interdisciplinary collaboration with colleagues with specific social sciences expertise to most effectively advocate for these research-informed positions. [ABSTRACT FROM AUTHOR]

Background: Understanding mosquito biting behaviours is important for designing and evaluating protection methods against nuisance biting and mosquito-borne diseases (e.g. dengue, malaria and zika). We investigated the preferred biting sites by Aedes aegypti and Anopheles arabiensis on adult volunteers in standing or sleeping positions; and estimated the theoretical protection limits affordable from protective clothing or repellent-treated footwear. Methods: Adult volunteers dressed in shorts and t-shirts were exposed to infection-free laboratory-reared mosquitoes inside screened chambers from 6am to noon (for day-biting Ae. aegypti) or 6pm to midnight (night-biting An. arabiensis). Attempted bites on different body parts were recorded. Comparative observations were made on same volunteers while wearing sandals treated with transfluthrin, a vapour-phase pyrethroid that kills and repels mosquitoes. Results: An. arabiensis bites were mainly on the lower limbs of standing volunteers (95.9% of bites below the knees) but evenly-distributed over all exposed body surfaces when the volunteers were on sleeping positions (only 28.8% bites below knees). Ae. aegypti bites were slightly concentrated on lower limbs of standing volunteers (47.7% below knees), but evenly-distributed on sleeping volunteers (23.3% below knees). Wearing protective clothing that leave only hands and head uncovered (e.g. socks + trousers + long-sleeved shirts) could theoretically prevent 78–83% of bites during sleeping, and at least 90% of bites during non-sleeping hours. If the feet are also exposed, protection declines to as low as 36.3% against Anopheles. The experiments showed that transfluthrin-treated sandals reduced An. arabiensis by 54–86% and Ae. aegypti by 32–39%, but did not change overall distributions of bites. Conclusion: Biting by An. arabiensis and Ae. aegypti occur mainly on the lower limbs, though this proclivity is less pronounced in the Aedes species. However, when hosts are on sleeping positions, biting by both species is more evenly-distributed over the exposed body surfaces. High personal protection might be achieved by simply wearing long-sleeved clothing, though protection against Anopheles particularly requires covering of feet and lower legs. The transfluthrin-treated footwear can reduce biting risk, especially by An. arabiensis. These findings could inform the design and use of personal protection tools (both insecticidal and non-insecticidal) against mosquitoes and mosquito-borne diseases. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Infant mortality remains a major global concern. Sudden unexpected death in infancy (SUDI) is common in South Africa, but evidence on the effect of possible risk factors remains limited. Respiratory infections have repeatedly been implicated in the death of these infants, but temporality has not yet been confirmed and SUDI remains a multi-factorial phenomenon. Methods: This study investigated the relationship between risk factors and positive human rhinovirus in the trachea and lungs of infants admitted to the Tygerberg Medico-legal Mortuary in Cape Town between 2012 and 2019. This study included a total of 407 cases. Results: The median (range) age of the infants was 9.1 (0.3 to 57.3) weeks. Infants who shared a bed with ≤ 1 person were significantly younger than those where bed-sharing with ≥ 3 people was reported (7.5 vs. 11.9 weeks, p=0.045). Cases with human rhinovirus present in the trachea and lung were significantly older (12.3 and 12.9 weeks, respectively; p<0.001) than those where no human rhinovirus was detected (8.0 and 8.7 weeks). After adjusting for possible confounders, the number of people bed-sharing and human rhinovirus detected in the trachea (standardized β [95%CI], p<0.001 and p=0.016 respectively) were independently associated with age when SUDI occurred. Conclusion: This study correlated laboratory results with demographic data and risk factors in SUDI cases. The most prominent findings were bed-sharing and the presence of human rhinovirus in the trachea. Infection can be reduced by modifiable means, such as ventilation where possible, sleeping position and providing the infant with a separate sleeping area or bed. However, this may not be possible for many communities in South Africa due to poverty, overcrowding and other socioeconomic reasons. [ABSTRACT FROM AUTHOR]

Sleep-disordered breathing (SDB) occupies a leading position in the structure of sleep impairments and concomitant brain damage. This review analyzes results from experimental studies and addresses the roles of astrocyte, microcyte, and oligodendrocyte glia as the main mediators of brain damaged in SDB at the cellular level. In particular, the review discusses the roles of molecules expressed by glial cells and mediating oxidative damage (NADP oxidase), inflammation (hypoxia-inducible factor-1, inducible nitric oxide synthase, pro- and anti-inflammatory cytokines), and sympathetic hyperactivation. [ABSTRACT FROM AUTHOR]