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Summary This study compared the effects of sleeping in the supine position and rapid eye movement sleep on the severity of obstructive sleep apnea, and investigated the effect of sleep stage on position‐dependent obstructive sleep apnea, and of sleep position on rapid eye movement‐dependent obstructive sleep apnea. We analysed epoch‐labelled polysomnographic readouts of 3843 patients, and calculated the apnea–hypopnea index for each sleep position and sleep stage. Subgroup analyses were performed to evaluate whether the proportion of position‐dependent obstructive sleep apnea patients changed during rapid eye movement and non‐rapid eye movement sleep, and whether that of rapid eye movement‐dependent obstructive sleep apnea patients changed during supine/lateral sleep. The apnea–hypopnea index was highest in the rapid eye movement‐supine position (50.7 ± 22.6 events per hr), followed by non‐rapid eye movement‐supine, rapid eye movement‐lateral and non‐rapid eye movement‐lateral (39.2 ± 25.3, 22.9 ± 24.4, 15.9 ± 21.9 events per hr, respectively; p < 0.001). Patients with position‐dependent obstructive sleep apnea had a higher ratio of rapid eye movement sleep, and those with rapid eye movement‐dependent obstructive sleep apnea had a higher ratio of sleep time in the supine position (p < 0.001). During rapid eye movement sleep, position‐dependent obstructive sleep apnea was not observed in 21.1% of patients who otherwise had position‐dependent obstructive sleep apnea. In the lateral position, 36.9% of patients with rapid eye movement‐dependent obstructive sleep apnea did not retain rapid eye movement dependency. Although sleeping in the supine position and rapid eye movement sleep were both associated with more frequent respiratory events, this was the first study to demonstrate that the former had a stronger correlation with obstructive sleep apnea severity. Position dependency in patients with obstructive sleep apnea decreased during rapid eye movement sleep, and worsening of rapid eye movement dependency was alleviated in the lateral position, suggesting potential for personalized obstructive sleep apnea management. [ABSTRACT FROM AUTHOR]

Purpose: Breast cancer-related lymphedema (BCRL) is a common complication among breast cancer survivors. Most BCRL studies have focused on patients receiving adjuvant chemotherapy, with relatively little attention paid to BCRL in patients undergoing neoadjuvant chemotherapy (NAC). This study aimed to investigate the risk factors associated with BCRL in Chinese women undergoing NAC and axillary lymph node dissection (ALND). Methods: At our institution, this cohort study collected data from 336 women with breast cancer and documented axillary nodal metastasis at diagnosis, who received NAC and ALND surgery between 2015 and 2020. BCRL was assessed through both objective limb circumference measurements and subjective self-reported symptoms. Multivariate logistic regression was employed to identify risk factors for BCRL, considering clinical, demographic, and lifestyle-related characteristics. Results: The cumulative incidence of BCRL within 2.5 years was 43.75%. Factors independently associated with BCRL included radiotherapy (versus no radiotherapy; hazard ratio (HR) = 1.611; P = 0.020), NAC duration of 105 days or shorter (versus 105-143 days; HR = 0.471; P = 0.020), removal of more than 15 lymph nodes (versus 15 or fewer lymph nodes; HR = 1.593; P = 0.036), drainage duration of 20-29 days (versus 10-19 days; HR = 1.568; P = 0.028), and sleeping biased toward the affected arm (versus sleeping biased toward the healthy arm; HR = 2.033; P = 0.019). Conclusion: This study identified several risk factors for BCRL in breast cancer patients following NAC and ALND. Patients presenting with one or more of these factors should be monitored closely for early detection and intervention. Further research is warranted to explore the impact of drainage duration and sleep position on the development of BCRL. [ABSTRACT FROM AUTHOR]

Summary There is an ongoing debate in the United Kingdom and in other countries about whether twice‐yearly changes into and out of Daylight Saving Time should be abolished. Opinions are divided about whether any abolition of Daylight Saving Time should result in permanent Standard Time, or year‐long Daylight Saving Time. The British Sleep Society concludes from the available scientific evidence that circadian and sleep health are affected negatively by enforced changes of clock time (especially in a forward direction) and positively by the availability of natural daylight during the morning. Thus, our recommendation is that the United Kingdom should abolish the twice‐yearly clock change and reinstate Standard Time throughout the year. [ABSTRACT FROM AUTHOR]

Sleeping on the back after 28 weeks of pregnancy has recently been associated with giving birth to a small-for-gestational-age infant and late stillbirth, but whether a causal relationship exists is currently unknown and difficult to study prospectively. This study was conducted to build a computer vision model that can automatically detect sleeping position in pregnancy under real-world conditions. Real-world overnight video recordings were collected from an ongoing, Canada-wide, prospective, four-night, home sleep apnea study and controlled-setting video recordings were used from a previous study. Images were extracted from the videos and body positions were annotated. Five-fold cross validation was used to train, validate, and test a model using state-of-the-art deep convolutional neural networks. The dataset contained 39 pregnant participants, 13 bed partners, 12,930 images, and 47,001 annotations. The model was trained to detect pillows, twelve sleeping positions, and a sitting position in both the pregnant person and their bed partner simultaneously. The model significantly outperformed a previous similar model for the three most commonly occurring natural sleeping positions in pregnant and non-pregnant adults, with an 82-to-89% average probability of correctly detecting them and a 15-to-19% chance of failing to detect them when any one of them is present. [ABSTRACT FROM AUTHOR]

Sleep position recognition plays a crucial role in enhancing individual sleep quality and addressing sleep-related disorders. However, the conventional non-invasive technology for recognizing sleep positions tends to be limited in its widespread application due to high production and computing costs. To address this issue, an enhanced stacking model is proposed based on a specific air bag mattress. Firstly, the hyperparameters of the candidate base model are optimized using the Bayesian optimization algorithm. Subsequently, the entropy weight method is employed to select extreme gradient boosting (XGBoost), support vector machine (SVM), and deep neural decision tree (DNDT) as the first layer of the enhanced stacking model, with logistic regression serving as the meta-learner in the second layer. Comparative analysis with existing machine learning techniques demonstrates that the proposed enhanced stacking model achieves higher classification accuracy and applicability. [ABSTRACT FROM AUTHOR]

