Editing Sleep apnea (section)

==Management==
The treatment of obstructive sleep apnea is different than that of central sleep apnea. Treatment often starts with behavioral therapy and some people may be suggested to try a continuous positive airway pressure (CPAP) device. Many people are told to avoid alcohol, sleeping pills, and other sedatives, which can relax throat muscles, contributing to the collapse of the airway at night.<ref name=SleepApneaTreatments /> The evidence supporting one treatment option compared to another for a particular person is not clear.<ref name="pmid36278514">{{cite journal |last1=Pinto |first1=Ana Carolina Pereira Nunes |last2=Rocha |first2=Aline |last3=Drager |first3=Luciano F |last4=Lorenzi-Filho |first4=Geraldo |last5=Pachito |first5=Daniela V |date=24 October 2022 |editor-last=Cochrane Airways Group |title=Non-invasive positive pressure ventilation for central sleep apnoea in adults |url= |journal=Cochrane Database of Systematic Reviews |language=en |volume=2022 |issue=10 |pages=CD012889 |doi=10.1002/14651858.CD012889.pub2 |pmc=9590003 |pmid=36278514 }}</ref>

=== Changing sleep position ===
More than half of people with obstructive sleep apnea have some degree of positional obstructive sleep apnea, meaning that it gets worse when they sleep on their backs.<ref name="pmid28852945">{{cite journal |last1=Omobomi |first1=Olabimpe |last2=Quan |first2=Stuart F. |date=May 2018 |title=Positional therapy in the management of positional obstructive sleep apnea-a review of the current literature |url=https://dash.harvard.edu/bitstream/1/35427798/1/2017%20Omobomi%20and%20Quan%2c%20Positional%20therapy....pdf |journal=Sleep & Breathing = Schlaf & Atmung |volume=22 |issue=2 |pages=297–304 |doi=10.1007/s11325-017-1561-y |issn=1522-1709 |pmid=28852945 |s2cid=4038428 |access-date=30 December 2023 |archive-date=8 March 2024 |archive-url=https://web.archive.org/web/20240308031052/https://dash.harvard.edu/bitstream/handle/1/35427798/2017%20Omobomi%20and%20Quan,%20Positional%20therapy....pdf?sequence=1 |url-status=live }}</ref> Sleeping on their sides is an effective and cost-effective treatment for positional obstructive sleep apnea.<ref name="pmid28852945" />

===Continuous positive airway pressure===
[[File:Cpapanwender.jpg|thumb|Person using a CPAP mask, covering only the nose]]
[[File:CPAP device on a nightstand.jpg|thumb|CPAP device on a nightstand]]
{{see also|Continuous positive airway pressure}}
For moderate to severe sleep apnea, the most common treatment is the use of a continuous positive airway pressure (CPAP) or automatic positive airway pressure (APAP) device.<ref name=SleepApneaTreatments>{{cite web |url=http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_Treatments.html |title=How Is Sleep Apnea Treated? |publisher=[[National Heart, Lung, and Blood Institute]] |url-status=live |archive-url=https://web.archive.org/web/20071013043521/http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_Treatments.html |archive-date=13 October 2007 }}</ref><ref name=2012review/> These splint the person's airway open during sleep by means of pressurized air. The person typically wears a plastic facial mask, which is connected by a flexible tube to a small bedside CPAP machine.<ref name=SleepApneaTreatments/>

Although CPAP therapy is effective in reducing apneas and less expensive than other treatments, some people find it uncomfortable. Some complain of feeling trapped, having chest discomfort, and skin or nose irritation. Other side effects may include dry mouth, dry nose, nosebleeds, sore lips and gums.<ref name=AHRQ2011/>

Whether or not it decreases the risk of death or heart disease is controversial with some reviews finding benefit and others not.<ref name="Spi20152"/><ref>{{cite journal | vauthors = Yu J, Zhou Z, McEvoy RD, Anderson CS, Rodgers A, Perkovic V, Neal B | title = Association of Positive Airway Pressure With Cardiovascular Events and Death in Adults With Sleep Apnea: A Systematic Review and Meta-analysis | journal = JAMA | volume = 318 | issue = 2 | pages = 156–166 | date = July 2017 | pmid = 28697252 | pmc = 5541330 | doi = 10.1001/jama.2017.7967 }}</ref><ref name="pmid36278514" /> This variation across studies might be driven by low rates of compliance—analyses of those who use CPAP for at least four hours a night suggests a decrease in cardiovascular events.<ref>{{cite journal | vauthors = Gottlieb DJ | title = Does Obstructive Sleep Apnea Treatment Reduce Cardiovascular Risk?: It Is Far Too Soon to Say | journal = JAMA | volume = 318 | issue = 2 | pages = 128–130 | date = July 2017 | pmid = 28697240 | doi = 10.1001/jama.2017.7966 }}</ref>

