Supine position

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Supine position and prone position Supine and prone diagrams-en.svg
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 grants access to the peritoneal, thoracic and pericardial regions; as well as the head, neck and extremities. [1]


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


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] The realization that infants sleeping face down, or in a prone position, had an increased mortality rate re-emerged into medical awareness at the end of the 1980s when two researchers, Susan Beal in Australia and Gus De Jonge in the Netherlands, independently noted the association. [4]

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. [5] [6] 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 when throat muscles relax [7] 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. [8] 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. [9] [10]

See also

Related Research Articles

<span class="mw-page-title-main">Sleep apnea</span> Disorder involving pauses in breathing during sleep

Sleep apnea, also spelled sleep apnoea, is a sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal. Each pause can last for a few seconds to a few minutes and they happen many times a night. In the most common form, this follows loud snoring. There may be a choking or snorting sound as breathing resumes. Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day. In children, it may cause hyperactivity or problems in school.

<span class="mw-page-title-main">Snoring</span> Vibratory sound made while asleep

Snoring is the vibration of respiratory structures and the resulting sound due to obstructed air movement during breathing while sleeping. The sound may be soft or 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.

<span class="mw-page-title-main">Obesity hypoventilation syndrome</span> Condition in which severely overweight people fail to breathe rapidly or deeply enough

Obesity hypoventilation syndrome (OHS) is a condition in which severely overweight people fail to breathe rapidly or deeply enough, resulting in low oxygen levels and high blood carbon dioxide (CO2) levels. The syndrome is often associated with obstructive sleep apnea (OSA), which causes periods of absent or reduced breathing in sleep, resulting in many partial awakenings during the night and sleepiness during the day. The disease puts strain on the heart, which may lead to heart failure and leg swelling.

<span class="mw-page-title-main">Positive airway pressure</span> Mechanical ventilation in which airway pressure is always above atmospheric pressure

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.

Upper airway resistance syndrome is a sleep disorder characterized by the narrowing of the airway that can cause disruptions to sleep. The symptoms include unrefreshing sleep, fatigue, sleepiness, chronic insomnia, and difficulty concentrating. UARS can be diagnosed by polysomnograms capable of detecting Respiratory Effort-related Arousals. It can be treated with lifestyle changes, orthodontics, surgery, or CPAP therapy. UARS is considered a variant of sleep apnea, although some scientists and doctors believe it to be a distinct disorder.

<span class="mw-page-title-main">Polysomnography</span> Multi-parameter study of sleep and sleep disorders

Polysomnography (PSG), a type of sleep study, is a multi-parameter study of sleep and 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.

<span class="mw-page-title-main">Mandibular advancement splint</span>

A mandibular splint or mandibular advancement splint is a prescription custom-made medical device worn in the mouth used to treat sleep-related breathing disorders including: obstructive sleep apnea (OSA), snoring, and TMJ disorders. These devices are also known as mandibular advancement devices, sleep apnea oral appliances, oral airway dilators, and sleep apnea mouth guards.

<span class="mw-page-title-main">Non-invasive ventilation</span>

Non-invasive ventilation (NIV) is the use of breathing support administered through a face mask, nasal mask, or a helmet. Air, usually with added oxygen, is given through the mask under positive pressure; generally the amount of pressure is alternated depending on whether someone is breathing in or out. It is termed "non-invasive" because it is delivered with a mask that is tightly fitted to the face or around the head, but without a need for tracheal intubation. While there are similarities with regard to the interface, NIV is not the same as continuous positive airway pressure (CPAP), which applies a single level of positive airway pressure throughout the whole respiratory cycle; CPAP does not deliver ventilation but is occasionally used in conditions also treated with NIV.

<span class="mw-page-title-main">Obstructive sleep apnea</span> Sleeping and breathing disorder

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway leading to reduced or absent breathing during sleep. These episodes are termed "apneas" with complete or near-complete cessation of breathing, or "hypopneas" when the reduction in breathing is partial. In either case, a fall in blood oxygen saturation, a disruption in sleep, or both may result. A high frequency of apneas or hypopneas during sleep may interfere with restorative sleep, which – in combination with disturbances in blood oxygenation – is thought to contribute to negative consequences to health and quality of life. The terms obstructive sleep apnea syndrome (OSAS) or obstructive sleep apnea–hypopnea syndrome (OSAHS) may be used to refer to OSA when it is associated with symptoms during the daytime.

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.

<span class="mw-page-title-main">Continuous positive airway pressure</span> Form of ventilator which applies mild air pressure continuously to keep airways open

Continuous positive airway pressure (CPAP) is a form of positive airway pressure (PAP) ventilation in which a constant level of pressure greater than atmospheric pressure is continuously applied to the upper respiratory tract of a person. The application of positive pressure may be intended to prevent upper airway collapse, as occurs in obstructive sleep apnea, or to reduce the work of breathing in conditions such as acute decompensated heart failure. CPAP therapy is highly effective for managing obstructive sleep apnea. Compliance and acceptance of use of CPAP therapy can be a limiting factor, with 8% of people stopping use after the first night and 50% within the first year.

<span class="mw-page-title-main">Safe to Sleep</span> 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. The target age group of the campaign is 0–1 years of age, because this is when babies are at the greatest risk of experiencing SIDS. Since "Safe to Sleep" was launched in 1994, the incidence of SIDS has declined by more than 50%. However, there has been a rise in infant sleep-related suffocation events. Consequently, the campaign has broadened its goal to focus on safe sleep conditions and further preventative measures.

<span class="mw-page-title-main">Tummy time</span> Colloquialism related to child-rearing

Tummy time is a colloquialism for placing infant children in the prone position while awake and supervised, to encourage development of the neck and trunk muscles and prevent skull deformations.

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.

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Prone ventilation, sometimes called prone positioning or proning, refers to mechanical ventilation with the patient lying face-down (prone). It improves oxygenation in most patients with acute respiratory distress syndrome (ARDS) and reduces mortality. The earliest trial investigating the benefits of prone ventilation occurred in 1976. Since that time, many meta-analyses and one randomized control trial, the PROSEVA trial, have shown an increase in patients' survival with the more severe versions of ARDS. There are many proposed mechanisms, but they are not fully delineated. The proposed utility of prone ventilation is that this position will improve lung mechanics, improve oxygenation, and increase survival. Although improved oxygenation has been shown in multiple studies, this position change's survival benefit is not as clear. Similar to the slow adoption of low tidal volume ventilation utilized in ARDS, many believe that the investigation into the benefits of prone ventilation will likely be ongoing in the future.

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.

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, gagging, choking 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.


  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. S2CID   25942174.
  3. Marcarelli, Rebekah (3 May 2014). "Sudden Infant Death Syndrome Could Be Prevented By Making Sure Baby Sleeps On Back". Headlines & Global News. Retrieved 25 March 2016.
  4. Byard, Roger W.; Bright, Fiona; Vink, Robert (2018-03-01). "Why is a prone sleeping position dangerous for certain infants?". Forensic Science, Medicine and Pathology. 14 (1): 114–116. doi:10.1007/s12024-017-9941-y. ISSN   1556-2891. PMID   29243157. S2CID   3876558.
  5. 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. S2CID   21642651.
  6. "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.
  7. "What is sleep apnea therapy? Obstructive sleep apnea" . Retrieved 17 September 2018.
  8. 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.
  9. 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. PMID   19535668.
  10. "Sleep Apnea Treatment". Monday, 13 September 2021