Introduction The prevalence of moderate to severe sleep-disordered breathing is of 17% among men aged between 50 and 70-years, and of 9% among women in the same age group. In Brazil, obstructive sleep apnea (OSA) is also highly prevalent, and it is associated with metabolic and cardiovascular impacts, excessive daytime sleepiness, and increasing risk of traffic accidents. Laboratory-based polysomnography is the gold standard test for OSA diagnosis. However, its complexity has led to the search for alternatives to simplify the diagnosis, such as the out-of-center sleep test (OCST). Objectives To discusses the minimum OCST recording time and the potential effects of the supine position on this parameter. Data Synthesis We conducted a search on the PubMed, Web of Science, Scopus, and Embase databases to identify relevant studies on OCST recording time and a possible association with body position. We used a combination of terms, including Obstructive Sleep Apnea and Home Monitoring OR Home Care Services OR Portable Monitoring AND Supine OR Position OR Recording Time OR Positional Obstructive Sleep Apnea. The references of the selected articles were also reviewed to find other relevant studies. Through our approach, eighteen articles were retrieved and included in the present study. Conclusion Since OCSTs are conducted in an unattended environment, with potential signal loss during the night, it is crucial to determine the minimum recording time to validate the test and assess how the time spent in the supine position affects this parameter. After reviewing the literature, this topic remains to be clarified, and additional studies should focus on that matter. [ABSTRACT FROM AUTHOR]

Otitis media is a disease that commonly occurs in infants. Various risk factors have been reported. Sleep position has been reported to be associated with various diseases. There is no report on the relationship between otitis media and sleep position. We examined the incidence of otitis media and sleep position in infants. We used data from the Japan Environment Children's Study. We used multivariate logistic analysis to examine the relationship between sleep position and the incidence of otitis media in infants aged up to 6 months. In addition, we conducted a stratified analysis based on whether the child was able to turn over in bed at 6 months of age. The study population comprised 85,731 participants. The incidence of otitis media by sleep position was significantly higher when the infant was in the prone position compared to any other position (adjusted odds ratio, 1.206; 95 %CI, 1.038–1.401). Stratified analysis of turning showed that otitis media was more common in the prone position in all groups. In the current study, infants aged 6 months or younger who slept in the prone position were more likely to have otitis media. Sleep position interview and guidance on changing sleep position may be useful for the prevention of otitis media. [ABSTRACT FROM AUTHOR]

Background: National legislative guidelines for sleep and rest are lacking in the Canadian licensed childcare sector. No review of Canadian legislation for licensed childcare facilities has focused on sleep. This paper provides a review of the Canadian provincial and territorial legislative landscape, regarding sleep, rest, and naps in licensed childcare centers. Methods: Childcare statutes and regulations for each province and territory were identified and downloaded on a particular date. Statutes and regulations were reviewed focusing on sections articulating licensed childcare facility mandates governing sleep, rest, naps, and sleep equipment. An excel file was used to facilitate systematic data retrieval and comparisons across provinces and territories. Two authors developed and discussed themes that summarized data from the documents. Results: No statutes indicated recommendations for sleep, rest, or naps. Only one regulation defined rest (Alberta). Our analysis of regulations identified four themes representing sleep, rest, and naps: programming (general programming, daily programming); space (dedicated space, amount of space, age-specific space); equipment (developmental appropriateness, acceptable sleep equipment, age-specific equipment); and safety (staffing during sleep/rest, sleep position, sleep monitoring, sleep equipment safety, prohibited practices). In Canada, minimal regulatory consistency is evident in required sleep programming, space, acceptability of sleep equipment, and sleep safety considerations. Most jurisdictions' regulations indicated necessity for developmentally appropriate rest or sleep areas and equipment, in particular for infants, but there was minimal consistency in defining infant age groups. Conclusions: Although we identified themes related to sleep across regulations, childcare regulations differ in their definitions of infants and specifications for children's sleep and rest in licensed Canadian childcare facilities. Without adequate definitions in legislative components of appropriate sleep duration linked to children's developmental stages, childcare facilities lack guidance to support healthy sleep for children in their care. Future research can examine translation of healthy sleep guidelines into government legislation and mandates for sleep, rest, and naps among young children in licensed childcare. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Setting and Population Methods Main Outcome Measures Results Conclusions Trial Registration To assess the effectiveness and acceptability of a pillow‐like position modification device to reduce supine sleep during late pregnancy, and to determine the impacts on the severity of sleep‐disordered breathing (SDB) and foetal well‐being.Randomised cross‐over study.Individuals in the third trimester of pregnancy receiving antenatal care at a tertiary maternity hospital in Australia.Participants used their own pillow for a control week and an intervention pillow for a week overnight, in randomised order. Sleep position and total sleep time for each night of both weeks were objectively monitored, with a sleep study and foetal heart rate monitoring performed on the last night of each week.Primary outcome = percentage of sleep time in the supine position; secondary outcomes = apnoea–hypopnoea index, foetal heart rate decelerations and birthweight centile.Forty‐one individuals were randomised with data collected on 35 participants over 469 nights. There was no difference in percentage of total sleep time in the supine position overnight between the control or intervention pillow week (13.0% [6.1, 25.5] vs. 16.0% [5.6, 27.2], p = 0.81 with a mean difference of 2.5% [95% CI] = −0.7, 5.6, p = 0.12), and no difference in the severity of SDB or foetal heart rate decelerations across weeks. However, increased supine sleep was significantly related to a higher apnoea–hypopnoea index (rs = 0.37, p = 0.003), lower birthweight (rs = −0.45, p = 0.007) and lower birthweight centile (rs = −0.45, p = 0.006). The proportion of supine sleep each night of the week varied widely both within and across participants, despite awareness of side‐sleeping recommendations.We found no evidence to suggest that the adoption of a pillow designed to discourage supine sleep was effective in late pregnancy, with women spending an average of 1 h per night supine. Alternative devices should be investigated, incorporating lessons learnt from this study to inform trials of supine sleep minimisation in pregnancy.Clinical Trial: (Australia New Zealand Clinical Trials Registry): ACTRN12620000371998 [ABSTRACT FROM AUTHOR]

