Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 8 (1), 17504

Day-to-day Variations in Sleep Quality Affect Standing Balance in Healthy Adults


Day-to-day Variations in Sleep Quality Affect Standing Balance in Healthy Adults

Luis Montesinos et al. Sci Rep.


Acute sleep deprivation is known to affect human balance and posture control. However, the effects of variations in sleep quality and pattern over consecutive days have received less attention. This study investigated the associations between day-to-day variations in sleep quality and standing balance in healthy subjects. Twenty volunteers (12 females and 8 males; age: 28.8 ± 5.7 years, body mass index: 23.4 ± 3.4 kg/m2, resting heart rate: 63.1 ± 8.7 bpm) with no history of sleep disorders or balance impairments participated in the study. Sleep and balance were assessed over two consecutive days. Sleep quality variations were assessed using sleep diary, actigraphy and heart rate variability (HRV) measures. Sleep was monitored at home, using an unobtrusive wearable device. Balance was assessed in a gait lab using foot centre of pressure (COP) displacement during quiet standing. Subjects with a day-to-day deterioration in sleep quantity and quality (i.e., decreased duration and increased fragmentation, increased nocturnal activity and decreased HRV) exhibited significant changes in balance (i.e., larger COP area, amplitude and standard deviation). Conversely, subjects with no significant alterations in sleep quantity and quality showed no significant changes in COP displacements. These results confirmed our hypothesis that changes in sleep quality and pattern over consecutive days may affect balance.

Conflict of interest statement

The work of L.M. was supported by a scholarship awarded by CONACyT, the Mexican National Council for Science and Technology (409248). The work of R.C. was supported by the University of Warwick through the Institute of Advanced Study’s Early Career Fellowship and an EPSRC IAA grant (EP/R511808/1). F.P.C. leads the Sleep, Health and Society Programme at the University of Warwick. He holds the Cephalon Chair, an endowed post at Warwick Medical School, the result of a donation from the company (now incorporated). The appointment to the chair was made entirely independent of the company, and the post holder is free to devise his own program of research. Cephalon did not have any stake in intellectual property associated with the post holder, and the chair has complete academic independence from the company.


Figure 1
Figure 1
Plantar pressure map and centre of pressure trajectory. Left: Representative bi-plantar pressure map during quiet standing. The black and white circle represents the foot centre of pressure computed from pressure distribution data. Right: Representative centre of pressure trajectory (left foot) for a 20-second window.
Figure 2
Figure 2
Schematic diagram of the study protocol. Sleep monitoring was performed using a wearable device that records trunk acceleration and electrocardiogram signals. Balance testing was performed using a plantar pressure measurement and analysis system based on a pair of instrumented insoles.
Figure 3
Figure 3
Centre of pressure displacement measures. Mean (bars) and standard error of the mean (error lines) by group and session. The Control group comprises subjects without day-to-day variations in sleep quality; the Case group comprises subjects with variations. AP = Anterior-posterior; p = p-value from two-tailed paired Wilcoxon tests.

Cited by 1 PubMed Central articles


    1. Winter DA. Human balance and posture control during standing and walking. Gait Posture. 1995;3:193–214. doi: 10.1016/0966-6362(96)82849-9. - DOI
    1. Duarte M, Freitas SM. Revision of posturography based on force plate for balance evaluation. Braz. J. Phys. Ther. 2010;14:183–192. doi: 10.1590/S1413-35552010000300003. - DOI - PubMed
    1. Visser JE, Carpenter MG, van der Kooij H, Bloem BR. The clinical utility of posturography. Clin. Neurophysiol. 2008;119:2424–2436. doi: 10.1016/j.clinph.2008.07.220. - DOI - PubMed
    1. Paillard T, Noé F. Techniques and Methods for Testing the Postural Function in Healthy and Pathological Subjects. BioMed Res. Int. 2015;2015:1–15. - PMC - PubMed
    1. Scoppa F, Capra R, Gallamini M, Shiffer R. Clinical stabilometry standardization. Gait Posture. 2013;37:290–292. doi: 10.1016/j.gaitpost.2012.07.009. - DOI - PubMed