ࡱ> yuzxܥhc e  22222N^|2mcXFWYF@n22Prof. dr.sc. Ivica GrbacPRIVATE  *Doc. dr.sc. Andrija Bogner **Prof. dr.sc. Stanislav Dzi(gielewski *Faculty of Forestry, University of Zagreb, Croatia **Akademia Rolnicza, Poznan, Poljska INVESTIGATION INTO THE QUALITY OF SLEEP ON VARIOUS TYPES OF BEDS AND MATTRESSES Summary Man spends a third of his life in sleep. Since early times it is well known that sleep is an essential physiological function, but it is not thoroughly investigated to these days. Even some sixty years ago the sleep was a poorly explained phenomenon. Despite all this it can be stated that hardly any other physiological function attracted human curiosity and initiated the need for the elementary understanding as did the sleep. The object of this research is a mattress, or the interaction of the man and the bed in the function of healthy sleeping. Polysomnographic tests were used to investigate the quality of sleep on two types of beds ("GR" and lattoflex type). Somnological analysis showed that the sleeping on the bed with the GR-spring core is better than on the lattoflex bed. However, no significant differences were found among the analyzed characteristics. The research, which was performed at the Faculty of Forestry of the University of Zagreb and in the Centre for sleep and sleeping anomalies in Zagreb indicate that the problem of bed and sleep should be treated in an interdisciplinary way, and the specifications are given for the application of the results of this study, as well as for the further research. Key words: technical design, bedroom furniture, quality of sleep (somnology), healthy sleep 1. Introduction Great attention is these days being paid to human health. Many institutes in the world work on the design of improved types of beds so that they can offer better rest and sleep. The spinal deformations are becoming more frequent and accordingly increase the demands of the users that the bedroom furniture is becoming ever better and that it fully meets the requirements in use. In order to solve the problem the experts dealing with these issues are organized in teams which often combine the professionals in furniture design and those dealing with health aspects (orthopaedists, somonologists, psychologists etc.). The pain in spine and joints, insomnia and headaches are some of the symptoms which take the user of the improper bed first to the doctor, and then to the furniture shop where he can chose an adequate bed and assure his good sleep. There is no doubt that the customers who know that the reasons for their sleep disturbances lay in the old bed frame and mattress, come to the shop with a strong decision not to repeat former mistakes. Regardless whether they are buying a complete new bedroom furniture or only replacing some technical details which should lead to a better sleep, the customers expect to get professional instructions and are ready to pay for a good advice (3,4,6,7,8). All the medicinal experts agree that the combination of the frame and mattress which become similar to a sleeping net, is harmful to health, principally damaging the spine. Modern research into the problems of sleep lead to the findings according to which the former recommendations by orthopaedists to put a board under the mattress were completely wrong. Hard and stiff base causes the spine to be distorted in every sleeping position, and the intervertebral discs are always compressed. It is well known that the intervertebral discs, which are of the utmost importance for the flexibility of the spine, are in the phase of regeneration during the nights sleep. Good bed fulfils these requirements inasmuch as it supports and "holds" the body and exhibits the flexibility which follows the movements of the sleeper. Besides the demands for good rest and sleep, the bed must also meet the requirement for positioning the head and upper body in an elevated pose which enables the relaxation of the circulatory system. 2. OBJECT OF RESEARCH The form of the spine in a laying position must resemble its configuration in an upright standing position of a human. Therefore the ideal construction of the mattress must offer a differentiating support for the resting body. It has been mentioned afore that each person spends a third of his life in bed. Whether we shall feel well or not depends on the nights rest. These days we are fully aware of the significance of a healthy sleep and the importance of a sound spine for the overall healthy condition. In order to meet the essential requirements the bed must exhibit the following characteristics: - it can be neither too hard nor too soft - it must enable the sustenance of the constant temperature and humidity - it must be noiseless - can contain no metal parts - must be easy for maintenance The market offers bed systems which possess a good balance of all these elements which are of crucial importance for a resting sleep. Some of these marks are lattoflex, dunlopillo, sembella etc. The advantages of these beds are: 1. The well adapted design enables the back muscular system to be completely relaxed during sleep 2. The number, the width and the distance between the slats are adjusted according to physiological requirements 3. A bed frame with mobile slat joints enables