Introduction and purpose Sleep apnea is a disturbance of sleep that affects about 10% of adult population and is not easily detected due to unspecific symptoms. The aim of this literature review is to present, respectively, obstructive sleep apnea and central sleep apnea symptoms and integrate the available data in the literature regarding the pathogenesis and treatment methods. Materials and methods A review of literature was performed using PubMed and Google Scholar database. The search criteria included keywords such as sleep apnea, obstructive sleep apnea treatment, central sleep apnea treatment. State of knowledge Sleep disturbances that involve breathing can be categorized as obstructive sleep apnea (OSA) and central sleep apnea. First one is associated with the obstruction of the upper airways and the second one -- with malfunctioning breathing generator in the pontomedullary breathing pacemaker. Symptoms are unspecific which makes diagnostic process difficult. However, the right diagnosis and treatment may prevent patients from developing many cardiovascular diseases. Treatment options for OSA include: CPAP, reducing body weight, changing sleep position, braces and surgeries; for CSA: CPAP and acetazolamide. Conclusions OSA and CSA need to be further investigated in order to find more precise ways of diagnosis and treatment, as these diseases remain underreported. It is worth noting, that these conditions predispose to serious diseases, e.g. stroke. Therefore, developing new treatment techniques would beneficial for the health of population. [ABSTRACT FROM AUTHOR]

The respiration state during overnight sleep is an important indicator of human health. However, existing contactless solutions for sleep respiration monitoring either perform in controlled environments and have low usability in practical scenarios or only provide coarse-grained respiration rates, being unable to accurately detect abnormal events in patients. In this article, we propose Respnea, a non-intrusive sleep respiration monitoring system using an ultra-wideband device. Particularly, we propose a profiling algorithm, which can locate the sleep positions in non-controlled environments and identify different subject states. Further, we construct a deep learning model that adopts a multi-head self-attention mechanism and learns the patterns implicit in the respiration signals to distinguish sleep respiration events at a granularity of seconds. To improve the generalization of the model, we propose a contrastive learning strategy to learn a robust representation of the respiration signals. We deploy our system in hospital and home scenarios and conduct experiments on data from healthy subjects and patients with sleep disorders. The experimental results show that Respnea achieves high temporal coverage and low errors (a median error of 0.27 bpm) in respiration rate estimation and reaches an accuracy of 94.44% on diagnosing the severity of sleep apnea-hypopnea syndrome. [ABSTRACT FROM AUTHOR]

Summary Little is known about the physiological and biomechanical factors that determine individual preferences in lying posture during sleep. This study investigated relationships between position preference and position‐specific arousals, awakenings, limb movements and limb movement arousals to explore the mechanisms by which biomechanical factors influence position preference. Forty‐one mature‐aged adults underwent 2 nights of at‐home polysomnography ~2 weeks apart, on a standardised firm foam mattress, measuring nocturnal sleep architecture and position. The lateral supine ratio and restlessness indices specific to lateral and supine positions including limb movement index, limb movement arousal index, arousal index, wake index, respiratory arousal index and apnea–hypopnea index were calculated and analysed via linear mixed‐effects regression. In the supine position, all restlessness indices were significantly increased compared with the lateral position, including a 379% increase in respiratory arousals (β = 7.0, p < 0.001), 108% increase in arousal index (β = 10.3, p < 0.001) and 107% increase in wake index (β = 2.5, p < 0.001). Wake index in the supine position increased significantly with more lateral sleep (β = 1.9, p = 0.0013), and significant correlation between lateral supine ratio polysomnography 1 and lateral supine ratio polysomnography 2 (β = 0.95, p < 0.001) indicated strong consistency in sleep preference. Overall, the findings suggest that some individuals have low tolerance to supine posture, represented by a comparatively high wake index in the supine position, and that these individuals compensate by sleeping a greater proportion in the lateral position. [ABSTRACT FROM AUTHOR]

Summary: Although understanding the physiological mechanisms of obstructive sleep apnea (OSA) is important for treating OSA, limited studies have examined OSA patients' sleep architecture at the epoch‐by‐epoch level and analysed the impact of sleep position and stage on OSA pathogenesis. The epoch‐labelled polysomnogram was analysed multidimensionally to investigate the effect of sleep position on the sleep architecture and risk factors of apnea in patients with OSA. This retrospective multicentric case–control study reviewed full‐night diagnostic polysomnography of 6983 participants. The difference in the proportion of time spent supine during non‐rapid eye movement (NREM) and REM stages, and the mean duration of respiratory events per body position were evaluated. The frequency of sleep stage transition per body position shift type was computed. Further subgroup analysis was performed based on OSA severity and positional dependency. Supine time in patients with OSA varied across sleep stages, with lower proportions in N3 and REM, and shorter durations with severity. Patients with OSA spent less time in supine positions during N3 and REM, and experienced longer apnea events in both positions compared to the control group. The frequency of all sleep stage transitions increased with OSA severity and was higher among non‐positional OSA than positional OSA and the control group, regardless of body position shift type. The sleep stage transition from N3 and REM to wakefulness was notably heightened during position shift. Understanding the sleep architecture of patients with OSA requires analysing various sleep characteristics including sleep position simultaneously, with future studies focusing on position detection to predict sleep stages and respiratory events. [ABSTRACT FROM AUTHOR]

The vector forces at the human-mattress interface are not only crucial for understanding the distribution of vertical and shear forces exerted on the human body during sleep but also serves as a significant input for biomechanical models of sleeping positions, whose accuracy determines the credibility of predicting musculoskeletal system loads. In this study, we introduce a novel method for calculating the interface vector forces. By recording indentations after supine and lateral positions using a vacuum mattress and 3D scanner, we utilize image registration techniques to align body pressure distribution with the mattress deformation scanning images, thereby calculating the vector force values for each unit area (36.25 mm × 36.25 mm). This method was validated through five participants attendance from two perspectives, revealing that (1) the mean summation of the vertical force components is 98.67% ± 7.21% body weight, exhibiting good consistency, and mean ratio of horizontal component force to body weight is 2.18% ± 1.77%. (2) the predicted muscle activity using the vector forces as input to the sleep position model aligns with the measured muscle activity (%MVC), with correlation coefficient over 0.7. The proposed method contributes to the vector force distribution understanding and the analysis of musculoskeletal loads during sleep, providing valuable insights for mattress design and evaluation. [ABSTRACT FROM AUTHOR]

