title: Effect of pillow height on the biomechanics of the head-neck complex: investigation of the cranio-cervical pressure and cervical spine alignment.
abstract: BACKGROUND
  While appropriate pillow height is crucial to maintaining the quality of sleep and overall health, there are no universal, evidence-based guidelines for pillow design or selection. We aimed to evaluate the effect of pillow height on cranio-cervical pressure and cervical spine alignment.
  
  
  METHODS
  Ten healthy subjects (five males) aged 26 ± 3.6 years were recruited. The average height, weight, and neck length were 167 ± 9.3 cm, 59.6 ± 11.9 kg, and 12.9 ± 1.2 cm respectively. The subjects lay on pillows of four different heights (H0, 110 mm; H1, 130 mm; H2, 150 mm; and H3, 170 mm). The cranio-cervical pressure distribution over the pillow was recorded; the peak and average pressures for each pillow height were compared by one-way ANOVA with repeated measures. Cervical spine alignment was studied using a finite element model constructed based on data from the Visible Human Project. The coordinate of the center of each cervical vertebra were predicted for each pillow height. Three spine alignment parameters (cervical angle, lordosis distance and kyphosis distance) were identified.
  
  
  RESULTS
  The average cranial pressure at pillow height H3 was approximately 30% higher than that at H0, and significantly different from those at H1 and H2 (p < 0.05). The average cervical pressure at pillow height H0 was 65% lower than that at H3, and significantly different from those at H1 and H2 (p < 0.05). The peak cervical pressures at pillow heights H2 and H3 were significantly different from that at H0 (p < 0.05). With respect to cervical spine alignment, raising pillow height from H0 to H3 caused an increase of 66.4% and 25.1% in cervical angle and lordosis distance, respectively, and a reduction of 43.4% in kyphosis distance.
  
  
  CONCLUSIONS
  Pillow height elevation significantly increased the average and peak pressures of the cranial and cervical regions, and increased the extension and lordosis of the cervical spine. The cranio-cervical pressures and cervical spine alignment were height-specific, and they were believed to reflect quality of sleep. Our results provide a quantitative and objective evaluation of the effect of pillow height on the biomechanics of the head-neck complex, and have application in pillow design and selection.
authors.affiliation: Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
authors.forename: Sicong
authors.initials: S
authors.lastname: Ren
authors.affiliation: Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.|The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China.
authors.forename: Duo Wai-Chi
authors.initials: DW
authors.lastname: Wong
authors.affiliation: Infinitus (China) Company Ltd., China.
authors.forename: Hui
authors.initials: H
authors.lastname: Yang
authors.affiliation: Infinitus (China) Company Ltd., China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Infinitus (China) Company Ltd., China.
authors.forename: Jin
authors.initials: J
authors.lastname: Lin
authors.affiliation: Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.|The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Zhang
keywords: Cervical spine alignment; Cranio-cervical pressure; Finite element analysis; Pillow design