P142 Head flexion has the greatest impact on OSA severity during REM sleep

Introduction Recent work has shown that head flexion has a modest worsening effect and head rotation has a modest protective effect on OSA severity. However, there is substantial variability both within and between individuals. In this analysis we aimed to identify if this variability is explained by sleep-state, BMI, age or sex. Methods 28 participants provided informed consent and were studied using diagnostic polysomnography with the addition of a customised, accelerometry based, head posture measurement device. For each epoch during supine sleep, the sleep state (NREM/REM), average head flexion (degrees) and average head rotation (degrees) were recorded. A logistic mixed effects model was fit across all epochs with the anthropometrics (BMI, sex, age), sleep state, average head flexion and average head rotation as explanatory variables with the absence/presence of one or more respiratory event(s) as the binary outcome variable. Results In total, 2122 of 5369 supine sleep epochs had a respiratory event. Three participants had no supine sleep. There were significant interaction effects for flexion-rotation, BMI-rotation and REM-flexion. The REM-flexion interaction effect was the strongest interaction effect with an odds ratio per 5 degrees of head flexion in REM sleep of 1.47 (95% CI: 1.13 – 1.86). Discussion Head flexion related worsening of OSA severity is greatest during REM sleep. This may be explained by attenuated upper airway neuromuscular activation in REM sleep compared with NREM sleep.

Effects of Head and Neck Position on Nasotracheal Tube Intracuff Pressure: A Prospective Observational Study

To prevent endotracheal tube-related barotrauma or leakage, the intracuff pressure should be adjusted to 20–30 cm H2O. However, changes in the nasotracheal tube intracuff pressure relative to neck posture are unclear. In this study, we investigated the effect of head and neck positioning on nasotracheal tube intracuff pressure. Fifty adult patients with nasotracheal tubes who were scheduled for surgery under general anesthesia were enrolled. Following intubation, intracuff pressure was measured by connecting the pilot balloon to a device that continuously monitors the intracuff pressure. Subsequently, the intracuff pressure was set to 24.48 cm H2O (=18 mmHg) for the neutral position. We recorded the intracuff pressures based on the patients’ position during head flexion, extension, and rotation. The initial intracuff pressure was 42.2 cm H2O [29.6–73.1] in the neutral position. After pressure adjustment in the neutral position, the intracuff pressure was significantly different from the neutral to flexed (p < 0.001), extended (p = 0.003), or rotated (p < 0.001) positions. Although the median change in intracuff pressure was <3 cm H2O when each patient’s position was changed, overinflation to >30 cm H2O occurred in 12% of patients. Therefore, it is necessary to adjust the intracuff pressure after tracheal intubation and each positional change.

Significance of Lower Body Postures in Chair Design

Objective This study examined a system-level perspective to investigate the changes in the whole trunk and head postures while sitting with various lower extremity postures. Background Sitting biomechanics has focused mainly on the lumbar region only, whereas the anatomy literature has suggested various links from the head and lower extremity. Method Seventeen male participants were seated in six lower extremity postures, and the trunk kinematics and muscle activity measures were captured for 5 s. Results Changes in the trunk-thigh angle and the knee angle affected the trunk and head postures and muscle recruitment patterns significantly, indicating significant interactions between the lower extremity and trunk while sitting. Specifically, the larger trunk-thigh angle (T135°) showed more neutral lumbar lordosis (4.0° on average), smaller pelvic flexion (1.8°), smaller head flexion (3.3°), and a less rounded shoulder (1.7°) than the smaller one (T90°). The smaller knee angle (K45°) revealed a more neutral lumbar lordosis (6.9°), smaller pelvic flexion (9.2°), smaller head flexion (2.6°), and less rounded shoulder (2.4°) than the larger condition (K180°). The more neutral posture suggested by the kinematic measures confirmed significantly less muscular recruitment in the trunk extensors, except for a significant antagonistic co-contraction. Conclusion The lower and upper back postures were more neutral, and back muscle recruitment was lower with a larger trunk-thigh angle and a smaller knee angle, but at the cost of antagonistic co-contraction. Application The costs and benefits of each lower extremity posture can be used to design an ergonomic chair and develop an improved sitting strategy.

