Cervical Braces Are Not Recommended by AASM for Sleep Apnea Treatment
The American Academy of Sleep Medicine does not recommend cervical braces as a treatment for obstructive sleep apnea, and no AASM guidelines mention cervical collars or braces as an approved therapeutic option. The AASM's established treatment hierarchy prioritizes CPAP as first-line therapy, with mandibular advancement devices, surgical interventions, and other modalities as alternatives—but cervical braces are notably absent from these recommendations 1, 2, 3.
AASM-Recommended Treatment Options
The AASM's clinical practice guidelines establish the following treatment algorithm for adults with OSA:
First-Line Therapy
- CPAP therapy is the gold standard initial treatment for OSA, with strong evidence supporting improvements in excessive sleepiness, sleep-related quality of life, and comorbid hypertension 2, 4.
- CPAP can be initiated using either auto-adjusting PAP at home or in-laboratory titration, with educational interventions strongly recommended at therapy initiation 2, 4.
Alternative Therapies for CPAP-Intolerant Patients
- Custom, titratable mandibular advancement devices (MADs) are the primary AASM-recommended alternative for patients who cannot tolerate CPAP, with moderate improvement in quality of life outcomes 2, 1.
- Surgical consultation should be discussed with adults with OSA and BMI <40 kg/m² who are intolerant or unaccepting of PAP 1.
- Bariatric surgery referral should be discussed with adults with OSA and obesity (BMI ≥35 kg/m²) who are intolerant or unaccepting of PAP 1.
Limited Research on Cervical Collars
While one recent study examined soft cervical collars for OSA, the findings do not support their use as a standard treatment:
- A 2025 study found that soft cervical collars reduced AHI from 44.44 to 36.69, but this reduction was not statistically significant (p=0.08) in the overall population 5.
- The collar showed benefit only in a subgroup with BMI <30 kg/m², where AHI significantly decreased (p=0.02), and improved lowest oxygen saturation from 76.35% to 83.74% (p=0.01) 5.
- This single study has not been incorporated into AASM guidelines and represents insufficient evidence to recommend cervical collars as a treatment option 5.
Critical Clinical Pitfalls
- Do not prescribe cervical braces/collars as OSA treatment based on current AASM guidelines, as they lack the evidence base and guideline support that established therapies possess 1, 2.
- Patients seeking alternatives to CPAP should be offered custom, titratable MADs as the evidence-based alternative, not cervical collars 2.
- Weight loss should be encouraged for all overweight and obese patients with OSA as part of the treatment plan 2.