Approximately 45% of adults snore occasionally, and 25% snore regularly, with a higher prevalence in men and an increase among postmenopausal women due to hormonal changes. Snoring is a health concern linked to vascular disease and decreased quality of life for both snorers and their bed partners. Effective snoring treatment, which aims to reduce or eliminate the sound, is challenging and depends on factors like age, comorbidities, disease severity, and anatomical features. This review aims to provide a systematic overview of the current literature on the effects of positional therapy (PT) on snoring. Various devices facilitate PT, including anti-snoring pillows and vibration alarms. PT devices maintain head and neck alignment to keep airways open, while head of bed elevation (HOBE) solutions reduce upper airway collapses by elevating the head and trunk. Studies show that PT and HOBE reduce snoring by increasing airway cross-sectional area and decreasing closing pressure. Despite their benefits, these non-surgical treatments have limitations, such as discomfort in certain sleeping positions and intolerance to prolonged head elevation. While reducing snoring intensity is critical for health reasons, further comparative studies between the different devices are needed to enhance snoring management. [ABSTRACT FROM AUTHOR]

Positional OSA (POSA) is a recognized subtype of OSA that exhibits distinct endotypic characteristics when compared with nonpositional OSA (NPOSA). The basis for the disparity in endotypes between these subtypes remains poorly understood. (1) Do individuals with NPOSA and POSA have different underlying OSA endotypes? (2) Which endotypic characteristics are critical in determining NPOSA and POSA severity? Within the Shanghai Sleep Health Study cohort, individuals with OSA were recruited and classified as having POSA or NPOSA. Endotypes were calculated using polysomnography. Endotype analysis was conducted in 1,036 individuals with OSA. Compared with individuals with NPOSA, those with POSA had lower loop gain calculated during all sleep stages and all sleep positions (0.55; interquartile range [IQR], 0.46-0.66 vs 0.68, IQR, 0.52-0.90; P <.001), lower arousal threshold calculated during all sleep stages and all sleep positions (ArTH All) (138.67; IQR, 118.94-180.87 percentage of the eupneic ventilation [%Veupnea] vs 189.00; IQR, 129.71-257.76 %Veupnea; P <.001), lower pharyngeal collapsibility calculated during all sleep stages and all sleep positions (Vpassive All) (91.85; IQR, 83.13-95.15 %Veupnea vs 76.38; IQR, 23.77-92.08 %Veupnea; P <.001), and higher muscle compensation calculated during all sleep stages and all sleep positions (6.50; IQR, −6.77 to 16.39 %Veupnea vs 3.65; IQR, −10.47 to 12.14 %Veupnea; P =.003). Logistic regression analyses indicated that higher Vpassive All was associated with increased odds of POSA vs NPOSA. In NPOSA, fully adjusted linear regression analyses indicated that Vpassive All (β = −0.55; 95% CI, −0.68 to −0.42; P <.001) and lower loop gain calculated during all sleep stages and all sleep positions (β = 0.19; 95% CI, 0.08-0.30; P <.001) were significant independent predictors of the apnea hypopnea index, with Vpassive All being the most critical factor. In contrast, in POSA, collapsibility appeared to be less influential (β = −0.09; 95% CI, −0.21 to 0.03; P =.138). Nonanatomic endotypic characteristics (LG All : β = 0.29; 95% CI, 0.18-0.41; P <.001; arousal threshold in all sleep stages and all sleep positions: β = 0.15; 95% CI, 0.01-0.28; P =.031; muscle compensation in all sleep stages and all sleep positions: β = −0.21; 95% CI, −0.29 to −0.12; P <.001) were significant in determining the severity of POSA, with loop gain being the most crucial factor. This study highlights the differences in endotypes between NPOSA and POSA. In Chinese individuals, anatomic factors were more significant in determining the severity of NPOSA, whereas nonanatomic traits were more likely to determine the severity of POSA. Future research should focus on developing personalized management strategies for individuals with NPOSA and POSA based on their endotypes. Chinese Clinical Trial Registry; No.: ChiCTR1900025714; URL: https://www.chictr.org.cn/indexEN.html. [ABSTRACT FROM AUTHOR]

This study aims to assess how commonly 15 parental practices, known to have positive effects on child and adult health, are carried out by families in Italy, if they are related, and which characteristics are associated with implementation. Children participating in the NASCITA Cohort, a prospective study in which family pediatricians in Italy collect data on children and their families, were included if they had sufficient data. Data on practice implementation, socio-demographic characteristics, and interrelatedness between practices were analyzed. In all, 3337 children were included. Their mothers had an average age at birth of 33 years (range 17–52) and medium-high levels of education (86% of mothers) and employment (72%). No smoking or alcohol in pregnancy, supine infant sleeping position, and tummy time were the most commonly implemented practices (by over 85% of mothers, each), while the least common was exclusive breastfeeding at 6 months (28%). Parental practices are related and several socio-demographic characteristics influence their implementation, with mother's educational level and geographic area of residence influencing most of the practices (each influencing 12 of 15 practices). Low educational level (OR 0.34; 95% CI 0.26–0.44), being born abroad (OR 0.43; 95% CI 0.34–0.56), and residing in the South (OR 0.49; 95% CI 0.41–0.58) most reduce the probability of implementing numerous supportive practices (all three P < 0.001). Conclusion: Socio-demographic factors contribute significantly to carrying out supportive practices. Future interventions should address the identified inequalities, prioritizing families most in need. Direct involvement of pediatricians is warranted given their favorable position for promoting positive behaviors. What is Known: • Several parental actions in the early life of a child are known to have positive effects on later child health and development. • While folic acid supplementation and exclusive breastfeeding have been promoted for years, other supporting actions are less well-known. What is New: • Rates of parental adherence to the different supportive actions varied greatly and actions were often scantly adopted. • Socio-demographic characteristics influenced adherence, with young, unemployed mothers with low educational levels, living in the South, or who were born abroad adhering significantly less. [ABSTRACT FROM AUTHOR]

