Obstructive Sleep Apnea and Forward Head Posture
In this week's blog article we are going to talk about a very common adult sleeping disorder. It affects a large number of the adult population and the condition is called obstructive sleep apnea. Obstructive sleep apnea is when breathing stops temporarily during sleep. This can be due to the neck muscles relaxing and closing off the airway. It is associated with snoring, morning headache, sudden waking with gasping or choking, and tiredness throughout the day. Obstructive sleep apnea is the most common sleep disorder in the adult population. It affects 2-4% of the population and most commonly men over the age of 60.
The information I am going over today comes from a chapter in the book, “Sleep Apnea – Recent Updates”. In this chapter the author goes over obstructive sleep apnea and the association with forward head posture and upper cervical morphological changes. I will focus on the postural changes that the author observed. In the studies done, it was found that patient with obstructive sleep apnea had an extended posture of the head when compared to control subjects. It is hypothesized that this is because when the head is extended, it causes an increase in the pharyngeal airway. “In OSA patients, an extended posture of the head in relation to the upper cervical spine in the upright awake position was found to be associated with larger pharyngeal airway dimensions [9, 20–25]. It was especially the lower part of the pharyngeal airway that was increased in relation to an extended head posture. Furthermore, an extended posture of the head has also been demonstrated in men with OSA compared to healthy controls.”
The author also found that there was a linear correlation between degree of head extension and severity of obstructive sleep apnea and that there is less obstruction with head extension. It is my belief that because of the righting reflex, the head posture is brought forward to keep the eyes level with the horizon. The righting reflex is what corrects the orientation of the body when it is brought out of its normal upright position. Below is an example of imaging taken to show a healthy control subject vs an obstructive sleep apnea patient.
It is my personal belief that the association between forward head posture/loss of cervical curve (based on the above image) and obstructive sleep apnea can be viewed as an area that needs further study. I feel that loss of cervical curve and the resulting forward head posture can actually be associated with the cause of sleep apnea rather that a resulting posture because of sleep apnea. The most common age group affected by this disorder is men over the age of 60. There needs to be studies looking at obstructive sleep apnea patients that have had lateral cervical radiographs previously in their lives. See if there is a correlation to loss of cervical curve/ forward head posture early in life and obstructive sleep apnea later in life. This needs to be compared to healthy subjects who have had lateral cervical radiographs earlier in their lives. Looking at both of the groups and assessing for and comparing cervical curve and forward head posture. This should be able to give more insight into the etiology of the condition and when the beginning of the cause of symptoms began. Obstructive sleep apnea could be causing the postural reflex of forward head posture to increase the pharyngeal airway. Or the forward head posture early in life could be the cause of obstructive sleep apnea later in life. Like I said previously, there needs to be a study designed to look at more of these variables. It is my personal belief that forward head posture early in life is more likely the cause of obstructive sleep apnea later in life.
If you would like to have your spine evaluated for loss of cervical curve and forward head posture, always feel free to visit our schedule page and book an appointment. We are located right here in Littleton, CO right off the intersection of Broadway and C470. At Complete Health Chiropractic, we pride ourselves on offering the highest level of quality and competency when it comes to your spinal health care. We accept all major insurances and have cash pricing plans to make care affordable for everyone. Don’t hesitate to put your health first.
Sources: https://en.wikipedia.org/wiki/Righting_reflex https://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/diagnosis-treatment/drc-20352095 Liselotte Sonnesen (2017). Head Posture and Upper Cervical Spine Morphology in Patients with Obstructive Sleep Apnea, Sleep Apnea - Recent Updates, Dr. Mayank Vats (Ed.), InTech, DOI: 10.5772/65436. Available from: https://www.intechopen.com/books/sleep-apnea-recent-updates/head-posture-and-upper-cervical-spine-morphology-in-patients-with-obstructive-sleep-apnea