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Journal of Clinical Sleep Medicine :... Sep 2022Supine-predominant obstructive sleep apnea (OSA) is highly prevalent. The proportion of time spent in the supine position may be overrepresented during polysomnography,...
STUDY OBJECTIVES
Supine-predominant obstructive sleep apnea (OSA) is highly prevalent. The proportion of time spent in the supine position may be overrepresented during polysomnography, which would impact on the apnea-hypopnea index (AHI) and have important clinical implications. We aimed to investigate the difference in body position during laboratory or home polysomnography compared to habitual sleep and estimate its effect on OSA severity. Secondary aims were to evaluate the consistency of habitual sleeping position and accuracy of self-reported sleeping position.
METHODS
Patients undergoing diagnostic laboratory or home polysomnography were recruited. Body position was recorded using a neck-worn device. Habitual sleeping position was the average time spent supine over 3 consecutive nights at home. Primary outcomes were the proportion of sleep time spent supine (% time supine) and AHI adjusted for habitual sleeping position.
RESULTS
Fifty-seven patients who underwent laboratory polysomnography and 56 who had home polysomnography were included. Compared to habitual sleep, % time supine was higher during laboratory polysomnography (mean difference 14.1% [95% confidence interval: 7.2-21.1]; = .0002) and home polysomnography (7.1% [95% confidence interval 0.9-13.3]; = .03). Among those with supine-predominant OSA, there was a trend toward lower adjusted AHI than polysomnography-derived AHI ( = .07), changing OSA severity in 31.6%. There was no significant between-night difference in % time supine during habitual sleep ( = .4). Self-reported % time supine was inaccurate (95% limits of agreement -49.2% to 53.9%).
CONCLUSIONS
More time was spent in the supine position during polysomnography compared to habitual sleep, which may overestimate OSA severity for almost one-third of patients with supine-predominant OSA.
CLINICAL TRIAL REGISTRATION
Registry: Australia and New Zealand Clinical Trials Registry (ANZCTR); Title: Sleeping position during sleep tests and at home; Identifier: ACTRN12618000628246; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374873&isReview=true.
CITATION
Yo SW, Joosten SA, Wimaleswaran H, et al. Body position during laboratory and home polysomnography compared to habitual sleeping position at home. . 2022;18(9):2103-2111.
Topics: Humans; Polysomnography; Posture; Sleep; Sleep Apnea, Obstructive; Supine Position
PubMed: 35459447
DOI: 10.5664/jcsm.9990 -
BMC Cardiovascular Disorders Oct 2023To study effect of change in position (supine and standing) on pulmonary artery pressure (PAP) in ambulatory heart failure (HF) patients.
AIM
To study effect of change in position (supine and standing) on pulmonary artery pressure (PAP) in ambulatory heart failure (HF) patients.
METHODS
Seventeen patients with CardioMEMS® sensor and stable heart failure were consented and included in this single center study. Supine and standing measurements were obtained with at least 5 min interval between the two positions. These measurements included PAP readings utilizing the manufacturer handheld interrogator obtaining 10 s data in addition to the systemic blood pressure and heart rate recordings.
RESULTS
Mean supine and standing readings and their difference (Δ) were as follows respectively: Systolic PAP were 33.4 (± 11.19), 23.6 (± 10) and Δ was 9.9 mmHg (p = 0.0001), diastolic PAP were 14.2 (± 5.6), 7.9 (± 5.7) and Δ was 6.3 mmHg (p = 0.0001) and mean PAP were 21.8 (± 7.8), 14 (± 7.2) and Δ was 7.4 mmHg (p = 0.0001) while the systemic blood pressure did not vary significantly.
CONCLUSION
There is orthostatic variation of PAP in ambulatory HF patients demonstrating a mean decline with standing in diastolic PAP by 6.3 mmHg, systolic PAP by 9.9 mmHg and mean PAP by 7.4 mmHg in absence of significant orthostatic variation in systemic blood pressure or heart rate. These findings have significant clinical implications and inform that PAP in each patient should always be measured in the same position. Since initial readings at the time of implant were taken in supine position, it may be best to use supine position or to obtain a baseline standing PAP reading if standing PAP is planned on being used.
Topics: Humans; Blood Pressure; Heart Failure; Heart Rate; Pulmonary Artery; Hypotension, Orthostatic; Standing Position; Supine Position
PubMed: 37817090
DOI: 10.1186/s12872-023-03534-y -
Urology Journal 2011To share the experience of the authors with the urological family in the world by the review of literature on supine percutaneous nephrolithotomy (PCNL). (Review)
Review
PURPOSE
To share the experience of the authors with the urological family in the world by the review of literature on supine percutaneous nephrolithotomy (PCNL).
