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J Alzheimers Dis. 2019;67(2):631-638. doi: 10.3233/JAD-180697.

Head Position During Sleep: Potential Implications for Patients with Neurodegenerative Disease.

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Advanced Brain Monitoring, Carlsbad, CA, USA.
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Center for Sleep Medicine, Departments of Neurology and Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
Department of Clinical Neurosciences, San Raffaele Scientific Institute, Sleep Disorders Center Università Vita-Salute San Raffaele, Milan, Italy.
Advanced Neurobehavioral Health, San Diego, CA, USA.
Harvard Medical School, Boston, MA, USA.
Massachusetts General Hospital, Boston, MA, USA.



The characterization of sleep in those with neurodegenerative disease (NDD) is essential in understanding the potential neurobiological mechanisms that underlie the connection between sleep disruption and NDD manifestations and progression.


Explore the inter-relationships between NDD and age, sex, diagnosis of obstructive sleep apnea, snoring, and duration of sleep time with the head in the supine and non-supine positions.


A case-control design was used to evaluate differences in sleep position obtained from multi-night, in-home Sleep Profiler recordings in 45 patients with diagnosed NDD (24 with mild cognitive impairment, 15 with Alzheimer's disease, and 6 with Lewy Body, Parkinson's, or other dementias) and 120 age-sex matched controls with normal cognition (NC).


The frequency of supine sleep >2 h/night was significantly greater in the NDD than in the NC group (p < 0.001, odds ratio = 3.7), and remained significant after controlling for age, sex, snoring, and obstructive sleep apnea diagnosis (p = 0.01). There were no group differences in nocturnal mobility i.e., number of head position changes/h.


This study demonstrates the utility of in-home measurements of sleep in defining the association of supine sleep position with neurodegenerative disorders. Our findings warrant further investigation, particularly in light of the recent evidence suggesting that sleep may an active role in the brain's ability to clear CNS neurotoxins and metabolites.


Head position; neurodegeneration; obstructive sleep apnea; sleep; supine

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