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Phys. Ther. Korea 2024; 31(1): 8-17

Published online April 20, 2024

https://doi.org/10.12674/ptk.2024.31.1.8

© Korean Research Society of Physical Therapy

A Comparative Study on the Effects of Three Types of Pillows on Head-neck Pressure Distribution and Cervical Spine Alignment

Kyeong-Ah Moon1 , PT, BPT, Ji-Hyun Kim1 , PT, PhD, Ye Jin Kim1 , PT, BPT, Joo-Hee Park1,2 , PT, PhD, Hye-Seon Jeon1,2 , PT, PhD

1Department of Physical Therapy, The Graduate School, Yonsei University, 2Department of Physical Therapy, College of Health Sciences, Yonsei University, Wonju, Korea

Correspondence to: Hye-Seon Jeon
E-mail: hyeseonj@yonsei.ac.kr
https://orcid.org/0000-0003-3986-2030

Received: December 14, 2023; Revised: January 5, 2024; Accepted: January 8, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Sleep accounts for approximately one-third of a person’s lifetime. It is a relaxing activity that relieves mental and physical fatigue. Pillows of different sizes, shapes, and materials have been designed to improve sleep quality by achieving an optimal sleep posture.Objects: This study aimed to determine which pillow provides the most comfortable and supports the head and neck during sleep, which may enhance sleep quality.
Methods: Twenty-eight healthy adults (19 males and 9 females) with an average age of 29 years participated in this cross-sectional study. This experiment was conducted while the participants laid down for 5 minutes in four different pillow conditions (1) no pillow (NP), (2) neck support foam pillow (NSFP), (3) standard microfiber filled pillow (SFP), and (4) hybrid foam pillow (HFP). The head-neck peak pressure, cranio-vertebral angle in supine (CVAs), cranio-horizontal angle in supine (CHAs), chin-sternum distance (CSD), and muscle tone of sternocleidomastoid were analyzed using one-way repeated measures analysis of variance (ANOVA). The significance level was set at p < 0.05.
Results: The head-neck peak pressure was the highest in the NSFP condition, followed by the NP, SFP, and HFP conditions. The CVAs, CHAs, and CSD of the SFP were lower than those of the other pillows. Muscle tone was the highest in the NP condition, followed by the of NSFP, HFP, and SFP conditions. The participants subjective comfort level in both the supine and side-lying postures was highest in the HFP condition, followed by the SFP and NSFP conditions.
Conclusion: This study can be used to establish the importance of pillow selection for high-quality sleep. The results of this study, suggest that a hybrid pillow with a good supportive core and appropriate fluffiness can maintain comfort and correct cervical spine alignment during sleep.

Keywords: Neck, Sleep, Sleep quality, Supine position

Article

Original Article

Phys. Ther. Korea 2024; 31(1): 8-17

Published online April 20, 2024 https://doi.org/10.12674/ptk.2024.31.1.8

Copyright © Korean Research Society of Physical Therapy.

A Comparative Study on the Effects of Three Types of Pillows on Head-neck Pressure Distribution and Cervical Spine Alignment

Kyeong-Ah Moon1 , PT, BPT, Ji-Hyun Kim1 , PT, PhD, Ye Jin Kim1 , PT, BPT, Joo-Hee Park1,2 , PT, PhD, Hye-Seon Jeon1,2 , PT, PhD

1Department of Physical Therapy, The Graduate School, Yonsei University, 2Department of Physical Therapy, College of Health Sciences, Yonsei University, Wonju, Korea

Correspondence to:Hye-Seon Jeon
E-mail: hyeseonj@yonsei.ac.kr
https://orcid.org/0000-0003-3986-2030

Received: December 14, 2023; Revised: January 5, 2024; Accepted: January 8, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Sleep accounts for approximately one-third of a person’s lifetime. It is a relaxing activity that relieves mental and physical fatigue. Pillows of different sizes, shapes, and materials have been designed to improve sleep quality by achieving an optimal sleep posture.Objects: This study aimed to determine which pillow provides the most comfortable and supports the head and neck during sleep, which may enhance sleep quality.
Methods: Twenty-eight healthy adults (19 males and 9 females) with an average age of 29 years participated in this cross-sectional study. This experiment was conducted while the participants laid down for 5 minutes in four different pillow conditions (1) no pillow (NP), (2) neck support foam pillow (NSFP), (3) standard microfiber filled pillow (SFP), and (4) hybrid foam pillow (HFP). The head-neck peak pressure, cranio-vertebral angle in supine (CVAs), cranio-horizontal angle in supine (CHAs), chin-sternum distance (CSD), and muscle tone of sternocleidomastoid were analyzed using one-way repeated measures analysis of variance (ANOVA). The significance level was set at p < 0.05.
Results: The head-neck peak pressure was the highest in the NSFP condition, followed by the NP, SFP, and HFP conditions. The CVAs, CHAs, and CSD of the SFP were lower than those of the other pillows. Muscle tone was the highest in the NP condition, followed by the of NSFP, HFP, and SFP conditions. The participants subjective comfort level in both the supine and side-lying postures was highest in the HFP condition, followed by the SFP and NSFP conditions.
Conclusion: This study can be used to establish the importance of pillow selection for high-quality sleep. The results of this study, suggest that a hybrid pillow with a good supportive core and appropriate fluffiness can maintain comfort and correct cervical spine alignment during sleep.