===Weight loss===
Excess body weight is thought to be an important cause of sleep apnea.<ref name="young">{{cite journal |last1=Young |first1=Terry |last2=Peppard |first2=Paul E. |last3=Gottlieb |first3=Daniel J. |title=Epidemiology of Obstructive Sleep Apnea: A Population Health Perspective |journal=American Journal of Respiratory and Critical Care Medicine |date=May 2002 |volume=165 |issue=9 |pages=1217–1239 |doi=10.1164/rccm.2109080 |pmid=11991871 |s2cid=23784058 }}</ref> People who are overweight have more tissues in the back of their throat which can restrict the airway, especially when sleeping.<ref>{{cite news |last1=Watson |first1=Stephanie |title=Weight loss, breathing devices still best for treating obstructive sleep apnea |url=https://www.health.harvard.edu/blog/weight-loss-breathing-devices-still-best-for-treating-obstructive-sleep-apnea-201310026713 |work=Harvard Health Blog |date=2 October 2013 |access-date=21 October 2019 |archive-date=3 July 2019 |archive-url=https://web.archive.org/web/20190703145118/https://www.health.harvard.edu/blog/weight-loss-breathing-devices-still-best-for-treating-obstructive-sleep-apnea-201310026713 |url-status=live }}</ref> In weight loss studies of overweight individuals, those who lose weight show reduced apnea frequencies and improved apnoea–hypopnoea index (AHI).<ref name="young"/><ref>{{cite journal | vauthors = Tuomilehto HP, Seppä JM, Partinen MM, Peltonen M, Gylling H, Tuomilehto JO, Vanninen EJ, Kokkarinen J, Sahlman JK, Martikainen T, Soini EJ, Randell J, Tukiainen H, Uusitupa M | title = Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea | journal = American Journal of Respiratory and Critical Care Medicine | volume = 179 | issue = 4 | pages = 320–7 | date = February 2009 | pmid = 19011153 | doi = 10.1164/rccm.200805-669OC }}</ref> Weight loss effective enough to relieve [[obesity hypoventilation syndrome]] (OHS) must be 25–30% of body weight. For some obese people, it can be difficult to achieve and maintain this result without [[bariatric surgery]].<ref>{{cite journal |last1=Mokhlesi |first1=Babak |last2=Masa |first2=Juan Fernando |last3=Brozek |first3=Jan L. |last4=Gurubhagavatula |first4=Indira |last5=Murphy |first5=Patrick B. |last6=Piper |first6=Amanda J. |last7=Tulaimat |first7=Aiman |last8=Afshar |first8=Majid |last9=Balachandran |first9=Jay S. |last10=Dweik |first10=Raed A. |last11=Grunstein |first11=Ronald R. |last12=Hart |first12=Nicholas |last13=Kaw |first13=Roop |last14=Lorenzi-Filho |first14=Geraldo |last15=Pamidi |first15=Sushmita |last16=Patel |first16=Bhakti K. |last17=Patil |first17=Susheel P. |last18=Pépin |first18=Jean Louis |last19=Soghier |first19=Israa |last20=Tamae Kakazu |first20=Maximiliano |last21=Teodorescu |first21=Mihaela |title=Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline |journal=American Journal of Respiratory and Critical Care Medicine |date=1 August 2019 |volume=200 |issue=3 |pages=e6–e24 |doi=10.1164/rccm.201905-1071ST |pmid=31368798 |pmc=6680300 }}</ref>