the uniform distribution of the pressure exerted by a body. Optimal positions of the body during sleep The most important condition for the physiologically adequate and healthy sleep is the function of the mattress in which it supports the spine, arms and legs and other parts of the body. It is important to mention here that the bones are not dead mineral objects but alive tissue which contribute to the metabolism of the complete organism. The mechanical endurance of a spine is great, and Evans (7) claims that the weight required for a deformation of a spine of 12 mm amounts to 690 kg. Saibert (7) stated that only 14.5 % of school children between 9 and 14 years of age exhibit normal curvature of a spine. Similar deterioration of a conditions of spine was noticed also by Smetana (7) in research which he performed on 280 children from Prague. He found out that girls had the worse form of a spine. The conditions further deteriorate with age. Mayer (7) performed in 1971 a research on 123 pupils and established that no one of examinees showed a normal body posture of the A type (according to Harvard silhouette, figure 1). This research resulted in a finding that the bed and mattress, and especially their comfort, demand the utmost concern. Figure 1. Forms of a body posture according to a Harvard silhouette A - Normally expressed lordosis in the lower back, kyphosis in the thorax and a lordosis of the neck B - Fully bent back with expressed and elongated kyphosis in the thoracal portion of a spine C - Half-bent beck with well-defined embossments D - Abnormal flat back with flattened curvatures of the spine The lying is comfortable when the body is uniformly supported on the bed and when the physiological curvature of the spine is optimal. German physician Wilhelm Ackermann (7) established during his five years research the results which are important for the proper position of the spine in a lying position. A segment of the results is shown on figure 2 a - f. Figure 2a shows the position of a spine on a too soft bed. The heaviest part of the body sinks into the bed, and the pelvis lays too deep and causes the spinal column to be unnaturally bent, which causes the back pain. Figure 2b shows the side position of a body on the same type of a bed. It is obvious that the body weight is unevenly distributed, and the too low position of a pelvis deforms the spinal column and causes pains and problems of circulation. Figure 2c presents too hard bed which causes tension because the back can not be supported and impressed. This causes the nervous pains and the feeling of shattering. Figure 2d presents the side position on the same hard bed. It is obvious that the hip and the shoulder are not impressed enough. This changes the form of a back, and therefore the position of a spinal column. Shoulders and arms become numb, the occiput aches and an rotated pelvis causes further damage. So-called "Ackermann bed" is presented on figures 5e - f. Figure 2e presents a lying position on a back. The back is uniformly supported, so that the spinal column and the pelvis are in anatomically correct position. Figure 2f shows a side lying on an "Ackermann" bed. The shoulder and pelvis are so impressed that the pelvis and a spine rest in their natural form. Intensive research is performed today to obtain a bed which can adjust to a human body in a best possible way. We have at disposal pocket-spring beds, lattoflex beds, latex mattresses, water beds, air beds, double-spring beds etc. Many papers describe the effect of the particular type of bed on the human rest and the results of research in this field (1,2,5,6,7,8,10,11,13,14). Figure 2a - d: Position of a spine on various types of beds Figure 2e - f: "Ackermann" bed It is obvious fom the literature review that the problem of rest i.e. issues of sleep are being combated with greater attention in many countries. We did not perform investigation which would give answer to the question about which of the beds of our home production is best for proper rest and sleep. Since this area is linked with the research of the quality of sleep, the cooperation between the experts of various fields, i.e. from the medicinal and wood technology field, proved indispensable. This idea lead to the experimental approach according to which various bed designs were tested in parallel to the somnological investigations. Some typical and representative specimens were chosen between a number of various bed designs, for example a bed with the "GR" spring core and a "LATTOFLEX" bed - figures 3 and 4. The main scope of research was the evaluation of the quality of sleep on the basis of polysomnographic testing of sleep on various designs of beds. 4. SAMPLES, EXAMINEES AND METHODS 4.1 Samples Two different technical designs of beds were chosen among characteristic types of beds. 1. Lattoflex mattress This mattress presents one of the recently developed designs, made of foam, and which was highly esteemed in the foreign literature. 2. Bed with the "GR" spring core This technical design is based on a years-long experience in the production of upholstered furniture and exhibits a number of positive characteristics. 