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| − | SAMPLE LANGUAGE TEXT:<br />
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| − | OSCAR is beschikbaar op de officiële downloadpagina: '''https://sleepfiles.com/OSCAR/'''<br />
| + | <center>[[File:Sandbox_kid.jpg]] <font size=4>This is the Apnea Board Wiki '''Sandbox''' page.</font> |
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| − | Er zijn OSCAR-versies beschikbaar voor Windows, Apple Mac en Linux.<br />
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| − | U kunt de pagina ook in een aantal verschillende talen lezen - de lijst met talen staat bovenaan de pagina.<br />
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| − | FOREIGN LANGUAGE FONTS:<br />
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| − | Russian: Български<br />
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| − | Chinese: 简体中文<br />
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| − | Hebrew: עִבְרִית <br /><br />
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| − | =Soft Cervical Collars and Apnea=
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| − | ==Introduction==
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| − | This article provides guidance for the selection and use of a soft cervical collar to prevent a common cause of positional apnea. Many CPAP users(at least 1/3 of forum members including the writer) experience significant
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| − | clustered flow restrictions, hypopnea, and obstructive apnea that do not respond to pressure due
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| − | to misalignment and restriction of the airway caused by tucking the chin down toward the chest
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| − | (neck flexion). With chin tucking the soft tissues under the jaw are pressed upward causing a
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| − | restriction or collapse during inspiration. It takes very little pressure to make this happen and the
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| − | negative pressure of the airway during inspiration increases the restriction. This has been
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| − | confirmed in at least one medical study <ref> Effect of Jaw and Head Position on Airway Resistance in Obstructive Sleep Apnea Choi JK, et al., Sleep and Breathing, 2000;4(4):163-168.
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| − | https://www.ncbi.nlm.nih.gov/pubmed/11894202 </ref>. To demonstrate this, sit relaxed in a chair and take a couple of deep breaths. Then let your chin
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| − | drop to your chest, take more deep breaths, and note the increased resistance. This is a common,
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| − | perhaps the most common, form of what we call positional apnea and, as previously mentioned,
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| − | usually cannot be resolved by increased pressure.<br>
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| − | Flow restrictions caused by chin tucking can be eliminated by wearing a loose fitting soft
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| − | cervical collar (SCC), or an alternative to be discussed below, to restrict neck flexion. Here are
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| − | images of a typical SCC.<br>
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| − | [[File:Cvs collar.jpg|Soft Cervical Collar]]
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| − | [[File:Extended collar.png|Extended Soft Cervical Collar]] <br>
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| − | It consists of foam rubber with a cloth cover and a Velcro closure at the rear. The Velcro closure
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| − | allows several inches of adjustment to achieve the correct fit. They are available in a variety of
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| − | lengths and heights to suit individual needs. (The length and height in the example above would
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| − | not be appropriate for everyone.)<br>
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| − | Anti-snore pillows (collars) that are similar to an SCC in the front but have just a strap around the
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| − | back are an effective alternative for those who find a foam collar that completely surrounds the
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| − | neck too warm or otherwise uncomfortable. They are much less available locally, however, and are usually more expensive.<br><br>
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| − | A small pillow set under the chin will also prevent tucking but is less effective than a collar and
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| − | will probably not stay in place.<br> Please see [[http://www.apneaboard.com/wiki/index.php?title=Optimizing_therapy|the Optimizing_therapy Wiki]] for additional information on what is often referred to as "positional apnea".