MATERIALS AND METHODS
We have searched all the available databases, including PubMed or MEDLINE and Embase Biomedical Database to find any English articles related to supine PCNL from 1998 to 2010. Of 17 studies, 11 were case series and 6 were comparative.
RESULTS
A total of 1914 patients were studied. Only the results of mean operation time were significant. Supine PCNL offers several advantages, including less operation time, less patient handling, needing only one drape, easier access to the urethra and upper calyces, facilitation of drainage of stone fragment with the Amplatz sheath, less anterior kidney displacement due to lying the kidney in its normal anatomical position, less risk of the colon injury, more tolerable for the patients with pulmonary or cardiovascular disease, and better for morbid obese patients. The overlap density of the vertebrae in the semi-supine position can be avoided. Furthermore, the fluoroscopy tube is far from the puncture site; thus, the space is open for the surgeon to work and the surgeon can perform the procedure in a more comfortable seated position.
CONCLUSION
The study showed that PCNL in the supine position is feasible. Although supine PCNL has numerous advantages, it is not routine in many surgical centers throughout the world. The practice of supine PCNL will be popular when the academic centers be encouraged to start it.
Topics: Humans; Nephrostomy, Percutaneous; Patient Positioning; Supine Position
PubMed: 22090042
DOI: No ID Found -
Medicina (Kaunas, Lithuania) Feb 2023: Supracondylar fractures of the humerus (SCHF) make up about one-third of pediatric fractures and are the most common elbow fractures in children. Reduction and... (Review)
Review
: Supracondylar fractures of the humerus (SCHF) make up about one-third of pediatric fractures and are the most common elbow fractures in children. Reduction and fixation of SC fractures can be performed with the patient in the prone or supine position. However, the role of the patient's position during surgery is still unclear. The purpose of this systematic review is to evaluate, based on data from the literature, the role of patient position during closed reduction and fixation of pediatric SCHFs. : A systematic review of the current literature from 1951 to 2021 was conducted according to PRISMA guidelines. Articles were identified from 6 public databases. Articles were screened and abstracted by two investigators and the quality of included publications ( = 14) was assessed (MINORS criteria). Statistical analyses were performed using R studio 4.1.2. : The systematic literature review identified 114 articles, from which, according to inclusion and exclusion criteria, 14 studies were identified. A total of 741 children were treated in the prone position and 538 in the supine position. The results of the systematic review showed that there were no statistical differences between the two positions with regard to clinical, radiographic, and complication outcomes. : The functional and radiographic outcome of displaced SCHFs is generally excellent regardless of the position, prone or supine, in which the patient is positioned for surgery. The choice of how to position the patient depends on the habit and experience of the surgeon and anesthesiologist performing the surgery.
Topics: Child; Humans; Supine Position; Prone Position; Humerus; Humeral Fractures; Fracture Fixation, Internal; Treatment Outcome; Retrospective Studies
PubMed: 36837576
DOI: 10.3390/medicina59020374 -
Neurology India 2013Syncope is a common cause of transient loss of consciousness. In the analysis of patients having syncope, body position has not been systematically studied and... (Comparative Study)
Comparative Study
CONTEXT
Syncope is a common cause of transient loss of consciousness. In the analysis of patients having syncope, body position has not been systematically studied and correlated with triggers, prodromal symptoms and circumstances. This correlation is important in differentiating syncope from its mimics.
AIMS
To study syncope with respect to body positions, triggers, prodromal symptoms and circumstances.
SETTINGS AND DESIGN
Prospective study set in Neurology Department of Tertiary Care Center.
MATERIALS AND METHODS
Patients fulfilling guidelines set by The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC) were recruited. Detailed clinical history, examination and investigations (ECG, 2D-ECHO, Head Up Tilt Test, Holter monitor, EEG, MRI Brain) were carried out.
RESULTS
Out of the 111 recruited patients, 67 developed syncope in standing, 16 in sitting, 23 in both standing and sitting, 1 in both sitting and supine and 4 in all three positions. Prodromal symptoms were present in 81% while triggers in 42% and circumstances in 41% of patients. Black out, sweating, dizziness and headache were most common prodromal symptoms. Intense pain, smell and fear were most common triggers while prolonged standing, hot crowded room and fasting were most common circumstances associated with syncope.
CONCLUSIONS
Against common belief, syncope can occur in sitting as well as in supine position. Emotional triggers were commoner in patients with syncope in supine and sitting positions while prodromal symptoms and circumstances were similar for all positions. Syncope should be considered in body positions other than standing.