Aim: The supine sleeping position in the prevention of sudden infant death syndrome in preterm infants is poorly understood. We aimed to investigate the effect of sleep posture on cardiorespiratory parameters and movement patterns in preterm infants close to discharge. Methods: This observational study included neonates born in 2022 at the University Hospital Schleswig‐Holstein, Lübeck, Germany. Motion sensor data, heart rate, respiratory rate and oxygen saturation were recorded for infants with postconceptional age 35–37 weeks during sleep in the prone and supine positions. Results: We recorded data from 50 infants, born at 31 (24–35) weeks of gestation (mean(range)), aged 5.2 ± 3.7 weeks (mean ± SD), of whom 48% were female. Five typical movement patterns were identified. In the prone position, the percentage of calm, regular breathing was higher and active movement was less frequent when compared to the supine position. The percentage of calm irregular breathing, number of apnoeas, bradycardias, desaturations and vital sign changes were not influenced by position. Conclusion: The prone position seems to be associated with a higher arousal threshold. The supine position appears advantageous for escape from life‐threatening situations such as sudden infant death syndrome. [ABSTRACT FROM AUTHOR]

Sudden infant death syndrome (SIDS) has been mainly described from a risk perspective, with a focus on endogenous, exogenous, and temporal risk factors that can interact to facilitate lethal outcomes. Here we discuss the limitations that this risk-based paradigm may have, using two of the major risk factors for SIDS, prone sleep position and bed-sharing, as examples. Based on a multipronged theoretical model encompassing evolutionary theory, developmental biology, and cultural mismatch theory, we conceptualize the vulnerability to SIDS as an imbalance between current physiologic-regulatory demands and current protective abilities on the part of the infant. From this understanding, SIDS appears as a developmental condition in which competencies relevant to self-protection fail to develop appropriately in the future victims. Since all of the protective resources in question are bound to emerge during normal infant development, we contend that SIDS may reflect an evolutionary mismatch situation—a constellation in which certain modern developmental influences may overextend the child's adaptive (evolutionary) repertoire. We thus argue that SIDS may be better understood if the focus on risk factors is complemented by a deeper appreciation of the protective resources that human infants acquire during their normal development. We extensively analyze this evolutionary-developmental theory against the body of epidemiological and experimental evidence in SIDS research and thereby also address the as-of-yet unresolved question of why breastfeeding may be protective against SIDS. [ABSTRACT FROM AUTHOR]

The 5G-heterogeneous system has become worldwide in the current life scenario, advancing in many wireless applications. However, managing Handoff is a major issue because the improper Handoff procedure leads to high power consumption and less throughput ratio. Hence, the lower throughput ratio tends to report a poor data transmission rate. So, the current research work has planned to end these issues by executing a novel Wolf-based Power-Optimized Handoff (WbPOH) strategy for managing signal drop and power usage. WiMax and cellular network macrocells are created with several Small Cells (SC) to make the heterogeneous system. Hereafter, the fitness process of the grey wolf has afforded continuous monitoring for forecasting the nearest incoming signal of Handoff and work-free node prediction. Moreover, the power usage in this designed system has been optimized by making the workless node the sleep position. Apart from that, during the Handoff process, the designed WbPOH first enabled the single strongest near signal, and then the previous signal was lost. After that, parameters like throughput, network efficiency, and Handoff behaviour have been measured and validated with other conventional models. Furthermore, in the proposed novel WbPOH, 5Mbps throughput is obtained for the cellular network, and 5.2Mbps throughput is gained for the Worldwide Inter-operability for Microwave Access (WiMax) network. In addition, the recorded cellular network efficiency is 95%, and the WiMax network efficiency is 96%. [ABSTRACT FROM AUTHOR]

(1) Background: Home sleep apnea testing, known as polysomnography type 3 (PSG3), underestimates respiratory events in comparison with in-laboratory polysomnography type 1 (PSG1). Without head electrodes for scoring sleep and arousal, in a home environment, patients feel unfettered and move their bodies more naturally. Adopting a natural position may decrease obstructive sleep apnea (OSA) severity in PSG3, independently of missing hypopneas associated with arousals. (2) Methods: Patients with suspected OSA performed PSG1 and PSG3 in a randomized sequence. We performed an additional analysis, called reduced polysomnography, in which we blindly reassessed all PSG1 tests to remove electroencephalographic electrodes, electrooculogram, and surface electromyography data to estimate the impact of not scoring sleep and arousal-based hypopneas on the test results. A difference of 15 or more in the apnea–hypopnea index (AHI) between tests was deemed clinically relevant. We compared the group of patients with and without clinically relevant differences between lab and home tests (3) Results: As expected, by not scoring sleep, there was a decrease in OSA severity in the lab test, similar to the home test results. The group of patients with clinically relevant differences between lab and home tests presented more severe OSA in the lab compared to the other group (mean AHI, 42.5 vs. 20.2 events/h, p = 0.002), and this difference disappeared in the home test. There was no difference between groups in the shift of OSA severity by abolishing sleep scoring in the lab. However, by comparing lab and home tests, there were greater variations in supine AHI and time spent in the supine position in the group with a clinically relevant difference, either with or without scoring sleep, showing an impact of the site of the test on body position during sleep. These variations presented as a marked increase or decrease in supine outcomes according to the site of the test, with no particular trend. (4) Conclusions: In-lab polysomnography may artificially increase OSA severity in a subset of patients by inducing marked changes in body position compared to home tests. The location of the sleep test seems to interfere with the evaluation of patients with more severe OSA. [ABSTRACT FROM AUTHOR]

Although the mechanism of action in newborns is unknown, sleep positioning is associated with many pathophysiological events. This study aimed to compare the effects of supine and prone sleeping positions on cardiac output (CO), systolic pulmonary arterial pressure (SPAP), and superior vena cava (SVC) flow in healthy newborns. In the first 24–72 h of life, 40 healthy term newborns born in the same hospital were included in this prospective, cross-sectional, observational study. CO, SVC flow, and SPAP values of newborns in the supine and prone sleeping positions were calculated using echocardiographic examination. The measurements were statistically compared. In the supine sleeping position, CO, SVC flow, and SPAP were 235.00 (193.07–283.30) ml/kg/min, 92.80 (77.82–121.87) ml/kg/min, and 27.85 (24.70–30.48) mmHg. In the prone sleeping position, CO, SVC flow, and SPAP were measured as 195.35 (166.00–229.40) ml/kg/min, 67.25 (51.82–96.66) ml/kg/min, 31.60 (28.45–37.20) mmHg, respectively. Depending on sleeping position, these variables were significantly different between the groups. SVC flow and CO decreased in the prone sleeping position compared to the supine sleeping position in healthy newborns, whereas SPAP increased. The different hemodynamic effects of sleeping position on the cardiac, pulmonary, and nervous systems should be considered as flow and pressure changes are important in newborns. [ABSTRACT FROM AUTHOR]