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| − |
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| − | ==Where and How to Find Them==
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| − | In the United States, an SCC can be purchased at most pharmacies and big box stores for around $20 but the selection of
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| − | sizes will be limited. The best selection of sizes and prices (as low as $10) will be found at
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| − | internet vendors such as Amazon and eBay.<br>
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| − | A large number of choices of SCC can be found by entering “soft cervical collar” or “soft foam collar” in a
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| − | search engine. A similar search at the site of vendor such as Amazon or eBay will also bring up many choices with fewer extraneous hits.<br><br>
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| − | Anti-snore collars may be available at some big box stores but the best source is internet vendors
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| − | It is difficult to find a good selection by entering “anti snore collar” in a search engine or even at
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| − | the site of an internet vendor. It is more successful to search for specific brands/models such as
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| − | Dr. Dakota Anti Snore Pillow Cushion, or Eliminator Series Sleep Aid Cushion. The Caldera
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| − | Releaf Neck Rest, which more closely resembles an SCC has also been recommended by some
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| − | forum members.<br>
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| − | [[File:Snore-collar.jpg|Anti-Snore Collar]]
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| − |
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| − | ==Fit and Use==
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| − | Proper fit is very important. The SCC needs to support the jaw and chin, without impinging on
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| − | the throat or soft tissue between the chin and throat or immobilizing neck movement more than is
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| − | required to prevent the chin from tucking to the chest. Both height and circumference (length)
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| − | are important. With respect to circumference, too tight a fit will be uncomfortable and may have
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| − | adverse consequences and too loose a fit will not prevent chin tucking.<br><br>
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| − | The length of the collar should be a couple of inches more than your neck size as determined
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| − | using a cloth measuring tape. The SCC package should give the length or the range in neck sizes
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| − | for which the collar is designed.
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| − | '''Keep in mind that the size stated is for the intended use of the collar which is a tight fit to immobilize the neck of someone who has had an injury. For our purpose the collar must be a looser fit. Therefore, a collar longer than the measured neck circumference should be selected.'''
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| − | Many sold by internet vendors such as Amazon are
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| − | described just as small, medium, and large. Often there will be a sizing chart stating the range of neck sizes for each category. Select the size for which your neck size falls near the middle of the
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| − | range. Precision is not important because most have a Velcro strap at the back and can be
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| − | adjusted an inch or two beyond the stated range.<br><br>
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| − | With respect to height, a collar that is too short may permit enough chin tucking to compromise
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| − | the airway whereas one that is too tall will extend the neck up and back which will be
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| − | uncomfortable. Collars are available in heights ranging from 50 to 75mm (2” to 5”). Choose a collar with a
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| − | height close to the distance from the bottom of the chin to where the point where the neck meets
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| − | the chest.<br><br>
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| − | Internet vendors offer the best selection of heights. 3M markets an SCC called the Futuro that has
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| − | a height adjustment tab. We have no reports on how well it works but 3M products are usually of
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| − | good quality. It is available at most chain pharmacies such as CVS and Walgreens.<br><br>
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| − | Adjust the collar so it is just tight enough to prevent the chin from tucking behind it,
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| − | '''but no tighter'''
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| − | , so that it feels loose and can easily be moved around on the neck. It should be possible
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| − | to easily insert one or two fingers between the neck and collar. It is important that the fit not only
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| − | be loose but that the collar only be worn while sleeping.
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| − | '''Constant prolonged use''' of a cervical collar, especially if tight, can result in damage to nerves and tendons and muscle atrophy.<br><br>
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| − | We feel comfortable recommending the use of the SCC as described above because it is not worn
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| − | tight as it would be for its intended use, to stabilize the neck following injury, and is only worn
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| − | while sleeping and not constantly. Evidence that there are no adverse side effects from long term
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| − | use of a loose fitting SCC worn only while sleeping is, however, anecdotal from the experience
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| − | of forum members. We have no solid data with respect to safety.<br><br>
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| − | Most of the data demonstrating the successful use of SCC for treating "positional apnea" is
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| − | strictly anecdotal. Although most doctors, sleep centers, and therapists are not aware of this
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| − | application, it has not escaped the attention of sleep medicine researchers. We are aware of one
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| − | pending study <ref> Evaluation of Treatment Effect of Cervical Collar in Moderate Obstructive Sleep Apnea, Florim Delijaj, Uppsala University. https://clinicaltrials.gov/ct2/show/NCT03754270 </ref> and three that have been completed. In one completed study five subjects with
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| − | severe obstructive sleep apnea (OSA) that was not resolved with CPAP alone (mean AHI 21.2
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| − | with CAP) had a reduction in mean AHI to 0.8 with combined CPAP and cervical collar
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| − | treatment <ref>Efficacy of the Addition of a Cervical Collar in the Treatment of Persistent Obstructive Apneas Despite Continuous Positive Airway Pressure, Arnaud Prigent, et al., 2017 Dec 15; 13(12): 1473–1476.