===Rapid palatal expansion===
{{see also|Palatal expansion}}

In children, [[Orthodontics|orthodontic]] treatment to expand the volume of the nasal airway, such as nonsurgical rapid [[palatal expansion]] is common. The procedure has been found to significantly decrease the AHI and lead to long-term resolution of clinical symptoms.<ref>{{cite journal |last1=Villa |first1=Maria Pia |last2=Rizzoli |first2=Alessandra |last3=Miano |first3=Silvia |last4=Malagola |first4=Caterina |title=Efficacy of rapid maxillary expansion in children with obstructive sleep apnea syndrome: 36 months of follow-up |journal=Sleep and Breathing |date=1 May 2011 |volume=15 |issue=2 |pages=179–184 |doi=10.1007/s11325-011-0505-1 |pmid=21437777 |s2cid=4505051 }}</ref><ref>{{cite journal |last1=Machado-Júnior |first1=Almiro-José |last2=Zancanella |first2=Edilson |last3=Crespo |first3=Agrício-Nubiato |title=Rapid maxillary expansion and obstructive sleep apnea: A review and meta-analysis |journal=Medicina Oral, Patología Oral y Cirugía Bucal |date=2016 |volume=21 |issue=4 |pages=e465–e469 |doi=10.4317/medoral.21073 |pmid=27031063 |pmc=4920460 }}</ref>

Since the palatal suture is fused in adults, regular RPE using tooth-borne expanders cannot be performed. Mini-implant assisted rapid palatal expansion (MARPE) has been recently developed as a non-surgical option for the transverse expansion of the [[maxilla]] in adults. This method increases the volume of the nasal cavity and [[Pharynx|nasopharynx]], leading to increased airflow and reduced respiratory arousals during sleep.<ref>{{cite journal |last1=Li |first1=Qiming |last2=Tang |first2=Hongyi |last3=Liu |first3=Xueye |last4=Luo |first4=Qing |last5=Jiang |first5=Zhe |last6=Martin |first6=Domingo |last7=Guo |first7=Jing |title=Comparison of dimensions and volume of upper airway before and after mini-implant assisted rapid maxillary expansion |journal=The Angle Orthodontist |date=1 May 2020 |volume=90 |issue=3 |pages=432–441 |doi=10.2319/080919-522.1 |pmid=33378437 |pmc=8032299 |doi-access=free }}</ref><ref>{{cite journal |last1=Abdullatif |first1=Jose |last2=Certal |first2=Victor |last3=Zaghi |first3=Soroush |last4=Song |first4=Sungjin A. |last5=Chang |first5=Edward T. |last6=Gillespie |first6=M. Boyd |last7=Camacho |first7=Macario |title=Maxillary expansion and maxillomandibular expansion for adult OSA: A systematic review and meta-analysis |journal=Journal of Cranio-Maxillofacial Surgery |date=1 May 2016 |volume=44 |issue=5 |pages=574–578 |doi=10.1016/j.jcms.2016.02.001 |pmid=26948172 }}</ref> Changes are permanent with minimal complications.

===Surgery===
[[File:Cautérisation des parties molles - apnée du sommeil.svg|thumb|Illustration of surgery on the mouth and throat]]

Several surgical procedures ([[sleep surgery]]) are used to treat sleep apnea, although they are normally a third line of treatment for those who reject or are not helped by CPAP treatment or dental appliances.<ref name="Spi20152"/> Surgical treatment for obstructive sleep apnea needs to be individualized to address all anatomical areas of obstruction.<ref name="Chang-2023" />

====Nasal obstruction====
Often, correction of the nasal passages needs to be performed in addition to correction of the [[oropharynx]] passage. [[Septoplasty]] and [[Nasal concha|turbinate]] surgery may improve the nasal airway,<ref>{{cite journal |last1=Sundaram |first1=Supriya |last2=Lim |first2=Jerome |last3=Lasserson |first3=Toby J |last4=Lasserson |first4=TJ |title=Surgery for obstructive sleep apnoea in adults |journal=Cochrane Database of Systematic Reviews |date=19 October 2005 |issue=4 |pages=CD001004 |doi=10.1002/14651858.CD001004.pub2 |pmid=16235277 }}</ref> but has been found to be ineffective at reducing respiratory arousals during sleep.<ref>{{cite journal |last1=Li |first1=Hsueh-Yu |last2=Wang |first2=Pa-Chun |last3=Chen |first3=Yu-Pin |last4=Lee |first4=Li-Ang |last5=Fang |first5=Tuan-Jen |last6=Lin |first6=Hsin-Ching |title=Critical Appraisal and Meta-Analysis of Nasal Surgery for Obstructive Sleep Apnea |journal=American Journal of Rhinology & Allergy |date=January 2011 |volume=25 |issue=1 |pages=45–49 |doi=10.2500/ajra.2011.25.3558 |pmid=21711978 |s2cid=35117004 }}</ref>

