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Background:  Obstructive Sleep Apnea (OSA) causes repeated airway blockages during sleep, leading to low oxygen levels, poor sleep quality, and increased risk of cardiovascular disease and type 2 diabetes. Treatments such as mandibular advancement devices (MAD) or CPAP (Continuous Positive Airway Pressure), require high adherence, which is often lacking. As a result, many patients remain untreated, underscoring the need for new therapeutic alternatives.

Aims and Methods: Paper I: A randomised controlled study investigated the effect of telemedicine (TM) compared with standard clinic visits (SC) on adherence to CPAP treatment after 6 months. It also examined the impact of other factors, including CPAP side effects, on treatment adherence in 217 patients with OSA. 

Paper II: A randomised, open, parallel-group intervention study evaluated the effect of head extension using a cervical collar on the respiratory events index [(REI) i.e. apnea-hypopnea index (AHI)] in 100 patients with moderate OSA. The lifestyle intervention group (LS) received life-style advice only, while the cervical collar group (CC/LS) received both lifestyle advice and treatment with an adjustable cervical collar to promote head extension during sleep. Assessments, including questionnaires and polygraphy, were performed at baseline and after 6 ± 2 weeks.

Paper III: A qualitative study explored and highlighted patients’ experiences of cervical collar treatment for OSA in seven patients from the intervention group (CC/LS) of the previous randomised controlled trial (Paper II). Qualitative content analysis was performed in accordance with the method of Graneheim and Lundman.

Results and conclusions: There were no differences in CPAP adherence between the TM and SC groups after 6 months, suggesting that TM does not improve adherence to CPAP treatment over this period. Factors negatively affecting CPAP adherence included smoking and side effects such as dry throat, increased awakenings, and difficulty exhaling.

The patient group (CC/LS) showed a greater reduction in REI compared with the LS group. The reduction in REI was particularly pronounced in the supine position. Thus, a cervical collar may be a viable second-line treatment option for OSA, especially in cases of positional OSA. 

Patients found the cervical collar improved sleep and daytime alertness but noted it was bulky and required adjustment. Despite challenges, it is viewed as helpful and should be more widely available.