Effects of smartphone screen viewing duration and body position on head and neck posture in elementary school children

BACKGROUND: Electronic media have become integral parts of modern life, in which prolonged screen viewing time (SVT) by children is nearly unavoidable. Prolonged use of smartphones could lead to musculoskeletal problems. OBJECTIVES: To investigate the effect of SVT on head and neck posture during and after using smartphones for various periods of time in either standing or sitting postures. METHODS: This observational study included 34 male children aged 5–12 years who were assigned to one of two groups based on average smartphone use duration per day: group A comprised 18 children averaging > 4 hours per day (h/day) of smartphone use, and group B comprised 16 children with < 4 h/day of smartphone use. The children’s postures were photographed in standing and sitting positions while using a smartphone and 30 min after ceasing smartphone use. The head flexion, neck flexion, gaze, and craniocervical angles were measured using the software program Kinovea. RESULTS: Significant increases were found in head flexion, neck flexion, and gaze angles. Furthermore, both groups saw a significant decrease in craniocervical angle when sitting compared to when standing, both during and 30 min after smartphone use. The head flexion, neck flexion, and gaze angles of group A were significantly higher than those of group B, and the craniocervical angle of group A was significantly lower than that of group B in both postures (p< 0.05). CONCLUSION: SVT is associated with increased neck and head flexion posture in children, especially in a sitting position.

La posición de la cabeza durante el uso de dispositivos electrónicos y la postura en bípedo / The position of the head during the use of electronic devices and posture in biped

Summary. Posture is a feature that allows us to understand the biological, mechanical, mental and emotional functioning of human beings; the positioning of the head on the body meets the physiological requirements of breathing, hearing, vision and balance, and the stimuli to which the children are subjected determine to a great extent the postural balance they will have in adulthood. The aim of the present study was to determine the relationship between the position of the head during the use of electronic devices and bipedal position in the sagittal plane in children aged 6 to 10 years. It is a cross-sectional study of 56 children enrolled in a private school in Bogotá, mean age of 8.2 + 2 years whose participation was voluntary. The position of the child in the sagittal plane and the position of the head during the use of electronic devices were evaluated by means of photographs. Correlation measurements and non-parametric tests were used for comparison of medians. 69% of the participants presented advanced head, the average distance from cervical 1 (C1) to the perpendicular traced (P) in children with head forward was 5 cm. The average flexion of the head during the use of the digital tablet was 30 ° while with the computer it was 20 ° (p = .005). No relationship was found between head positions and posture in the sagittal plane in the sample evaluated; a significant difference was found between head flexion during tablet and computer use.Resumen. La postura es una característica que permite entender el funcionamiento biológico, mecánico, mental y emocional de los seres humanos; el posicionamiento de la cabeza sobre el cuerpo cumple con requisitos fisiológicos de respiración, audición, visión y equilibrio, además los estímulos a los que los niños están sometidos determinan en gran medida el equilibrio postural que tendrán en la edad adulta. El objetivo del presente estudio era determinar la relación entre la posición de la cabeza durante el uso de dispositivos electrónicos y la postura en bípedo en el plano sagital en niños de 6 a 10 años. Se trata de un estudio transversal realizado en 56 niños escolarizados en un colegio privado de Bogotá, edad promedio de 8.2 + 2 años cuya participación fue voluntaria. Se evaluó la postura del niño en el plano sagital y la posición de la cabeza durante el uso de dispositivos electrónicos por medio de fotografías. Se utilizaron medidas de correlación y pruebas no paramétricas para comparación de medianas. El 69% de los participantes presentó cabeza adelantada, la distancia promedio desde la cervical 1 (C1) hasta la perpendicular trazada (P) en los niños con cabeza hacia adelante fue de 5 cm. El promedio de flexión de la cabeza durante el uso de la tableta digital fue de 30° mientras que con el computador fue de 20° (p = .005). No se encontró relación entre las posiciones de la cabeza y la postura en el plano sagital en la muestra evaluada; se encontró una diferencia significativa entre la flexión de la cabeza durante el uso de la tableta y el computador.

CONCEPT OF TEXT NECK SYNDROME AND ITS MANAGEMENT THROUGH AYURVEDA

Text neck syndrome is an emerging disease of today’s world. The term ‘text neck’ is used to describe a re-petitive stress injury or an overuse syndrome due to forward head flexion and bent down looking at handheld devices like mobile phone, tablet or other wireless electronic devices for prolonged period of time. Our young generation is at high risk of developing this disease because they spend their most of the times by hunching over the mobile phones. It is manifested by neck pain, neck stiffness, reduced mobility of neck and headache. If it is left untreated then it may lead to flattening of the spinal curve, onset of early arthritis, spinal misalignment, disc compression, disc herniation, nerve damage and muscle damage etc. It can be correlated with Manyastambha due to similarity in their symptoms. Manyastambha is characterized by neck pain, neck stiffness and restricted movements of neck. One should follow proper preventive measures to avoid Text neck syndrome, as we know ‘Prevention is better than cure’. In this article Ayurve-dic management of this disease has been discussed in detail. It includes Nidana parivarjana, Abhyanga, Ruksha Swedana, Nasya Karma, Greeva basti and Shamana aushadhis etc. along with these some Yoga-asanas have also been mentioned that are beneficial to combat this disease.