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Sleeping on a wedge diminishes exposure of the esophagus to refluxed acid

Hamilton et al. Digestive Dis Sciences (1988).

Using continuous monitoring of pH (acidity) within the esophagus among several alternative positions at rest, this randomized clinical trial detected a significant decrease in the time that the esophagus was exposed to highly acid conditions when using a foam wedge to elevate the head, and also showed a decrease in the time necessary for the acid to be cleared. Interestingly, use of a wedge-shaped mechanism was significantly more effective than elevation through the use of standard bed blocks.

Davis C. Ryman

MD/PhD candidate, Case Western Reserve University

Lamb lab, Departments of Neuroscience and Genetics

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The effect of 10-degree leg elevation and 30-degree head elevation on body displacement and sacral interface pressures over a 2-hour period

Harada C, Shigematsu T, Hagisawa S.

Oita Medical University, School of Nursing, Hasama, Japan. charada@oita-med.ac.jp

OBJECTIVE: This pilot study was undertaken to determine the effects of a 10-degree leg elevation for 30-degree head-up position on body displacement and sacral interface pressure for 2 hours.

DESIGN: The study used a comparative, quasi-experimental design with repeated measures. Settings and Subjects: A convenience sample of 10 healthy Japanese women was used.

INSTRUMENTS: Body displacement was defined as the difference over time between the top edge of the mattress and subject’s acromion and was measured every 10 minutes by tape measure (in centimeters). Sacral interface pressure was measured every 10 minutes using a pneumatic pressure sensor.

METHODS: The subject was placed supine on a standard hospital bed. The head of the bed was then elevated to 30 degrees according to 2 protocols: (1) supine for 10 minutes without leg elevation alternating with 10 minutes of side-lying, or (2) supine for 10 minutes with leg elevation at 10 degrees alternating with side-lying every 10 minutes. Body displacement and mean sacral interface pressures in both protocols were compared by using repeated measures analysis of variance.

RESULTS: The 30-degree head-up position with 10-degree leg elevation significantly reduced the amount of body displacement at the acromion compared with no elevation of the legs. There were no significant differences in mean sacral interface pressure in either position.

CONCLUSION: Leg elevation at 10 degrees in the 30-degree head-up position was effective for reducing body displacement at the acromion; it was not effective for reducing sacral interface pressures.