Background: Sleeping mattress parameters signifificantly inflfluence sleeping comfort and health, as reflflected by the extensive investigations of sleeping supportbiomechanics to prevent sleep-related musculoskeletal problems.

Methodology: Herein, we review the current trends, research methodologies,and determinants of mattress biomechanics research, summarizing evidencepublished since 2008. In particular, we scrutinize 18 articles dealing with the development of new designs, recommendation criteria, instruments/methods of spine alignment evaluation, and comparative evaluation of different designs.

Results: The review demonstrated that mattress designs have strived for customization, regional features, and real-time active control to adapt to thebiomechanical features of different body builds and postures. However, the suggested threshold or target values for desirable spine alignment and body pressure distribution during sleep cannot yet be justifified in view of the lack of suffificient evidence.