4.2 Examinees Examinees were male adults, five healthy students of the Faculty of Forestry of the Zagreb University, all of the same age. The aim of this investigation was to establish whether a particular type of bed influences human rest and sleep. No one of examinees was informed about a type of bed on which he will sleep. For easier analysis the beds were marked with numbers, lattoflex being No 1, and GR-core bed being No 2. Examinees were instructed to pursue their normal daily habits: - to perform their normal duties during the day - to take food according to their normal habits - to use the toilette before sleep. The conditions during the sleep were 18 - 20 ?C and 60 % relative air humidity. The sleep lasted according to the natural rhythms of examinees. These people did not report in their test any particular physical or psychical burdens. Figure 3. Cross section of a GR-spring core Figure 4. Cross section of a "Lattoflex" mattress 4.3 Polysomnographic analysis 4.3.1 Technique and method of recording The nights polygraphic investigation of the examinees was performed in the somnographic department of the Centre for sleep disturbances of the Psychiatrical clinic Vrape - Zagreb. The department contains a sleeping room of the hotel room type and a laboratory which encompasses the recording units, video equipment, TV screen etc. The laboratory is linked with the sleeping room by means of a video camera. Recording and registration was performed using a 16 channel polygraphic instrument Grass. Polygraphic investigation is a simultaneous recording and analysis of a number of physiological parameters, such as electroencephalogram (EEG), electrooculogram (EOG), electromyogram (EMG), electrocardiogram (EKG) and a record of breathing movements. The recording was performed in a following manner: -EEG 10 channels -EOG 2 channels -EMG 1 channel -EKG 1 channel - respiration 1 channel - breathing activity 1 channel. The recording lasted during the whole night. The recording started at the usual bed time of examinees. The recording lasted in average 8 hours, from the switching off the light and wishing "good night" to the moment of spontaneous waking up. 4.3.2. Methods of picking up the signals of particular parameters Particular physiological parameters were registered using silver-plated electrodes of a spherical shape, 12 mm in diameter. These probes were fixed with collodium impregnated cotton gauze onto the skin which was previously cleaned with acetone. The conducting was improved using an electrode cream. 4.3.3. Methods of analysis The video tape of the whole nights sleep was analyzed according to the propositions from the Kales and Rechtschafen: A Manual of Standardized Terminology, Technique and Scoring for Sleep Stages of Human Subjects, edition of the UCLA Brain Information Service, National Institute of Health, Bethesda, 1968 (10). Analysis was made in 120 s intervals, which means that particular phases of sleep or wakefulness were scored on every sixth page. Special attention was paid to the movements which were ranged as small movements (=), generalized movements (-) or mioclonisms (--). The following parameters of sleep were analyzed: 1. Total sleeping time (TVS) is a time (in minutes) recorded as sleep when the pages with movements (AT) and time of wakefulness (WT) were subtracted. The wakefulness is recorded when more than 50 % of certain page shows a record of the characteristics of wakefulness. 2. Latency of falling asleep (LU), time (in minutes) form the beginning of recording (the light being switched off) to the beginning of sleep (i.e. the episode of sleep). 3. Proportion (%) of particular sleep phases in the total sleeping time (e.g. % III and IV). 4. Latency of REM, i.e. the time from the moment of falling asleep to the first record of REM. 5. Proportion of REM in the total sleeping time (% REM). 6. Efficacy of sleep (Ef), the ratio of the total sleeping time and total recording time (TVS/TVSn). 7. Frequency of sequences of wakefulness from the moment of falling asleep to the ultimate wakefulness (f Sq W). 8. Total frequency of body movements: a) MT - number of pages where EEG and EOG curves are overwritten by signals of movements for more than 15 seconds, i.e. 50 %. b) BM - total frequency of major body movements c) T - total frequency of small movements, like muscular mimics, finger jerks etc. d) K - contraction of muscles in a form of twitches. 9. Number of cycles. 5. RESULTS OF POLYSOMNOGRAPHIC ANALYSIS The recorded data served as a basis for preparation of the sleeping profiles and tables from which every sleeping phase and its duration could be seen. The data were sorted out for every examinee and his sleep on bed No 1 and bed No 2. However, these tables are too extensive to be presented in this limited report. The results of the analysis of the sleeping parameters were as follows: 1. There is a difference in a total sleeping time during all three nights between sleeping on bed 1 and bed 2 (the latter being better), but only at a critical level of the test of 12 % (t = 2.101). The analysis of the last two nights (the first night excluded) does not show a significant difference in TVS (t = 0.724). 2. There is no difference in a latency of falling asleep (LU): for all three nights t = -1.230 without first night t = -0.276. 