Aims and background: To evaluate the effect of sleeping in the lateral decubitus position on the average thickness of the retinal nerve fiber layer (RNFL) in the peripapillary region of the optic nerve since the effect of posture on intraocular pressure (IOP) and glaucoma progression is not yet sufficiently understood. Materials and methods: A cross-sectional observational study was carried out with 40 volunteers who preferably slept in a right lateral decubitus (RLD) (RLD group N = 20) and left lateral decubitus (LLD) (LLD group N = 20) position. IOP was measured in both eyes, first in the sitting position and again after 10 minutes in a supine position, right lateral, and LLD, respectively. The mean thickness of the RNFL and the vertical papillary cup were measured by optical coherence tomography. Results: The average age of the volunteers was 60.53 ± 7.26 years. There were 32 female and eight male. There was an increase in IOP with the change from the sitting position to the lateral decubitus of 2.7 and 3.6 mm Hg in the RLD group (p < 0.001) and an increase of 3.0 and 3.15 mm Hg in the LLD group (p < 0.001), right eye (RE) vs left eye (LE), respectively. However, there was no difference in IOP values between the groups. The average thickness of the RNFL was in the RLD group--75.10 vs 78.05 μm (p = 0.325) and in the LLD group--81.55 vs 79.95 μm (p = 0.580). Vertical papillary excavation was in the RLD group--0.70 vs 0.65 (p = 0.175) and in the LLD group--0.65 vs 0.65 (p = 1.000), RE vs LE, respectively. Conclusion: We found no relationship between the lateral decubitus position when adopted preferentially for sleeping and the reduction of the RNFL. Clinical significance: Search for risk factors for the asymmetrical development of glaucoma, especially in well-controlled IOP in daytime measurements. [ABSTRACT FROM AUTHOR]

This document is a letter to the editor of the journal "Child's Nervous System" discussing patient positioning during surgery for fourth ventricular tumors in children. The author reflects on an article that argues for a telovelar approach without removing the posterior arch of C1, emphasizing the importance of the modified prone position. The author suggests that the surgeon's position is crucial, advocating for a lateral-posterior position. They also discuss the advantages and disadvantages of different patient positions, such as the sitting position and the prone position. The author concludes by supporting the removal of the posterior arch of C1 and emphasizing the importance of achieving a comfortable viewing angle for successful surgery. [Extracted from the article]

This study aimed to investigate the following: (i) sleep characteristics in preterm infants at 9–20 weeks of corrected age, and (ii) differences in early spontaneous movements and developmental functioning results between the groups based on some sleep characteristics. Seventy-four preterm infants (36 female) were included. Sleep characteristics were assessed according to the Brief Infant Sleep Questionnaire (BISQ). The infants were divided into two groups based on total sleep duration: less than 12 h (38 infants), and 12 h and more (36 infants). Video recordings were made for the General Movements Assessment (GMA) and evaluated using the Motor Optimality Score for 3- to 5-Month-Old-Infants-Revised (MOS). Cognitive, language, and motor development were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). The total sleep duration of all preterm infants (mean ± SD) was 11.8 ± 3.3 h. Infants who had absent fidgety movements slept less than 12 h, and fidgety movements differed between the groups (p = 0.012). Infants who slept 12 h or more had significantly higher MOS (p = 0.041), cognitive (p = 0.002), language (p < 0.001), and motor (p = 0.002) development results. Infants who snored had lower MOS (p = 0.001), cognitive (p = 0.004), language (p = 0.002), and motor (p = 0.001) development results. Infants with fewer than three nocturnal awakenings had significantly higher Bayley-III cognitive (p = 0.007), language (p = 0.032), and motor (p = 0.005) domain results. Prone and supine sleeping positions showed higher motor domain results than lateral positions (p = 0.001). Sleep in preterm infants might be a key factor in early developmental functioning processes and nervous system integrity. Even in the first months of life, there are substantial differences in cognitive, language, and motor development in association with sleep characteristics. • Total sleep duration and the presence of snoring could affect the detailed GMA in preterm infants at three months of age. • Preterm infants who slept less than 12 h had low MOS and developmental functioning results. • The snoring rate in preterm infants was 32.4 % and infants who slept less than 12 h had a higher rate of snoring. • Infants who snore had more abnormal movement and postural patterns. • Three or more nocturnal awakenings in preterm infants negatively affected cognitive, motor, and language development. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine the sleep stage during which isolated snoring occurs in children and adults, and to analyze changes after treatment of obstructive sleep apnea (OSA). Methods: This retrospective study examined duration of snoring time and respiratory events during each sleep stage in adults and children who underwent polysomnography, had an apnea-hypopnea index (AHI) < 15/h and had snoring time ≥ 10% of total sleep time. Changes in duration of snoring time were also examined in adult patients after treatment with an oral appliance (OA). Results: Snoring time was shown to be predominant during N3 and N2 sleep and less dominant during REM sleep in both children (n = 47) and adults (n = 93). These results were seen even in children with REM dependency. The percentage of snoring time during N3 sleep was more pronounced in women than in men among young adult patients aged < 40 years but was not significantly different between men and women overall. There were no significant differences in the percentage of snoring time in each sleep stage between young women with mild OSA and non-OSA. In children, there were no significant differences between boys and girls in the percentage of snoring time in any sleep stage. The percentage of snoring time during N3 was significantly higher sleep in the non-supine position than in the supine position in children, whereas no significant differences were noted between the supine and non-supine positions in any sleep stage in adults. OA treatment for adult patients (n = 20) significantly increased the percentage of snoring time during N3 sleep, although it significantly decreased AHI, total snoring time, and snoring time during N1 sleep and REM sleep. Conclusions: Snoring presented exclusively during the N3 sleep stage, especially in young women with mild OSA, and in children with OSA, especially in the non-supine position. Snoring time during N3 sleep increased during OA treatment for OSA. [ABSTRACT FROM AUTHOR]

