{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T23:36:15Z","timestamp":1785454575302,"version":"3.56.0"},"reference-count":40,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T00:00:00Z","timestamp":1738022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Sleep Research"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    As available treatments in obstructive sleep apnea are all associated with side\u2010effects or adherence problems, there is a need for alternative treatment options. In this randomized, open, parallel\u2010group intervention study, the effect of head extension by cervical collar was evaluated in patients with moderate obstructive sleep apnea. One\u2010hundred patients with moderate obstructive sleep apnea (apneas and hypopneas per estimated hours asleep\u2009=\u2009respiratory events index: 15\u201330) were randomized to either lifestyle intervention, or cervical collar in combination with lifestyle intervention. Both groups received lifestyle advice. In addition, the treatment group was 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\u2009\u00b1\u20092\u2009weeks. A linear regression model was used to assess a total effect on respiratory events index, which was the primary endpoint. In the intention\u2010to\u2010treat analysis, the cervical collar in combination with lifestyle intervention group decreased their respiratory events index (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.008) and oxygen desaturation index (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.008) more than the lifestyle intervention group, with a mean difference of \u22124.5 and \u22124.3, respectively. In the sub\u2010analysis, there was a clear effect on respiratory events index in the supine position (mean difference between the groups \u22129.1,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.018) but not on non\u2010supine apnea\u2013hypopnea index (\u22122.3,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.17). 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 obstructive sleep apnea. Cervical collar can be a second\u2010line treatment option in this group, especially in positional obstructive sleep apnea.\n                  <\/jats:p>","DOI":"10.1111\/jsr.14463","type":"journal-article","created":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T21:24:40Z","timestamp":1738099480000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Treatment effect of head extension by cervical collar on moderate obstructive sleep apnea\u2013A randomized controlled trial"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-0661-3583","authenticated-orcid":false,"given":"Florim","family":"Delijaj","sequence":"first","affiliation":[{"name":"Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Uppsala University  Sweden"},{"name":"Centre for Clinical Research S\u00f6rmland (CKFD)  Eskilstuna Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4640-9149","authenticated-orcid":false,"given":"Lars","family":"Lindhagen","sequence":"additional","affiliation":[{"name":"Uppsala Clinical Research Center Uppsala University  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linus","family":"Johnsson","sequence":"additional","affiliation":[{"name":"Centre for Research Ethics &amp; Bioethics (CRB) Uppsala University  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per","family":"Kristiansson","sequence":"additional","affiliation":[{"name":"Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Uppsala University  Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8552-4510","authenticated-orcid":false,"given":"Eva","family":"Lindberg","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Respiratory, Allergy and Sleep Research Uppsala University  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,28]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"StatPearls","author":"Atanelov Z.","year":"2023"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.157.1.9706079"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.93.4.678"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00431-2020"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.305.6846.160"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.4172\/2167-0277.1000252"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.10686"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsab076"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1288\/00005537-198911000-00004"},{"issue":"4","key":"e_1_2_11_11_1","first-page":"107","article-title":"Three\u2010dimensional changes of the upper airway in patients with obstructive sleep apnea syndrome after a non\u2010adjustable oral appliance treatment","volume":"62","author":"Farronato G.","year":"2013","journal-title":"Minerva Stomatologica"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.5665\/sleep.1728"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.3978\/j.issn.2072-1439.2015.06.11"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.33588\/rn.6906.2019061"},{"key":"e_1_2_11_15_1","first-page":"383","article-title":"Sleepiness\u2010related accidents in sleep apnea patients","volume":"3","author":"Horstmann S.","year":"2000","journal-title":"Sleep"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ncl.08.003"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/14.6.540"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60734-5"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-020-02369-3"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.164.11.2102028"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-1844"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202305-472RL"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.04.064"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2015.01.016"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000008818"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2869.1995.tb00205.x"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.6852"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.4858"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00405-007-0311-3"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1067\/mod.2002.121006"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1152\/jappl.1959.14.5.760"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.125.1.118"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2393"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1177\/0962280216683570"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11325-014-0945-5"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2007.11.005"},{"issue":"10","key":"e_1_2_11_37_1","first-page":"1440","article-title":"Influence of head extension, flexion, and rotation on collapsibility of the passive upper airway","volume":"31","author":"Walsh J. 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