3. The percentage proportion of particular sleeping phase in regard to a total sleeping time did not differ significantly for bed 1 and bed 2. For all three nights: relative ratio (I+II)/TVS t = -0.980 relative ratio (III + IV)/TVS t = 0.912 without first night : relative ratio (I+II)/TVS t = -0.520 relative ratio (III + IV)/TVS t = 1.916. 4. Latency of REM of examinees does not show significant differences, although the recorded differences indicate that the latency is greater on bed No 2, for all three nights t = -0.456 without first night t = -0.794. 5. Proportion of REM in the total sleeping time (TVS) was not significantly different for bed 1 and bed 2, for all three nights t = -0.036 without first night t = -0.762. 6. Efficiency of sleep (Ef) showed that the bed No 2 is better, but only at a critical test level of 12%, for all three nights t = 2.004 without first night t = 0.152. 7. Frequency of the sequences of wakefulness within the sleeping episode is statistically the same for all three nights and for two nights, for all three nights bed 1 = 2.6 bed 2 = 2.0 without first night bed 1 = 2.8 bed 2 = 1.8. 8. There is no significant differences between the total frequencies of the body movements, For all three nights: MT - Wilcoxon's sum of ranks W = 28 BM - Wilcoxon's sum of ranks W = 28 T - Wilcoxon's sum of ranks W = 28 K - Wilcoxon's sum of ranks W = 24 Critical level is greater than 9.6%. Without first night: MT - Wilcoxon's sum of ranks W = 28 BM - Wilcoxon's sum of ranks W = 33 T - Wilcoxon's sum of ranks W = 29 K - Wilcoxon's sum of ranks W = 24 Critical level is greater than 9.6%. It is important to mention here that the differences which were obvious on the level of small movements were not significant, but the results indicate that the bed 2 was somewhat better. 9. Number of cycles does not show significant differences, for all three nights bed 1 = 4.0 bed 2 = 3.8 without first night bed 1 = 4.4 bed 2 = 4.6. 6. CONCLUSION The research, which was performed at the Faculty of Forestry of the University of Zagreb and in the Centre for sleep and sleeping anomalies in Zagreb confirm that the type of bed, the sleeping habits and the ways of resting influence the form of the spine and initiation of some spine anomalies, especially with older persons. The doctors tried to cure the deformations, whereas today it is sought that the anomalies are prevented. Therefore the main role of the medicinal treatment of the spine is prevention. Proper and adequate bed plays the vital role in the prevention of the anomalies of bones, and especially the deformations of a spine. This research showed the necessity of interdisciplinary approach to the complex bed-sleep. It is obvious that all individual attempts in treating this problem did not yield comprehensive and acceptable results, particularly due to the complexity of the problem. It is necessary to continue the research in the field of the quality of bed and healthy sleep, combining the efforts of the professionals in furniture design and those dealing with health aspects (orthopaedists, somonologists, psychologists etc.). This should result in design and production of beds which would suit our individual needs. The research yielded the following results: - somnological analysis showed that the sleep is better on the bed with a spring core than on the lattoflex mattress. All the analyzed characteristics however did not show significant differences; - this research should be expanded on a larger number of examinees and types of beds in order that the comparisons between these give the evaluation tools for the relevant parameters of a healthy rest and sleep. Modern accommodation and furnishing standards, science, technical and economic possibilities reached a reasonably high level. Under circumstances the bedroom furniture which can be found on the market should offer a satisfactory quality, functionality and design, particularly meeting the essential requirements of a comfortable and healthy feeling in the sleep. 7. LITERATURE 1.Berlat, W.:Matratzen Merkblatt zur Rheuma-Prophylaxe Nr 11, Zrich Schweiz. Rheumaliga 1970.2.Biener, K., Jggi, D.:Your back, Your sleep, Your bed, Switzerland 1982.3.Drrigl, V.:Karakteristike paradoksalne faze spavanja (REM studija) u shizofrenih bolesnika (habilitacija), Zagreb 1972.4.Drrigl, V.:Spavanje, poremeaji spavanja i osnovni principi lijeenja, Krka, KPN 3/82, Novo Mesto5.Grandjean, E.:Whonen und Schlafen aus Whonphysiologischer Sicht, Mbel Kultur 4/75, 84-86 str.6.Grbac, I:Istraivanje trajnosti i elastinosti razliitih konstrukcija leaja, Magistarski rad, umarski fakultet, Zagreb 1984.7.Grbac, I:Istraivanje kvalitete leaja i poboljanje njegove konstrukcije, disertacija 1-583 str. umarski fakultet-Zagreb, 1988.8.Grbac, I:A bed in eyes of its designers, medical professionals, and its users, Congres of the croatian ortopedic and thraumathology association, Zagreb 1996.9.Hodoba, D.:Utjecaj interiktalnih epileptikih izbijanja na tok i cikliku organizaciju spavanja (magistarski rad), Medicinski fakultet Sveuilita u Zagrebu, Zagreb 1983.10.Kales, Rechtschafen:A manual of Standardizied Terminology, Tehnique and Scoring System for Sleep Stages of Human subjects, UCLA Brain Information Service, National institute of Health, Bethesda, 1968.11.Kinkel, H.J., Maxion, H.:Schlafpsysiologische Untersuchungen zur Beurteilung verschiedener Matratzen, Int. Z. angew. Physiol. 