Keywords: Neck, Sleep, Sleep quality, Supine position

Fig 1.

Figure 1.Four different pillow conditions. (A) No pillow, (B) neck support foam pillow, (C) standard microfiber filled pillow, and (D) hybrid foam pillow.
Physical Therapy Korea 2024; 31: 8-17https://doi.org/10.12674/ptk.2024.31.1.8

Fig 2.

Figure 2.Two type of pillow. (A) Neck support foam pillow and (B) standard microfiber filled pillow.
Physical Therapy Korea 2024; 31: 8-17https://doi.org/10.12674/ptk.2024.31.1.8

Fig 3.

Figure 3.Hybrid foam pillow. (A) Memory foam core and (B) complete set of the pillow with cover.
Physical Therapy Korea 2024; 31: 8-17https://doi.org/10.12674/ptk.2024.31.1.8

Fig 4.

Figure 4.Measurement of CVAs, CHAs, and CSD. (A) Contact between back and back, (B) tragus, (C) canthus, (D) chin, and (E) sternal notch. CVAs, cranio-vertebral angle in supine; CHAs, cranio-horizontal angle in supine; CSD, chin-sternum distance.
Physical Therapy Korea 2024; 31: 8-17https://doi.org/10.12674/ptk.2024.31.1.8

Fig 5.

Figure 5.Head-neck pressure distribution under the four pillow conditions from a typical subject. (A) No pillow, (B) neck support foam pillow, (C) standard microfiber filled pillow, and (D) hybrid foam pillow.
Physical Therapy Korea 2024; 31: 8-17https://doi.org/10.12674/ptk.2024.31.1.8

Fig 6.

Figure 6.Head-neck pressure distribution and alignment values of pillow conditions. (A) Peak pressure, (B) CVAs, (C) CHAs, and (D) CSD. NP, no pillow; NSFP, neck support foam pillow; SFP, standard microfiber filled pillow; HFP, hybrid foam pillow; CVAs, cranio-vertebral angle in supine; CHAs, cranio-horizontal angle in supine; CSD, chin-sternum distance. *p < 0.05, **p < 0.01, ***p < 0.001.
Physical Therapy Korea 2024; 31: 8-17https://doi.org/10.12674/ptk.2024.31.1.8

Table 1 . General characteristics of the participants (N = 28).

VariableValue
Sex (male/female)19/9
Age (y)29.3 ± 6.1
Height (cm)173.4 ± 9.4
Weight (kg)75.3 ± 16.5
BMI (kg/m2)24.8 ± 3.6

Values are presented as number only or mean ± standard deviation. BMI, body mass index..


Table 2 . Head-neck alignment and muscle tone in four pillow conditions.

Variable(A) NP(B) NSFP(C) SFP(D) HFPFp-value
(Bonferroni)
Peak pressure (mmHg)128.67 ± 9.82166.56 ± 7.5777.71 ± 7.2557.03 ± 2.9659.72< 0.001
(B>A>C>D)
CVAs (°)47.51 ± 6.1739.61 ± 3.1632.54 ± 3.0035.29 ± 3.2297.10< 0.001
(A>D>C>B)
CHAs (°)16.55 ± 0.9910.01 ± 1.00–0.15 ± 0.946.73 ± 0.59120.50< 0.001
(D>A>C>B)
CSD (cm)11.54 ± 0.3111.32 ± 0.329.32 ± 0.3210.23 ± 0.2960.99< 0.001
(A>D>B>C)
Muscle tone (Hz)13.27 ± 0.1812.61 ± 0.1712.37 ± 0.1312.48 ± 0.1530.390.24

Values are presented as mean ± standard deviation. CVAs, cranio-vertebral angle in supine; CHAs, cranio-horizontal angle in supine; CSD, chin-sternum distance; NP, no pillow; NSFP, neck support foam pillow; SFP, standard microfiber filled pillow; HFP, hybrid foam pillow..


Table 3 . Level of subjective comfort.

Average rankχ2dfp-value

NSFPSFPHFP
Supine1.661.982.367.6220.02*
Side-lying1.272.232.5027.152< 0.001

NSFP, neck support foam pillow; SFP, standard microfiber filled pillow; HFP, hybrid foam pillow. *p < 0.05..