Topics: Adult; Female; Humans; Male; Middle Aged; Posture; Prodromal Symptoms; Prospective Studies; Supine Position; Syncope
PubMed: 23860141
DOI: 10.4103/0028-3886.115060 -
Current Opinion in Nephrology and... Sep 2012Supine hypertension is a common finding in autonomic failure that can worsen orthostatic hypotension and predispose to end-organ damage. This review focuses on... (Review)
Review
PURPOSE OF REVIEW
Supine hypertension is a common finding in autonomic failure that can worsen orthostatic hypotension and predispose to end-organ damage. This review focuses on nonpharmacologic and pharmacologic approaches to manage hypertension in these patients in the face of disabling orthostatic hypotension.
RECENT FINDINGS
The hypertension of autonomic failure can be driven by sympathetic-dependent or independent mechanisms, contingent on the site of autonomic lesions. Management of supine hypertension should include simple nonpharmacologic approaches including avoiding the supine position during the daytime and sleeping in a head-up tilt position at night. Most patients, however, require pharmacologic treatment. Several antihypertensive therapies lower nighttime pressure in autonomic failure, but none improve nocturnal volume depletion or morning orthostatic tolerance. Regardless, treatment may still be beneficial in some patients but must be decided on an individual basis. Blood pressure monitoring is helpful in this regard, as well as titration of doses, as these patients are hypersensitive to depressor agents due to loss of baroreceptor reflexes.
SUMMARY
Autonomic failure provides a unique opportunity to study blood pressure regulation independent of autonomic influences. Understanding mechanisms driving supine hypertension will have important implications for the treatment of autonomic failure and will improve our knowledge of cardiovascular regulation in other populations, including essential hypertension and elderly hypertensive individuals with comorbid orthostatic hypotension.
Topics: Autonomic Nervous System Diseases; Blood Pressure; Humans; Hypertension; Supine Position; Vasodilator Agents
PubMed: 22801444
DOI: 10.1097/MNH.0b013e328356c52f -
Ultrasound in Medicine & Biology Apr 2021Ultrasound bladder vibrometry (UBV) parameters have been shown in previous studies to strongly correlate with measurements from urodynamic studies. Just like urodynamic... (Comparative Study)
Comparative Study
Ultrasound bladder vibrometry (UBV) parameters have been shown in previous studies to strongly correlate with measurements from urodynamic studies. Just like urodynamic studies, UBV can be performed in supine and sitting positions. The objective of this study is to compare UBV parameters obtained in the two different positions using statistical methods. We recruited eight volunteers with healthy bladders for this purpose. The elasticity, group velocity squared and thickness of the bladder were the UBV parameters of interest, and their values were recorded at different bladder volumes for each volunteer. The results presented indicate that the measurements made in the two positions are in agreement using the Bland-Altman method and a parameter q which compares the values at each bladder volume for each volunteer. UBV parameters were also repeatable for measurements recorded in the supine and sitting positions.
Topics: Adult; Aged; Elasticity; Elasticity Imaging Techniques; Female; Humans; Male; Middle Aged; Patient Positioning; Pilot Projects; Prospective Studies; Sitting Position; Supine Position; Urinary Bladder; Young Adult
PubMed: 33446373
DOI: 10.1016/j.ultrasmedbio.2020.12.016 -
Early Human Development Jun 2014Maternal supine posture in late pregnancy and labor is known to compromise maternal hemodynamics and subsequently affect the fetus. Recently, maternal supine sleep...
OBJECTIVE
Maternal supine posture in late pregnancy and labor is known to compromise maternal hemodynamics and subsequently affect the fetus. Recently, maternal supine sleep position during late pregnancy has been postulated to play a role in stillbirth. However, no objective data exist regarding how often pregnant women sleep supine. This study was therefore conducted to determine the proportion of pregnant women who spend time asleep in the supine position.
METHODS
A secondary analysis of data from pregnant women who underwent home sleep studies.
RESULTS
Of 51 pregnant women, mean gestational age 28.3±6.9weeks, the vast majority of women (82.4%) spent some time sleeping in the supine position. The median proportion of overall time spent in the supine sleep position was 26.5% (90%CI 0.0-82.9%).
CONCLUSION
Our data suggest that if supine position plays a role in stillbirth, most women may benefit from education regarding sleep position.
PRACTICE IMPLICATIONS
Most pregnant women spend time asleep on their back. Given the known data on supine posture and maternal cardiovascular compromise together with emerging data on supine sleep position and stillbirth, it may be pertinent for healthcare providers to provide pregnant women with information about sleep position particularly during late pregnancy.
