Supine position

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Supine position and prone position Supine and prone 2012-02-20.jpg
Supine position and prone position

The supine position ( /səˈpn/ or /ˈspn/ ) means lying horizontally with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it allows access to the peritoneal, thoracic and pericardial regions; as well as the head, neck and extremities. [1]

Contents

Using anatomical terms of location, the dorsal side is down, and the ventral side is up, when supine.

A man lying in the supine position Supine.jpg
A man lying in the supine position

Semi-supine

In scientific literature "semi-supine" commonly refers to positions where the upper body is tilted (at 45° or variations) and not completely horizontal. [2]

Relation to sudden infant death syndrome

The decline in death due to sudden infant death syndrome (SIDS) is said to be attributable to having babies sleep in the supine position. [3] It is believed that in the prone position babies are more at risk to re-breathe their own carbon dioxide. Because of the immature state of their central chemoreceptors, infants do not respond to the subsequent respiratory acidosis that develops. [4] [5] Typical non-infants realize autonomic responses of increased rate and depth of respiration (hyperventilation, yawning).

Obstructive sleep apnea

Obstructive sleep apnea (OSA) is a form of sleep apnea that occurs more frequently and is most severe when individuals are sleeping in the supine position. Studies and evidence show that OSA related to sleeping in the supine position is related to the airway positioning, reduced lung volume, and the inability of airway muscles to dilate enough to compensate as the airway collapses. [6] With individuals who have OSA, many health care providers encourage their patients to avoid the supine position while asleep and sleep laterally or sleep with the head of their bed up in a 30- or 45-degree angle. [7]

See also

Related Research Articles

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Snoring is the vibration of respiratory structures and the resulting sound due to obstructed air movement during breathing while sleeping. In some cases, the sound may be soft, but in most cases, it can be loud and unpleasant. Snoring during sleep may be a sign, or first alarm, of obstructive sleep apnea (OSA). Research suggests that snoring is one of the factors of sleep deprivation.

Obesity hypoventilation syndrome

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Positive airway pressure mechanical ventilation in which pressure is maintained to increase the volume of gas remaining in the lungs at the end of expiration

Positive airway pressure (PAP) is a mode of respiratory ventilation used in the treatment of sleep apnea. PAP ventilation is also commonly used for those who are critically ill in hospital with respiratory failure, in newborn infants (neonates), and for the prevention and treatment of atelectasis in patients with difficulty taking deep breaths. In these patients, PAP ventilation can prevent the need for tracheal intubation, or allow earlier extubation. Sometimes patients with neuromuscular diseases use this variety of ventilation as well. CPAP is an acronym for "continuous positive airway pressure", which was developed by Dr. George Gregory and colleagues in the neonatal intensive care unit at the University of California, San Francisco. A variation of the PAP system was developed by Professor Colin Sullivan at Royal Prince Alfred Hospital in Sydney, Australia, in 1981.

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Polysomnography comprehensive recording of the biophysiological changes that occur during sleep

Polysomnography (PSG), a type of sleep study, is a multi-parametric test used in the study of sleep and as a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG. The name is derived from Greek and Latin roots: the Greek πολύς, the Latin somnus ("sleep"), and the Greek γράφειν.

Mandibular advancement splint

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Obstructive sleep apnea (OSA) is the most common type of sleep apnea and is characterised by repeated episodes of complete or partial obstructions of the upper airway during sleep, despite the effort to breathe, and is usually associated with a reduction in blood oxygen saturation. In the Obstructive Sleep Apnea-Hypopnea Syndrome, the episodes of decreased breathing are called “hypopnea” and its definition requires a ≥30% drop in flow for 10 seconds or longer, associated with ≥3% oxygen desaturation. The episodes of breathing cessations are called “apneas” and to be defined, a ≥90% drop in flow for 10 seconds or longer must be assessed and associated with ≥3% oxygen desaturation, or an arousal.


Hypopnea is overly shallow breathing or an abnormally low respiratory rate. Hypopnea is defined by some to be less severe than apnea, while other researchers have discovered hypopnea to have a "similar if not indistinguishable impact" on the negative outcomes of sleep breathing disorders. In sleep clinics, obstructive sleep apnea syndrome or obstructive sleep apnea–hypopnea syndrome is normally diagnosed based on the frequent presence of apneas and/or hypopneas rather than differentiating between the two phenomena. Hypopnea is typically defined by a decreased amount of air movement into the lungs and can cause oxygen levels in the blood to drop. It commonly is due to partial obstruction of the upper airway.

Apnea of prematurity is defined as cessation of breathing by a premature infant that lasts for more than 20 seconds and/or is accompanied by hypoxia or bradycardia. Apnea is traditionally classified as either obstructive, central, or mixed. Obstructive apnea may occur when the infant's neck is hyperflexed or conversely, hyperextended. It may also occur due to low pharyngeal muscle tone or to inflammation of the soft tissues, which can block the flow of air though the pharynx and vocal cords. Central apnea occurs when there is a lack of respiratory effort. This may result from central nervous system immaturity, or from the effects of medications or illness. Many episodes of apnea of prematurity may start as either obstructive or central, but then involve elements of both, becoming mixed in nature.