====Pharyngeal obstruction====
[[Tonsillectomy]] and [[uvulopalatopharyngoplasty]] (UPPP or UP3) are available to address pharyngeal obstruction.<ref name="Chang-2023" />

[[File:UPPP. 4 figures..png|thumb|upright=1.5|Uvulopalatopharyngoplasty. A) pre-operative, B) original UPPP, C) modified UPPP, and D) minimal UPPP.]]

The "Pillar" device is a treatment for snoring and obstructive sleep apnea; it is thin, narrow strips of [[polyester]]. Three strips are inserted into the roof of the mouth (the [[soft palate]]) using a modified syringe and local anesthetic, in order to stiffen the soft palate. This procedure addresses one of the most common causes of snoring and sleep apnea&nbsp;— vibration or collapse of the soft palate. It was approved by the FDA for snoring in 2002 and for obstructive sleep apnea in 2004. A 2013 meta-analysis found that "the Pillar implant has a moderate effect on snoring and mild-to-moderate obstructive sleep apnea" and that more studies with high level of evidence were needed to arrive at a definite conclusion; it also found that the polyester strips work their way out of the soft palate in about 10% of the people in whom they are implanted.<ref name=pillar>{{cite journal | vauthors = Choi JH, Kim SN, Cho JH | title = Efficacy of the Pillar implant in the treatment of snoring and mild-to-moderate obstructive sleep apnea: a meta-analysis | journal = The Laryngoscope | volume = 123 | issue = 1 | pages = 269–76 | date = January 2013 | pmid = 22865236 | doi = 10.1002/lary.23470 | s2cid = 25875843 }}</ref>

====Hypopharyngeal or base of tongue obstruction====
Base-of-tongue advancement by means of advancing the [[Mental spine|genial tubercle]] of the [[mandible]], tongue suspension, or [[hyoid suspension]] (aka hyoid myotomy and suspension or hyoid advancement) may help with the lower pharynx.<ref name="Chang-2023" />

Other surgery options may attempt to shrink or stiffen excess tissue in the mouth or throat, procedures done at either a doctor's office or a hospital. Small shots or other treatments, sometimes in a series, are used for shrinkage, while the insertion of a small piece of stiff plastic is used in the case of surgery whose goal is to stiffen tissues.<ref name=SleepApneaTreatments/>

====Multi-level surgery====
[[Maxillomandibular advancement]] is considered the most effective surgery for people with sleep apnea, because it increases the posterior airway space.<ref>{{cite journal | vauthors = Prinsell JR | title = Maxillomandibular advancement surgery for obstructive sleep apnea syndrome | journal = Journal of the American Dental Association | volume = 133 | issue = 11 | pages = 1489–97; quiz 1539–40 | date = November 2002 | pmid = 12462692 | doi = 10.14219/jada.archive.2002.0079 }}</ref> However, health professionals are often unsure as to who should be referred for surgery and when to do so: some factors in referral may include failed use of CPAP or device use; anatomy which favors rather than impedes surgery; or significant [[Craniofacial abnormality|craniofacial abnormalities]] which hinder device use.<ref name="auspre01">{{cite journal |author=MacKay, Stuart |title=Treatments for snoring in adults |journal=Australian Prescriber |volume=34 |issue=34 |pages=77–79 |date=June 2011 |doi=10.18773/austprescr.2011.048 |doi-broken-date=7 November 2024 |doi-access= }}</ref>

====Potential complications====
Several inpatient and outpatient procedures use sedation. Many drugs and agents used during surgery to relieve pain and to depress consciousness remain in the body at low amounts for hours or even days afterwards. In an individual with either central, obstructive or mixed sleep apnea, these low doses may be enough to cause life-threatening irregularities in breathing or collapses in a patient's airways.<ref>{{cite book |first1=T. Scott |last1=Johnson |first2=William A. |last2=Broughton |first3=Jerry |last3=Halberstadt |title=Sleep Apnea&nbsp;– The Phantom of the Night: Overcome Sleep Apnea Syndrome and Win Your Hidden Struggle to Breathe, Sleep, and Live |publisher=New Technology Publishing |year=2003 |isbn=978-1-882431-05-2 |url-access=registration |url=https://archive.org/details/sleepapneaphanto0000john }}{{Page needed|date=September 2010}}</ref> Use of [[Analgesic|analgesics]] and sedatives in these patients postoperatively should therefore be minimized or avoided.<ref name="Chang-2023" />