Topics: Adult; Female; Hemodynamics; Humans; Pregnancy; Pregnancy Complications; Sleep; Stillbirth; Supine Position
PubMed: 24661447
DOI: 10.1016/j.earlhumdev.2014.03.001 -
Anesthesiology Mar 2010The literature on ventilation (V) and lung perfusion (Q) distributions during general anesthesia and controlled mechanical ventilation in supine and prone position is... (Comparative Study)
Comparative Study
BACKGROUND
The literature on ventilation (V) and lung perfusion (Q) distributions during general anesthesia and controlled mechanical ventilation in supine and prone position is contradictory. The authors aimed to investigate whether V, Q, and ventilation to perfusion ratio (V/Q ratio) matching in anesthetized and mechanically ventilated volunteers are gravity dependent irrespective of posture.
METHODS
Seven healthy volunteers were studied at two different occasions during general anesthesia and controlled mechanical ventilation. One occasion studied ventral to dorsal V and Q distributions in the supine posture and the other in the prone posture. Imaging was performed in supine posture at both occasions. A dual radiotracer technique and single photon emission computed tomography were used. V and Q were simultaneously tagged with Tc-Technegas (Tetley Manufacturing Ltd., Sydney, Australia) and In-labeled macroaggregates of human albumin (TechneScan LyoMAA, Mallinckrodt Medica, Petten, The Netherlands), respectively.
RESULTS
No differences in V between postures were observed. Q differed between postures, being more uniform over different lung regions in prone posture and dependent in supine posture. The contribution of the vertical direction to the total V/Q ratio heterogeneity was larger in supine (31.4%) than in prone (16.4%) (P = 0.0639, two-tailed, paired t test) posture.
CONCLUSIONS
During mechanical ventilation, prone posture favors a more evenly distributed Q between lung regions. V distribution is independent of posture. This results in a tendency toward lower V/Q gradients in the ventral to dorsal direction in prone compared with supine posture.
Topics: Adult; Anesthesia, General; Female; Humans; Indium Radioisotopes; Lung; Male; Oximetry; Oxygen; Prone Position; Pulmonary Circulation; Radiopharmaceuticals; Respiration, Artificial; Respiratory Mechanics; Sodium Pertechnetate Tc 99m; Supine Position; Tomography, Emission-Computed, Single-Photon
PubMed: 20179506
DOI: 10.1097/ALN.0b013e3181cf40c8 -
Clinical Autonomic Research : Official... Aug 2018Patients suffering from cardiovascular autonomic failure often develop neurogenic supine hypertension (nSH), i.e., high blood pressure (BP) in the supine position, which... (Review)
Review
Consensus statement on the definition of neurogenic supine hypertension in cardiovascular autonomic failure by the American Autonomic Society (AAS) and the European Federation of Autonomic Societies (EFAS) : Endorsed by the European Academy of Neurology (EAN) and the European Society of...
PURPOSE
Patients suffering from cardiovascular autonomic failure often develop neurogenic supine hypertension (nSH), i.e., high blood pressure (BP) in the supine position, which falls in the upright position owing to impaired autonomic regulation. A committee was formed to reach consensus among experts on the definition and diagnosis of nSH in the context of cardiovascular autonomic failure.
METHODS
As a first and preparatory step, a systematic search of PubMed-indexed literature on nSH up to January 2017 was performed. Available evidence derived from this search was discussed in a consensus expert round table meeting in Innsbruck on February 16, 2017. Statements originating from this meeting were further discussed by representatives of the American Autonomic Society and the European Federation of Autonomic Societies and are summarized in the document presented here. The final version received the endorsement of the European Academy of Neurology and the European Society of Hypertension.
RESULTS
In patients with neurogenic orthostatic hypotension, nSH is defined as systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg, measured after at least 5 min of rest in the supine position. Three severity degrees are recommended: mild, moderate and severe. nSH may also be present during nocturnal sleep, with reduced-dipping, non-dipping or rising nocturnal BP profiles with respect to mean daytime BP values. Home BP monitoring and 24-h-ambulatory BP monitoring provide relevant information for a customized clinical management.
CONCLUSIONS
The establishment of expert-based criteria to define nSH should standardize diagnosis and allow a better understanding of its epidemiology, prognosis and, ultimately, treatment.
Topics: Autonomic Nervous System Diseases; Cardiovascular Diseases; Consensus; Europe; Humans; Hypertension; Supine Position; United States
PubMed: 29766366
DOI: 10.1007/s10286-018-0529-8