28, 247-262, 1970.12.Lehmann, G.:Schlaf und Lrm, Whonungs medizin 2,21-28,1963.13. Mller, Limroth, W.: Untersuchungen ber den Einflu Unterschiedlicher Oberbett-materialen auf das Schlafverhalten und das Bettklima, Lehrstuhl und Institut fr Arbeitsphysiologieder Technichen Universitt Mnhen, 1977.14.Raphael, L.: Povratak zdravom snu, Biblioteka popularne psihologije, Zagreb, 1983.15.Roffwarg, H.P. i suradn.:Ontogenetic development of human sleep - dreem cycle, Science 1966., 152-604.16.Snedecor, Cochrani:Statistical methods, New York 1967. ISTRAIVANJE KVALITETE SPAVANJA NA RAZLIITIM KONSTRUKCIJAMA LEAJA-MADRACA S a e t a k Treinu ivota ovjek prespava. Spavanje je od pradavnih vremena svima poznato kao neizbjena fizioloka funkcija, no koja je do danas slabo istraena. tovie, spavanje je i prije nepunih ezdesetak godina bilo prava nepoznanica. Unato tome, moe se rei da e se vrlo teko nai bilo koja druga fizioloka fumkcija koja bi toliko inpresionirala ljudsku radoznalost i potakla toliku tenju za osnovnim spoznajama kao spavanje. Problematika ovog rada jest leaj-madrac, odnosno interakcija ovjek - leaj u funkciji zdravog spavanja. Na dvije vrste leaja (GR i lattoflex konstrukcija) provedena su istraivanja kvalitete spavanja na temelju polisomnografskog ispitivanja. Somnoloka obrada je pokazala da je spavanje na leaju-madracu s oprunom jezgrom GR bolje, nego na lattoflex leaju. U svim analiziranim znaajkama razlike nisu statistiki signifikantne.Istraivanja na umarskom Fakultetu Sveuilita u Zagrebu i Centru za spavanje i poremeaje spavanja u Zagrebu upuuju na potrebu multidiscipllinarnog i transdisciplinarnog pristupa kompleksu krevet-spavanje, pa se daju smjernice za primjenu rezultata i daljnja istraivanja. Kljune rijei: konstrukcije, ovjek-namjetaj za leanje, kvaliteta spavanja (somnologija,), krevet i zdravlje UVOD Danas se velika panja posveuje zdravlju ovjeka. U vezi s tim mnogi poznati instituti u svijetu rade na projektiranju najboljeg tipa leaja, jer na njemu se ovjek odmara, na njemu spava. Zbog sve eih bolesti kraljenice i poveanja zahtjeva korisnika za to boljim namjetajem sve se vea panja poklanja leaju i zadovoljavanju zahtjeva u upotrebi. U vezi s tim strunjaci organizirano rade na tom problemu pa danas u timu strunjaka koji se time bave susreemo i strunjake iz podruja namjetaja i medicine (rengenologe, ortopede, somnologe, psihologe i dr.). Bolovi u kraljenici i zglobovima, smetnje u spavanju, glavobolje, sve su to simptomi koji kupca namjetaja za leanje najprije dovode do lijenika, a zatim u trgovinu da odabere prikladan leaj i osigura mirno spavanje. Pri tome nema sumnje da korisnici namjetaja, koji znaju da je uzrok njihovih smetnji stari okvir i leaj, dolaze u trgovinu sa vrstom odlukom da ne prave prijanje greke. Svejedno je da li se radi o novoj spavaoj sobi ili samo o izmjeni nekog tehnikog detalja koji omoguuje dobro spavanje, oni oekuju struno objanjenje i za dobro spavanje voljni su dobro platiti (3,4,6,7,8 ). Svi medicinski strunjaci slau se da kombinacija okvira i leaja koji se pretvorio u viseu lealjku teti zdravlju, a najvie kraljenici. Modernim istraivanjim spavanja dolo se do spoznaje da je ranija preporuka ortopeda da se stavi daska u krevet potpuno pogrena. Tvrda i kruta podloga dovodi do toga da je kraljenica iskrivljena u bilo kojoj poziciji leanja, a diskusi izmeu kraljeaka uvijek su jednostrano optereeni. Dobro je poznato da su diskusi, koji su posebno vani za gibljivost kraljenice, u toku noi za vrijeme spavanja u fazi regeneracije. Dobar leaj ispunjava ove zahtjeve tako da podupire - nosi tijelo i da ima fleksibilnost koja u potpunosti slijedi pokrete spavaa. Uz uvijete za dobar odmor i spavanje postavlja se i zahtjev za mogunost stavljanja glave i gornjeg dijela tijela u povieni poloaj, ime se postie rastereenje krvotoka(3,4,6,7,8 ). 2. PROBLEMATIKA ISTRAIVANJA Oblik kraljenice u leeem poloaju mora odgovarati njenom obliku kad ovjek stoji uspravno. Zato se od idealnog leaja trai da njegova konstrukcija djeluje izdiferencirano na mirujue tijelo. Ve je spomenuto da treinu ivota provedemo u krevetu. Hoemo li se dobro osjeati, ovisi o nonom odmoru. Danas ve dovoljno znamo to znai zdravo spavanje i znaenje kraljenice za nae zdravlje. Kakav, dakle, mora biti idealan leaj da bi se ti zahtjevi ostvarili: ni previe tvrd, ni previe mekan da omoguuje postizanje stalne podjednake temperature i vlanosti beuman bez metalnih dijelova lak za odravanje Danas ve ima sistema leaja koji se odlikuju koordinacijom svih komponenata koje su od integralne vanosti za odmarajue spavanje npr. lattoflex, dunlopillo, sembella,i dr. Prednosti su im slijedee: Pomou savreno prilagoenog sistema lena se muskulatura potpuno odmara. Broj, irina i razmaci trajno elastinih poprenih lamela prilagoeni su fiziolokim zahtjevima. Leaj s pokretnim lancima usmjerenim na lamele prenosi i uspjeno proiruje djelovanje sistema na tijelo koje miruje. Optimalni poloaji tijela za vrijeme odmora i spavanja Za fizioloko zdravo leanje najvanije je da leaj ima funkciju potpore kraljenice, ekstremiteta i ostalih dijelova tijela. Vano je pri tom napomenuti da kosti nisu mrtve mineralne