The cervical pillow was designed to reduce the severity of snoring and sleep-disordered breathing in individuals with the Obstructive Sleep Apnea Syndrome

The cervical pillow was designed to reduce the severity of snoring and sleep-disordered breathing in individuals with the Obstructive Sleep Apnea Syndrome (OSAS). Snoring, sleeprelated breathing pauses, and excessive daytime sleepiness characterize this sleep disorder. The OSAS diagnosis is confirmed by a respiratory disturbance index (RDI, apneahypopnea index) ≥5 events/hr during polysomnography (sleep study) which includes monitoring of respiratory parameters. This disorder carries significant morbidity, including an increased risk for hypertension, cardiac dysrhythmias and failure, myocardial infarction, stroke, and sleepiness-related industrial and motor vehicle accidents. The cervical pillow was designed to extend the head in a posture similar to that used in cardiopulmonary resuscitation (CPR) to create an open airway in an unconscious victim. Similarly, studies have documented better visualization and patency of the upper airway for intubation of children and adults with the head extended (Westhorpe, 1987; Shorten et al., 1995a; 1995b). Prior investigators have observed that head position modifies upper airway resistance, with less resistance noted when the subjects’ heads were extended (Liistro et al., 1988; Jan et al., 1994). A 20-degree head extension resulted in a significant increase in the cross-sectional dimension of the pharyngeal airway as shown by lateral skull radiographs (Hellsing, 1989). Although these studies evaluated conscious subjects, similar changes in upper airway resistance or crosssectional area would be expected with head position in sleeping subjects. However, asleep subjects, particularly those with OSAS, would be expected to have overall higher upper airway resistances due to relaxation of the upper airway musculature during sleep. Interestingly, similar findings were observed in dogs (Odeh et al., 1995), where head extension resulted in a more negative pressure at which upper airway collapse occurred and increased maximal flow compared to head flexion. The cervical pillow used in the present study (Figure 1) consists of a urethane foam foundation, an overlying NASA "memory foam" supporting the head and neck, a stretch terrycloth cover, and a cotton pillowcase. The pillow was customfitted to each subject by three simple measurements of the head and neck. The objective of the present study was to test whether the neck posture enforced by this pillow would be adequate to reduce the severity of the snoring and sleepdisordered breathing in OSAS subjects.