The meta-analysis aimed to evaluate the efficacy of mandibular advancement device (MAD) for the treatment of obstructive sleep apnea (OSA) and explore the effect of different positions on MAD for OSA. The Embase, PubMed, Medline, and Cochrane Library databases were searched for relevant studies evaluating the effect of MAD on the treatment of OSA from database inception to November 2022. The Bayesian random-effects mode was used to calculate the pooled outcome. Subgroup analysis and sensitivity analysis were applied to investigate the heterogeneity. A total of 6 studies enrolling 643 patients were eligible for further analysis. MAD treatment led to improvements in total apnea-hypopnea index (AHI) for both positional OSA(POSA) and Non-POSA groups, but there was no significant difference in the effect of MAD on Non-POSA and POSA (MD = −1.46,95%CI [-4.89,1.97], P = 0.40). In the supine position, AHI improvement after MAD treatment in POSA group was more than that in Non-POSA group by 15 events/hour in average (MD = 14.82, 95%CI [11.43,18.22], P＜0.00001), while in the non-supine position, the change of AHI in Non-POSA group was significantly better than that in POSA group by approximately 8 events/hour (MD = −7.55,95%CI[-10.73,-4.38],p < 0.00001). MAD is more suitable for POSA compared to Non-POSA in patients with habitual sleep in the supine or supine predominant position. While for patients with habitual sleep in the non-supine position, MAD is an effective treatment option for Non-POSA. • MAD treatment led to improvements in total AHI for both POSA and Non-POSA patients. • MAD is more suitable for POSA in patients with habitual sleep in the supine or supine predominant position. • For patients with habitual sleep in the non-supine position, MAD is an effective treatment option for Non-POSA. [ABSTRACT FROM AUTHOR]

This research paper introduces a novel methodology for optimizing pressure dispersion in interactive bed systems, aiming to enhance sleep comfort while considering variegated body shapes and sleeping positions. By controlling the spring constant with precision, which is further optimized by a secondary differential filter, the proposed methodology assures ideal pressure distribution across the bed surface. At the heart of the proposed methodology lies the design of an interactive bed system that effectively responds to the unconscious postural shifts of the user during sleep. The implementation of a secondary differential filter in modulating the spring constant is an integral part of this approach, facilitating the crafting of a responsive bedding surface that promptly adapts to pressure alterations. The effectiveness of this novel method is verified through finite element method (FEM) analysis, which confirms successful pressure dispersion across the bed surface, an essential factor in enhancing sleep comfort. The research also proposes potential enhancements to this methodology, such as incorporating air-pressure control mechanisms, thereby introducing additional pressure control axes akin to those present in existing technologies. This study represents a significant stride forward in the advancement of interactive bed systems by presenting a new method for optimizing pressure dispersion, and hence, enhancing sleep comfort. The employment of FEM analysis not only validates the effectiveness of the proposed methodology but also highlights the potential for the future development of personalized and adaptive bedding solutions. [ABSTRACT FROM AUTHOR]

Most research on mammalian resting and sleep behavior is conducted under controlled laboratory or zoo settings, with limited studies taking place in their natural habitats. To analyze these behaviors within a natural setting, actigraphy has been identified as a valuable method. This study sought to, firstly, measure inactivity and sleep in free-roaming Angolan giraffe (Giraffa giraffa angolensis) and, secondly, present their nocturnal behavioral rhythmicity. Three giraffe were fitted with an accelerometer-GPS device attached to an ossicone in November 2018 and behavioral data were collected daily between December 2018 and April 2019 to record their cranial movement. As giraffe show behavior specific head movements, sleep events could be detected as well as active and inactive behavior patterns. In this study, we analyzed how long giraffe were inactive during the night, how many sleep events they showed and for how long they were in the sleep position during the night. Giraffe were inactive for 490.8 ± 43.7 minutes during the night (from 19:00 to 7:00 local time), and a total of 857 sleep events were recorded with an average of 2.0 ± 1.0 events per night and total length of sleep per night averaged 8.6 ± 7.9 minutes. Further, results show a clear biphasic sleep profile during the night with peaks of inactivity and sleep events during the hours after sunset (21:00–23:00) and during the early morning hours before sunrise (3:00–5:00). We found individual differences for the number or sleep events, the total time sleeping as well as for inactivity. Interestingly, differences between months only were detected for inactivity. No differences were found for the number of sleep events nor for the total sleep time per night between months. For the first time, this study sheds light on the nocturnal sleep behavior and biphasic inactivity rhythm of giraffe in their natural habitat, providing additional support for previous findings indicating brief sleep episodes in giraffe [ABSTRACT FROM AUTHOR]

Currently, most studies on ungulates' behavior are conducted during the daylight hours, but their nocturnal behavior patterns differ from those shown during day. Therefore, it is necessary to observe ungulates' behavior also overnight. Detailed analyses of nocturnal behavior have only been conducted for very prominent ungulates such as Giraffes (Giraffa camelopardalis), African Elephants (Loxodonta africana), or livestock (e.g., domesticated cattle, sheep, or pigs), and the nocturnal rhythms exhibited by many ungulates remain unknown. In the present study, the nocturnal rhythms of 192 individuals of 18 ungulate species from 20 European zoos are studied with respect to the behavioral positions standing, lying—head up, and lying—head down (the typical REM sleep position). Differences between individuals of different age were found, but no differences with respect to the sex were seen. Most species showed a significant increase in the proportion of lying during the night. In addition, the time between two events of "lying down" was studied in detail. A high degree of rhythmicity with respect to this quantity was found in all species. The proportion of lying in such a period was greater in Artiodactyla than in Perissodactyla, and greater in juveniles than in adults. [ABSTRACT FROM AUTHOR]