tvari, nego su iva tkiva koja daju svoj udio iz metabolizma cijelog organizma (7). Mehanika izdrljivost kraljenice je velika, pa tako npr. Evans (7) tvrdi da je za deformaciju kraljenice od 12 mm potrebna masa (teina) od 690 kg. Iz godine u godinu razvoj tehnike ima veliki utjecaj na prirodni ovjekov okoli, a time i na razvoj ljudskog ivljenja. Saibert (7) tvrdi da samo 14,5 % djece kolske dobi od 9 do 14 godina ima pravilnu krivulju kraljenice. Ovo pogoranje kraljenice uvidio je i Smetana (7) u istraivanjima koja je proveo na 280 djece iz Praga. On je utvrdio da je najloiji poloaj kraljenice bio kod djevojica. To se stanje s vremenom pogorava. Mayer (7) je 1971. godine izvrio ispitivanja na 123 uenika i ustanovio pravilan poloaj tijela ovjeka tipa A (prema Harvardskoj silhueti slika 1.) nije imao nitko od ispitivanih. Ta ispitivanja navode da se velika panja mora posvetiti namjetaju za leanje, a prije svega samom konforu leanja. Slika 1. Nain dranja tijela prema Harvardskoj silhueti ovjeka A - Normalno izraena lordoza u slabinama, kifoza u podruju prsnog koa i lordoza vrata B - Posve zaobljena lea s jako izboenom i produenom kifozom prsnog dijela kraljenice C - Poluzaobljena lea s izrazitim izboenjima D - Nenormalna ravna lea s izravnatim udubljenjima i izboenjima kraljenice Komfor leanja je u asu kada je ovjeje tijelo ravnimjerno poduprto na leaju i kada je fizioloka krivulja kraljenice najpovoljnija. Njemaki lijenik Wilhelm Ackermann (7) u svom petogodinjem istraivanju doao je do rezultata vanih za pravilan poloaj kraljenice pri leanju. Dio tih istraivanja prikazan je na slici 2. A - F. Slika 2. A prikazuje poloaj kraljenice na premekanom leaju. Ovdije najtei dio tijela tone, a i zdjelica je preduboko i prisiljava kraljeniin stup da se neprirodno iskrivi, to uzrokuje bolove u leima. Na slici 2. B vidi se boni poloaj tijela na istom tipu leaja. Vidljivo je da je masa tijela rasporeena nepovoljno, te ulegnuta zdjelica deformira kraljeniin stup tako da dolazi do smetnji u cirkulaciji i do bolova. Slika 2. C prikazuje pretvrdi leaj koji uzrokuje napetost, jer lea ne mogu utonuti i biti poduprta. Time nastaju bolovi nerava i osjeaj razbijanja. Na slici 2. D ilustriran je postrani poloaj na istom tvrdom leaju. Vidljivo je da gornji dio boka i dio uz rame nisu dovoljno uleknuti. Tako se mijenja oblik lea, a time i kraljenini stup. Ramena i ruke spavaju, zatiljek boli. Iskrivljeni poloaj zdjelice djeluje tetno. Takozvani Ackermann - leaj prikazan je na slici 5. E - F. Slika 2. E prikazuje leanje ovjeka na leima. Ovdje je oblik lea potpuno prirodno poduprt, tako da se dobije anatomski pravilan poloaj kraljeninog stupa i zdjelice. Na slici 2. F prikazano je bono leanje na Ackermann - leaju. Ovdje rame i zdjelica mogu tako duboko ulegnuti da se dobije prirodan poloaj kraljeninog stupa i zdjelice. Danas se provode intenzivna istraivanja radi dobivanja leaja koji bi se ponajbolje prilagodio ljudskom tijelu. Tako su danas poznati, depiasti, lattoflex leajevi, latex i dr, vodeni leajevi, zrani, dvostruko opruni itd. Kako pojedini leajevi utjeu na spavanje i odmor ovjeka i to je na tom polju istraeno, opisano je u mnogim radovima (1,2,5,6,7,8,10,11,13,14). Slika 2. A - D Poloaj kraljenice na razliitim tipovima leajeva Slika 2. E - F Ackermann leaj CILJ ISTRAIVANJA Iz pregleda literature vidljivo je da su problemu odmaranja, odnosno spavanja, mnoge zemlje poele posveivati sve veu panju. Kod nas do sada nije bilo istraivanja koja bi dala odgovor na pitanje, koji je od naih leaja najpogodniji za dobar odmor, odnosno za dobro spavanje. Kako je to podruje vezano i za ispitivanje kvalitete spavanja, neophodna je povezanost strunjaka raznih profila i to sa podruja namjetaja i medicine. Voeni tom idejom pristupljeno je istraivanju kvalitete spavanja s neurofiziolokog i psiholokog aspekta, a u okviru toga izvreno je i somnologijsko ispitivanje u odnosu na razliite konstrukcije leaja. Od velikog broja razliitih konstrukcija leaja odabrani su neki tipini predstavnici, kao to je leaj s oprunom GR jezgrom i LATTOFLEX - leaj Slika 3.. i Slika 4.). Ciljevi istraivanja bili su: - istraivanje kvalitete spavanja na temelju polisomnografskog ispitivanja razliitih konstrukcija leaja- madraca UZORCI, ISPITANICI I METODE OBRADE 4.1. Uzorci Pri izboru karakteristinih tipova leaja, odluili smo se za dvije meusobno razliite konstrukcije. Leaj Lattoflex Ovaj leaj predstavlja najsuvremeniju konstrukciju, izraenu od spuve, koja je u strunoj literaturi dobila visoke ocjene. 2. Leaj s oprunom GR jezgrom Ova konstrukcija poiva na dugogodinjim iskustvima izrade ojastuenog namjetaja i ima mnoge dobre karakteristike. 