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Study objectives: This study aimed to investigate the effect of telemonitoring compared with standard clinic visits on adherence to continuous positive airway pressure (CPAP) treatment after 6 months. In addition, the impact of other factors including CPAP side effects on treatment adherence were assessed.

Methods: Consecutive patients (n = 217) who were prescribed CPAP treatment for obstructive sleep apnea were randomized to either telemonitoring or standard-care follow-up. All patients were followed up 6 months after treatment started. Clinical/anthropometric variables, socioeconomical and lifestyle factors, psychological distress, daily function, and personality traits along with CPAP side effects were assessed. Differences between groups were analyzed using 2-sample t-test, chi-square test, or Fisher's exact test. Regression modeling was used to explore associations between dependent and independent variables.

Results: There were no differences in CPAP adherence between telemonitoring and standard-care groups after 6 months (53.2% vs 48.7%; P = .54). CPAP side effects such as dry throat (odds ratio = 2.17; 95% confidence interval = 1.25-3.70), increased awakenings (2.50; 1.31-4.76), and exhaling problems (3.70; 1.25-10.1) were independently associated with low CPAP adherence, although these associations were weakened when adding smoking to the model. No other baseline or follow-up factors were associated with CPAP adherence at 6 months.

Conclusions: We could not show that telemonitoring follow-up improved adherence levels. Dry throat, increased awakenings, exhaling problems, and smoking had negative effects on CPAP adherence. Preventing side effects and assessing smoking status is therefore of importance when wanting to improve CPAP adherence.

As available treatments in obstructive sleep apnea (OSA) are all associated with side effects or adherence problems, there is a need for alternative treatment options.

In this randomised, open, parallel-group intervention study the effect of head extension by cervical collar was evaluated in patients with moderate OSA. 

One hundred patients with moderate OSA (apneas and hypopneas per estimated hours asleep = respiratory events index: 15–30) were randomised to either lifestyle intervention (LS) or cervical collar in combination with lifestyle intervention (CC/LS). Both groups received lifestyle advice. In addition, the treatment group were treated with a cervical collar, which allows adjustment of head extension, during sleep. Assessment with questionnaires and polygraphy were performed at baseline and after 6 ± 2 weeks.

A linear regression model was used to assess a total effect on respiratory events index, which was the primary endpoint. 

In the intention to treat (ITT) analysis, the CC/LS group decreased their respiratory events index (P = 0.008) and oxygen desaturation index (P = 0.008) more than the LS group with a mean difference of -4.5 and -4.3, respectively. In the sub-analysis, there was a clear effect on respiratory events index in the supine position (mean difference between the groups -9.1, p=0.018) but not on non-supine AHI (-2.3, p=0.17).  

We conclude that head extension by cervical collar during sleep resulted in improved respiratory events index and oxygen desaturation index values in patients with moderate OSA. Cervical collar can be a second-line treatment option in this group, especially in positional OSA.

Head extension using a cervical collar could potentially open up the airways during sleep in patients with obstructive sleep apnea (OSA). Patient satisfaction and compliance with daytime collar treatment in conditions other than OSA are generally low due to several factors such as discomfort, limited movement, interference with daily activities and appearance. 

Aim: In this qualitative study patients’ experiences of nighttime collar treatment for OSA were explored and highlighted. Methods: Seven patients who participated in the intervention group of a previous randomized controlled trial (RCT) were included in individual semi-structured interviews. Qualitative content analysis was performed according to Graneheim and Lundman. Results: The experiences with collar treatment were related to three main categories: surprisingly beneficial treatment; not without challenges; and should be available.   

The patients experienced that the collar improved their sleep, which contributed to feeling revitalized during daytime. Although the collar was experienced as simple and safe, it was also incommodious and bulky, requiring some adaptation. The patients expressed that they wanted a collar for future use and were eager to spread the word. Conclusions: We conclude that collar treatment for OSA is experienced as helpful, although not without challenges, and are recommended by the patients to be more widely available. Further research is needed to explore adherence and experiences of long-term use of the collar in a larger population.