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| − | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695995/</ref> . In another study a significant reduction in AHI was seen in patients with severe OSA with
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| − | combined cervical collar and MAD therapy as compared to MAD therapy alone. <ref>Reduced Apnea-Hypopnea Index in Patients with Severe Sleep Apnea Syndrome as Determined by Cervical Collar and Mandibular Advancement Device Combination Therapy, Delijaj et al., Journal of Sleep Disorders & Therapy, 2016, 5:5
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| − | https://www.longdom.org/open-access/redu...000252.pdf</ref> In a third study
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| − | only one of 20 subjects with severe OSA experienced a significant (67%) decrease in AHI
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| − | associated with use of the collar. The authors concluded “a soft cervical collar had no effect on
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| − | pharyngeal patency in patients with OSA”. <ref>Soft Cervical Collar in Obstructive Sleep Apnea, a Pilot Study, P Bordier, et al., Sleep, Volume 41, Issue suppl_1, April 2018
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| − | https://academic.oup.com/sleep/article/4...08/4988596</ref> <br>
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| − |
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| − | ==OSCAR Charts==
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| − | Without Collar<br>[[File:Severe Positional Apnea.png|500px]] [[File:Severe Positional Apnea FL Closeup.png|500px]]
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| − | [[File:Moderate Clustering Charts.jpg|500px]]
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| − | <br> <br>
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| − | With Collar<br>[[File:Normal w C Collar.png|500px]] [[File:Normal w C Collar closeup.png|500px]]
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| − |
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| − | ==Additional Info==
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| − | [[Optimizing_therapy#Positional_Apnea]]
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| − |
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| − | ==DISCLAIMER & LEGAL NOTICE==
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| − | BY USING A SOFT CERVICAL COLLAR OR OTHER MEANS TO PREVENT CHIN
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| − | TUCKING AS DESCRIBED IN THIS DOCUMENT, YOU UNDERSTAND THAT YOU ARE
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| − | PERSONALLY ASSUMING ALL ASSOCIATED RISK AND WILL NOT HOLD APNEA
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| − | BOARD, ITS MEMBERS, OWNERS, ADMINISTRATORS AND/OR MODERATORS
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| − | LIABLE FOR ANY PROBLEMS, DAMAGES, PHYSICAL HARM, (INCLUDING DEATH),
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| − | MENTAL HARM OR ANY OTHER HARM THAT MAY COME TO YOU, YOUR FAMILY
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| − | MEMBERS, FRIENDS, CO-WORKERS OR ANY OTHER PERSONS WHO MAY RECEIVE
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| − | THIS INFORMATION FROM YOU. YOU MAY NOT USE, COPY OR DOWNLOAD THIS
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| − | DOCUMENT UNLESS YOU HAVE A LEGAL RIGHT TO DO SO UNDER ALL
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| − | APPLICABLE U.S. LAWS. INFORMATION CONTAINED ON THIS WEB PAGE, APNEA
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| − | BOARD FORUMS AND ON THE APNEABOARD.COM WEB SITE SHOULD NOT BE
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| − | CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A QUALIFIED
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| − | PHYSICIAN BEFORE SEEKING TREATMENT FOR ANY MEDICAL CONDITION,
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| − | INCLUDING SLEEP APNEA.
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| − | ==References==
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