4.2. Ispitanici Za ispitanike je uzeto pet zdravih studenata umarskog fakulteta Sveuilita u Zagrebu, mukog spola i podjednake starosne dobi. Cilj je bio da se na tom podruju ustanovi da li pojedina vrsta leaja ima utjecaj na ovjekov odmor i spavanje. Za lake praenje Lattoflex leaj je broj 1, a leaj s GR jezgrom broj 2. Niti jednom od ispitanika nije bilo reeno na kojoj e vrsti leaja spavati. Ispitanici su se pridravali slijedeeg: - preko dana su se bavili svojim uobiajenim poslovima, - obroke hrane uzimali su takoer na uobiajeni nain, - prije spavanja svi su pustili mokrau. Uvijeti spavanja: - temperatura 18( - 20(C, - vlaga zraka oko 60%, - vrijeme spavanja, (odgovaralo je uobiajom vremenu spavanja ispitanika). Radi eliminacije egzogenih utjecaja vremenskih prilika leajevi 1 i 2 korieni su naizmjenino. Sl. 3. Presjek leaja s GR oprunom jezgrom Sl. 4. Presjek Lattoflex leaja Za vrijeme ispitivanja ispitanici nisu u svojim upitnim testovima naveli nikakva posebna tjelesna i duevna optereenja. Polysomnografska obrada Tehnika i metoda registracije Cijelonona poligrafska obrada ispitanika izvrena je u somnografskom odjelu Centra za poremeaje spavanja Psihijatrijske bolnice Vrape-Zagreb. Odjel ini spavaonica tipa hotelske sobe, te laboratorij u kojem je smjetena aparatura za registraciju, video ureaji, TV ekran i dr. Laboratorij je povezan sa spavaonicom putem specijalne kamere. Snimanje - registracija izvrena je 16- kanalnom poligrafskom ureaju tipa Grass. Poligrafska obrada predstavlja simultanu registraciju i analizu niza fiziolokih parametara, kao to su: elektroencefalogram (EEG), elektrookulogram (EOG), elektromiogram (EMG), elektrokardiogram (EKG), te disajni pokreti - aktogram. Registracija je izvrena na slijedei nain: - EEG 10 kanala, - EOG 2 kanala, - EMG 1 kanal, - EKG . 1 kanal, - respiracija . 1 kanal, - aktogram .. 1 kanal. Snimanje je vreno tokom cijele noi. Poetak snimanja bio je priblian vremenu svakodnevnog odlaenja na poinak. Registracija se vrila 8 sati u prosjeku i to u vremenu od kada je ugaeno svjetlo i zaeljena dobra no, pa sve do momenta spontanog buenja. 4.3.2.Metode odvoenja pojedinih fiziolokih parametara Pojedini fizioloki parametri registrirani su primjenom posrebrenih elektroda sfernog oblika, promjera 12 mm. Elektrode su fiksirane, na prethodno acetonom oienu kou, komadiem gaze namoene u kolodijumu. Kao provodno sredstvo koriena je pasta za elektrode. Metode analize Cijelonona snimka je vizuelno analizirana prema propozicijama iz prirunika Kalesa i Rechtschafena: A Manual of Standardized Terminology, Techni(ue and Scoring for Sleep Stages of Human Subjects, izdanje UCLA Brain Information Service, National Institute of Health, Bethesda, 1968. (10). Analiza je vrena svakih 120 sekundi, to znai da su pojedine faze spavanja ili budnosti skorirane na svakoj estoj stranici. Posebna panja posveena je pokretima. Panja je posveena sitnim pokretima (=), generaliziranim pokretima (-), te mioklonizmima (--). Za pokrete analizirana je svaka strana, tj. epoha. Analizirani su slijedei parametri spavanja: 1. Totalno vrijeme spavanja (TVS) je broj minuta skoriranih kao spavanje (odbijene su stranice pokreta (AT) i vrijeme provedeno u budnosti (WT)). Stanje budnosti skorira se tada kada 50 % od jedne stranice ima karakteristike budnosti. 2. Latencija usnivanja (LU), tj. vrijeme u minutama od zapoinjana snimanja uz ugaeno svjetlo u sobi, do poetka spavanja (odnosno epizode spavanja). Procentualna zastupljenost pojedinih stadija spavanja u odnosu na totalno vrijeme spavanja (npr. % III i IV). Latencija REM-a, tj. vrijeme od kada je ispitanik zaspao od pojave prvog REM-a. Procentualna zastupljenost REM-a u odnosu na totalno vrijeme spavanja (% REM). Efikasnost spavanja (Ef), tj. omjer totalnog vremena spavanja i totalnog vremena snimanja (TVS/TVSn). Uestalost sekvenci budnosti u spavanju od usnivanja do definitivnog buenja (f S( W). Ukupna uestalost pokreta tijela: MT - broj stranica kod kojih je EEG i EOG krivulja prikrivena artefaktima uslijed micanja vie od 15 sekundi, odnosno 50 %, BM - ukupna uestalost masivnih pokreta tijela, T - ukupna uestalost sitnih pokreta, kao mimine muskulature ili trzajevi prstiju itd., K - kontrakcija miia u vidu trzajeva ili twitchis. 9. Broj ciklusa. 5.REZULTATI POLYSOMNOGRAFSKE OBRADE Na temelju obrade rezultata istraivanja napravljeni su profili spavanja i tablice iz kojih je vidljiva vremenski svaka faza spavanja za svakog ispitanika na leaju broj 1 i na leaju broj 2, kao i uestalost pojedinih pokreta.Zbog saetosti prikaza ovog rada te tablice i profile memoemo ovdje prikazati. Rezultati analize prije navedenih parametara spavanja su slijedei: Kod analize totalnog vremena spavanja za sve tri ispitivane noi postoji razlika izmeu leaja 1 i leaja 2 (u korist leaja broj 2), ali uz kritini nivo testa oko 12 % (t = 2,101). Analiza bez prve noi ne pokazuje signifikantnu razliku TVS (t = 0,724). 2. Nema razlike u latenciji usnivanja - LU za sve tri noit = -1,230bez prve noit = -0,276Kod procentualne zastupljenosti pojedinih stadija spavanja u odnosu na totalno vrijeme spavanja nisu dobivene signifikantne razlike izmeu leaja 1 i leaja 2. Za sve tri noi: relativan odnos (I + II)/TVS t = -0,980 relativan odnos (III + IIII)/TVS t = 0,912 Bez prve noi: relativan odnos (I + II)/TVS t = -0,520 relativan odnos (III + IIII)/TVS t = 1,916 Latencija REM-a kod ispitanika ne pokazuje signifikantnu razliku, iako razlike koje postoje govore da je latencija vea na leaju broj 2, za sve tri noit = -0,456bez prve noit = 0,7945. Procentualna zastupljenost REM-a u odnosu na totalno vrijeme spavanja (TVS) kod leaja 1 i leaja 2 nije pokazala signifikantnu razliku, za sve tri noit = 0,036bez prve noit = -0,7626. Efikasnost spavanja (Ef) kod analize za sve tri noi pokazala je razliku izmeu dva leaja u korist leaja broj 2, ali uz kritini nivo testa oko 12 %, za sve tri noit = 2,004bez prve noit = 0,152 Frekvencija sekvenci budnosti unutar epizode spavanja u statistikom smislu je jednaka za sve tri noi, kao i za dvije noi, za sve tri noileaj 1.. 