Examining relationships between sleep posture, waking spinal symptoms and quality of sleep: A cross sectional study

PLoS One. 2021 Nov 30;16(11):e0260582. doi: 10.1371/journal.pone.0260582. eCollection 2021.


Introduction: Research with a focus on sleep posture has been conducted in association with sleep pathologies such as insomnia and positional obstructive sleep apnoea. Research examining the potential role sleep posture may have on waking spinal symptoms and quality of sleep is however limited. The aims of this research were to compare sleep posture and sleep quality in participants with and without waking spinal symptoms.

Methods: Fifty-three participants (36 female) were, based on symptoms, allocated to one of three groups; Control (n = 20, 16 female), Cervical (n = 13, 10 female) and Lumbar (n = 20, 10 female). Participants completed an online survey to collect general information and patient reported outcomes and were videoed over two consecutive nights to determine sleep posture using a validated classification system including intermediate sleep postures.

Results: Participants in the symptomatic groups also reported a lower sleep quality than the Control group. Compared to Control group participants, those in the Cervical group had more frequent posture changes (mean (SD); 18.3(6.5) versus 23.6(6.6)), spent more time in undesirable/provocative sleep postures (median IQR; 83.8(16.4,105.2) versus 185.1(118.0,251.8)) minutes and had more long periods of immobility in a provocative posture, (median IQR: 0.5(0.0,1.5) versus 2.0 (1.5,4.0)). There were no significant differences between the Control and Lumbar groups in the number of posture changes (18.3(6.5) versus 22.9(9.1)) or the time spent in provocative sleep postures (0.5(0.0,1.5) versus 1.5(1.5,3.4)) minutes.

Discussion: This is the first study using a validated objective measure of sleep posture to compare symptomatic and Control group participants sleeping in their home environment. In general, participants with waking spinal symptoms spent more time in provocative sleep postures, and experienced poorer sleep quality.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Posture*
  • Sleep Apnea, Obstructive / etiology
  • Sleep Apnea, Obstructive / physiopathology
  • Sleep Initiation and Maintenance Disorders / etiology
  • Sleep Initiation and Maintenance Disorders / physiopathology
  • Sleep Quality*
  • Spinal Diseases / complications
  • Spinal Diseases / physiopathology*
  • Spine / physiopathology*

Grants and funding

I would like to acknowledge support from the Australian Government (Research Training Program Scholarship) and Curtin University (Manuscript Writing Grant) (DC). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.