Understanding how the human body works during sleep and how this varies in the population is a task with significant implications for medicine. Polysomnographic studies, or sleep studies, are a common diagnostic method that produces a significant quantity of time-series sensor data. This study seeks to learn the causal structure from data from polysomnographic studies carried out on 600 adult volunteers in the United States. Two methods are used to learn the causal structure of these data: the well-established Granger causality and "DYNOTEARS", a modern approach that uses continuous optimisation to learn dynamic Bayesian networks (DBNs). The results from the two methods are then compared. Both methods produce graphs that have a number of similarities, including the mutual causation between electrooculogram (EOG) and electroencephelogram (EEG) signals and between sleeping position and SpO2 (blood oxygen level). However, DYNOTEARS, unlike Granger causality, frequently finds a causal link to sleeping position from the other variables. Following the creation of these causal graphs, the relationship between the discovered causal structure and the characteristics of the participants is explored. It is found that there is an association between the waist size of a participant and whether a causal link is found between the electrocardiogram (ECG) measurement and the EOG and EEG measurements. It is concluded that a person's body shape appears to impact the relationship between their heart and brain during sleep and that Granger causality and DYNOTEARS can produce differing results on real-world data. [ABSTRACT FROM AUTHOR]

Alvarezsauria is a group of early-branching maniraptoran theropods that are distributed globally from the Late Jurassic to the latest Cretaceous. Despite recent increases in the fossil record of this group, the scarcity of complete specimens still restricts interpreting their detailed anatomy, ecology, and evolution. Here, we report a new taxon of derived alvarezsaur, Jaculinykus yaruui gen. et sp. nov., from the Late Cretaceous of Mongolia, which represents a nearly complete and articulated skeleton. Our phylogenetic analysis reveals that Jaculinykus belongs to the sub-clade of Alvarezsauridae, Parvicursorinae, and forms a mononphyletic group with Mononykus and Shuvuuia. Its well-preserved manus has only two fingers, composed of a hypertrophied digit I and greatly reduced digit II, which implies an intermediate condition between the tridactyl manus of Shuvuuia and monodactyl manus of Linhenykus. This highlights a previously unrecognized variation in specialization of alvarezsaurid manus. Notably, the preserved posture of the specimen exhibits a stereotypical avian-like sleeping position seen in the troodontids Mei and Sinornithoides. Evidence of this behavior in the alvarezsaur Jaculinykus suggests that stereotypically avian sleeping postures are a maniraptoran synapomorphy, providing more evidence of bird-like traits being distributed broadly among avian ancestors. [ABSTRACT FROM AUTHOR]

Patients with Parkinson's disease (PD) tend to sleep more frequently in the supine position and less often change head and body position during sleep. Besides sleep quality and continuity, head and body positions are crucial for glymphatic system (GS) activity. This pilot study evaluated sleep architecture and head position during each sleep stage in idiopathic PD patients without cognitive impairment, correlating sleep data to patients' motor and non-motor symptoms (NMS). All patients underwent the multi-night recordings, which were acquired using the Sleep Profiler headband. Sleep parameters, sleep time in each head position, and percentage of slow wave activity (SWA) in sleep, stage 3 of non-REM sleep (N3), and REM sleep in the supine position were extracted. Lastly, correlations with motor impairment and NMS were performed. Twenty PD patients (65.7 ± 8.6 y.o, ten women) were included. Sleep architecture did not change across the different nights of recording and showed the prevalence of sleep performed in the supine position. In addition, SWA and N3 were more frequently in the supine head position, and N3 in the supine decubitus correlated with REM sleep performed in the same position; this latter correlated with the disease duration (correlation coefficient = 0.48, p-value = 0.03) and motor impairment (correlation coefficient = 0.53, p-value = 0.02). These preliminary results demonstrated the importance of monitoring sleep in PD patients, supporting the need for preventive strategies in clinical practice for maintaining the lateral head position during the crucial sleep stages (SWA, N3, REM), essential for permitting the GS function and activity and ensuring brain health. [ABSTRACT FROM AUTHOR]

The article discusses the use of position modification devices to prevent supine sleep during pregnancy. A study by Wilson et al. on the effectiveness of the 'Back-Off' pillow did not show significant differences in supine sleep, sleep-disordered breathing severity, or fetal well-being. An alternative device, PrenaBelt, was proposed as a wearable option focusing on the lower back and pelvis position. The authors suggest further investigation into alternative devices for reducing supine sleep during late pregnancy. [Extracted from the article]

Objectives: Safe sleep of infants is important to reduce the risk of Sudden Unexpected Death in Infancy (SUDI). The depiction of infant care behavior which is inconsistent with the safe sleep recommendations on social media has an impact on parental infant care thoughts, norms and behaviors. This study aims to determine the adherence of Instagram images to the Dutch safe sleeping advice. Design: A systematic social media analysis on Instagram was performed using 22 hashtags and 9 accounts of Dutch companies or platforms related to infants. Images of sleeping infants were analyzed on consistency with the criteria: supine sleeping position, own cot or crib, sleep sack, and an empty bed. Results: Based on 514 collected images, 5.9% was consistent with sleep sack use, 16.8% with an empty bed, 30.7% with an own cot or crib, and 67.5% with the supine sleeping position. For 311 images (60.5%), all four criteria could be rated, as for the others, at least one criterion was not clearly depicted. Only 6 of these images (1.9%) were consistent with all four criteria. Conclusions: Although Instagram images are probably not representative of regular infant care behavior, the exposure to these images that are mostly inconsistent with the safe sleep advice can contribute to the formation of norms, and therefore influence parental care behavior. Accurate communication of the safe sleep recommendations through social media is needed, and opportunities are described for preventive health professionals to engage more in this communication with their public. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is well known to often improve with non-supine positioning as opposed to supine positioning. Emerging research supports a role for sleep position management in patients with central sleep apnea (CSA) as well. We report a case of de novo complex sleep apnea syndrome (CompSAS) in a 78-year-old female, who presented after a car accident due to unclear syncope. Diagnostic polysomnography (PSG) showed moderate OSA. A CompSAS developed under automatic positive airway pressure (APAP), while 4 years of downloaded data showed good adherence. No significant benefit was reported under adaptive servo ventilation (ASV) and BiPAP-ST, while a reduction in CSA in the non-supine position was noticed. Oxygen and sleep positional therapy (SPT) were considered, resulting in a significant improvement in CSA and sleep quality. Further research on the prevalence of positional CSA is needed. [ABSTRACT FROM AUTHOR]