Safe to Sleep public health initiative to promote safe sleeping positions for babies

The Safe to Sleep campaign, formerly known as the Back to Sleep campaign, is an initiative backed by the US National Institute of Child Health and Human Development (NICHD) at the US National Institutes of Health to encourage parents to have their infants sleep on their backs to reduce the risk of sudden infant death syndrome, or SIDS. Since "Safe to Sleep" was launched in 1994, the incidence of SIDS has declined by more than 50%.

Tummy time is a colloquialism used to encourage parents to ensure that their infant children spend time in the prone position while awake and supervised.

Christian Guilleminault was a French physician and researcher in the field of sleep medicine who played a central role in the early discovery of obstructive sleep apnea and made seminal discoveries in many other areas of sleep medicine.

Central sleep apnea (CSA) or central sleep apnea syndrome (CSAS) is a sleep-related disorder in which the effort to breathe is diminished or absent, typically for 10 to 30 seconds either intermittently or in cycles, and is usually associated with a reduction in blood oxygen saturation. CSA is usually due to an instability in the body's feedback mechanisms that control respiration. Central sleep apnea can also be an indicator of Arnold–Chiari malformation.

The sleeping position is the body configuration assumed by a person during or prior to sleeping. It has been shown to have health implications, particularly for babies.

Sleep surgery is a surgery performed to treat sleep disordered breathing. Sleep disordered breathing is a spectrum of disorders that includes snoring, upper airway resistance syndrome, and obstructive sleep apnea. These surgeries are performed by surgeons trained in otolaryngology, oral maxillofacial surgery, and craniofacial surgery.

Hyoid suspension also known as hyoid myotomy and suspension or hyoid advancement, is a surgical procedure or sleep surgery in which the hyoid bone and its muscle attachments to the tongue and airway are pulled forward with the aim of increasing airway size and improving airway stability in the retrolingual and hypopharyngeal airway. The horseshoe shaped hyoid bone sits directly below the base of tongue with the arms of the bone flanking the airway. Hyoid suspension is typically performed as a treatment for obstructive sleep apnea (OSA). This procedure is frequently performed with a uvulopalatopharyngoplasty (UPPP) which targets sites of obstruction higher in the airway. Typically, a hyoid suspension is considered successful when the patient’s apnea-hypopnea index is significantly reduced after surgery.

Infantile apnea is a rare disease that is characterized by cessation of breathing in an infant for at least 20 seconds or a shorter respiratory pause that is associated with a slow heart rate, bluish discolouration of the skin, extreme paleness and/or decreased muscle tone. Infantile apnea occurs in children under the age of one and it is more common in premature infants. Symptoms of infantile apnea occur most frequently during the rapid eye movement (REM) stage of sleep. The nature and severity of breathing problems in patients can be detected in a sleep study called a polysomnography which measures the brain waves, heartbeat, body movements and breathing of a patient overnight. Infantile apnea can be caused by developmental problems that result in an immature brainstem or it can be caused other medical conditions. As children grow and develop, infantile apnea usually does not persist. Infantile apnea may be related to some cases of sudden infant death syndrome (SIDS) however, the relationship between infantile apnea and SIDS is not known.

References

  1. Rothrock, J. C. (2007) Alexander's Care of the Patient in Surgery 13th Ed. Mobsy Elsevier: St Louis, Missouri. p. 148.
  2. Petropoulou, E; Lancellotti, P; Piérard, LA (2006). "Quantitative analysis of semi-supine exercise echocardiography--influence of age on myocardial Doppler imaging indices". Acta Cardiologica. 61 (3): 271–7. doi:10.2143/ac.61.3.2014827. PMID   16869446.
  3. Marcarelli, Rebekah (3 May 2014). "Sudden Infant Death Syndrome Could Be Prevented By Making Sure Baby Sleeps On Back". hngn.com. Headlines & Global News. Retrieved 25 March 2016.
  4. L'Hoir MP, Engelberts AC, van Well GT, McClelland S, Westers P, Dandachli T, Mellenbergh GJ, Wolters WH, Huber J (1998). "Risk and preventive factors for cot death in The Netherlands, a low-incidence country". Eur. J. Pediatr. 157 (8): 681–8. doi:10.1007/s004310050911. PMID   9727856.
  5. "The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk". American Academy of Pediatrics. Archived from the original on 2008-12-03. Retrieved 2008-11-06.
  6. Joosten, Simon A.; O'Driscoll, Denise M.; Berger, Philip J.; Hamilton, Garun S. (2014-02-01). "Supine position related obstructive sleep apnea in adults: pathogenesis and treatment". Sleep Medicine Reviews. 18 (1): 7–17. doi:10.1016/j.smrv.2013.01.005. ISSN   1532-2955. PMID   23669094.
  7. Tuomilehto, Henri; Seppä, Juha; Partinen, Markku; Uusitupa, Matti (2009-07-01). "Avoiding the Supine Posture during Sleep for Patients with Mild Obstructive Sleep Apnea". American Journal of Respiratory and Critical Care Medicine. 180 (1): 101–102. doi:10.1164/ajrccm.180.1.101a. ISSN   1073-449X.