2,6leaj 2. 2,0bez prve noileaj 1 . 2,8leaj 2 1,8Nema statistiki znaajne razlike u ukupnoj frekvenciji pokreta tijela, za sve tri noi: MT - Wilcoxonova suma rangova W = 28 BM - Wilcoxonova suma rangova W = 28 T - Wilcoxonova suma rangova W = 28 K - Wilcoxonova suma rangova W = 24 Kritini nivo nije manji od 9,6 % bez prve noi: MT - Wilcoxonova suma rangova W = 28 BM - Wilcoxonova suma rangova W = 33 T - Wilcoxonova suma rangova W = 29 K - Wilcoxonova suma rangova W = 24 Kritini nivo nije manji od 9,6 % Vano je napomenuti da razlike koje su se pokazale kod malih pokreta nisu signifikantne, ali rezultati idu u prilog leaju 2. 9. Kod broja ciklusa ne postoje signifikantne razlike, za sve tri noileaj 1 . 4,0leaj 2 . 3,8bez prve noileaj 1 . 4,4leaj 2 . 4,6 6. ZAKLJUAK Istraivanja koja su provedena na umarskom fakultetu u Zagrebu i u Centru za spavanje u Zagrebu potvruju da vrsta leaja, navike spavanja, naini odmaranja imaju utjecaja, osobito kod starijih osoba, na oblik kraljenice i nastanak nekih njenih oboljenja. Prije se je lijenik trudio da lijei nastala oboljenja. Danas se bolest nastoji sprijeiti, pa glavni dio posla higijeniara jest preventiva. A upravo pogodan leaj je nedjeljiv dio preventive bolesti kostiju, osobito oboljenja kraljenice. Ova istraivanja ukazala su na potrebu mulitidisciplinarnog pristupa kompleksu krevet-spavanje. Oito je da svi dosadanji jednostrani pokuaji nisu mogli donijeti cjelovite i prihvatljive rezultate, posebno i stoga to je cijelokupan problem vrlo sloen. Neophodno je da se istraivanja na podruju kreveta i namjetaja za leanje nastave i to zajedno sa strunjacima s podruja medicine (rentgenolozima, psiholozima, ortopedima i drugim specijalistima.) kako bi se i kod dolo do namjetaja za leanje, koji bi najbolje odgovarao svakome od nas. Na temelju provedenih istraiavnja mogu se donijeti slijedei zakljuci: - somnologijska obrada je pokazala da je spavanje na leaju s oprunom jezgrom bolje, nego na Lattoflex leaju. U svim analiziranim znaajkama razlike nisu statistii signifikantne, - istraivanja proiriti sa veim brojem ispitanika i razliitih konstrukcija leaja kako bi se meusobnom komparacijom dobila vrijedna slika onog najkvalitetnijeg, odnosno najboljeg za ovjekovo spavanje i odmor. Danas, kad su kultura stanovanja, znanost, tehnike i ekonomske mogunosti drutva dostigle prilino visoku razinu, namjetaj za leanje i odmaranje, koji se pojavljuje na tritu, morao bi zadovoljiti kvalitetom, funkcionalnou i dizajnom, a naroito svojom osnovnom svrhom da se ovjek koji na njemu lei zaista dobro osjea. 7. LITERATURA 1.Berlat, W.:Matratzen Merkblatt zur Rheuma-Prophylaxe Nr 11, Zrich Schweiz. Rheumaliga 1970.2.Biener, K., Jggi, D.:Your back, Your sleep, Your bed, Switzerland 1982.3.Drrigl, V.:Karakteristike paradoksalne faze spavanja (REM studija) u shizofrenih bolesnika (habilitacija), Zagreb 1972.4.Drrigl, V.:Spavanje, poremeaji spavanja i osnovni principi lijeenja, Krka, KPN 3/82, Novo Mesto5.Grandjean, E.:Whonen und Schlafen aus Whonphysiologischer Sicht, Mbel Kultur 4/75, 84-86 str.6.Grbac, I:Istraivanje trajnosti i elastinosti razliitih konstrukcija leaja, Magistarski rad, umarski fakultet, Zagreb 1984.7.Grbac, I:Istraivanje kvalitete leaja i poboljanje njegove konstrukcije, disertacija 1-583 str. umarski fakultet-Zagreb, 1988.8.Grbac, I:A bed in eyes of its designers, medical professionals, and its users, Congres of the croatian ortopedic and thraumathology association, Zagreb 1996.9.Hodoba, D.:Utjecaj interiktalnih epileptikih izbijanja na tok i cikliku organizaciju spavanja (magistarski rad), Medicinski fakultet Sveuilita u Zagrebu, Zagreb 1983.10.Kales, Rechtschafen:A manual of Standardizied Terminology, Tehnique and Scoring System for Sleep Stages of Human subjects, UCLA Brain Information Service, National institute of Health, Bethesda, 1968.11.Kinkel, H.J., Maxion, H.:Schlafpsysiologische Untersuchungen zur Beurteilung verschiedener Matratzen, Int. Z. angew. Physiol. 28, 247-262, 1970.12.Lehmann, G.:Schlaf und Lrm, Whonungs medizin 2,21-28,1963.13. Mller, Limroth, W.: Untersuchungen ber den Einflu Unterschiedlicher Oberbett-materialen auf das Schlafverhalten und das Bettklima, Lehrstuhl und Institut fr Arbeitsphysiologieder Technichen Universitt Mnhen, 1977.14.Raphael, L.: Povratak zdravom snu, Biblioteka popularne psihologije, Zagreb, 1983.15.Roffwarg, H.P. i suradn.:Ontogenetic development of human sleep - dreem cycle, Science 1966., 152-604.16.Snedecor, Cochrani:Statistical methods, New York 1967.  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Ivica GrabacAny BodySumarski fakultet  FMicrosoft Word Document MSWordDocWord.Document.89q !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrwRoot Entry FF@nvWordDocument!CompObjjSummaryInformation()()(  FMicrosoft Word Document MSWordDocWord.Document.69qOh+'0  (4 \ h t Prof. dr.sc. Ivica GrabacIVI Any BodyNormalSumarski fakultet1Microsoft Word for WDocumentSummaryInformation8 Root Entry F@+@n}?nvWordDocument!CompObjjSummaryInformation()()(  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrwindows 95@@j@n@~WnM՜.+,0@HX` hp xHOME'F Prof. dr.sc. Ivica Grabac