Surgery on the mouth and throat, as well as dental surgery and procedures, can result in postoperative swelling of the lining of the mouth and other areas that affect the airway. Even when the surgical procedure is designed to improve the airway, such as [[tonsillectomy]] and [[adenoidectomy]] or tongue reduction, swelling may negate some of the effects in the immediate postoperative period. Once the swelling resolves and the palate becomes tightened by postoperative scarring, however, the full benefit of the surgery may be noticed.<ref name="Chang-2023" />

A person with sleep apnea undergoing any medical treatment must make sure their doctor and [[Nurse anesthetist|anesthetist]] are informed about the sleep apnea. Alternative and emergency procedures may be necessary to maintain the airway of sleep apnea patients.<ref>{{cite web |url=http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_LivingWith.html |title=What is Sleep Apnea? |year=2012 |website=National Heart, Lung, and Blood Institute |publisher=National Institutes of Health |access-date=15 February 2013 |url-status=live |archive-url=https://web.archive.org/web/20110828030048/http://www.nhlbi.nih.gov/health/dci/Diseases/SleepApnea/SleepApnea_LivingWith.html |archive-date=28 August 2011}}</ref>

===Other===

====Neurostimulation====
[[Diaphragm pacing]], which involves the rhythmic application of electrical impulses to the diaphragm, has been used to treat central sleep apnea.<ref name="BhimjiDia15">{{EMedicine|article|1970348|Diaphragm Pacing}}</ref><ref>{{cite journal | vauthors = Yun AJ, Lee PY, Doux JD | title = Negative pressure ventilation via diaphragmatic pacing: a potential gateway for treating systemic dysfunctions | journal = Expert Review of Medical Devices | volume = 4 | issue = 3 | pages = 315–9 | date = May 2007 | pmid = 17488226 | doi = 10.1586/17434440.4.3.315 | s2cid = 30419488 }}</ref>

In April 2014, the U.S. Food and Drug Administration granted pre-market approval for use of an upper airway stimulation system in people who cannot use a continuous positive airway pressure device. The Inspire Upper Airway Stimulation system is a [[hypoglossal nerve stimulation]] implant that senses respiration and applies mild electrical stimulation during inspiration, which pushes the tongue slightly forward to open the airway.<ref name="FDAInspire14">{{cite web |url=https://www.fda.gov/medicaldevices/productsandmedicalprocedures/deviceapprovalsandclearances/recently-approveddevices/ucm398321.htm |title=Inspire Upper Airway Stimulation&nbsp;– P130008 |work=FDA.gov |publisher=Food and Drug Administration |date=11 January 2016 |access-date=9 March 2016 |url-status=live |archive-url=https://web.archive.org/web/20160311075714/https://www.fda.gov/medicaldevices/productsandmedicalprocedures/deviceapprovalsandclearances/recently-approveddevices/ucm398321.htm |archive-date=11 March 2016 }}</ref>

====Medications====
There is currently insufficient evidence to recommend any medication for OSA.<ref name="Efficacy of pharmacotherapy for OSA">{{cite journal |last1=Gaisl |first1=Thomas |last2=Haile |first2=Sarah R. |last3=Thiel |first3=Sira |last4=Osswald |first4=Martin |last5=Kohler |first5=Malcolm |title=Efficacy of pharmacotherapy for OSA in adults: A systematic review and network meta-analysis |journal=Sleep Medicine Reviews |date=August 2019 |volume=46 |pages=74–86 |doi=10.1016/j.smrv.2019.04.009 |pmid=31075665 |s2cid=149455430 }}</ref> This may result in part because people with sleep apnea have tended to be treated as a single group in clinical trials. Identifying specific physiological factors underlying sleep apnea makes it possible to test drugs specific to those causal factors: airway narrowing, impaired muscle activity, low arousal threshold for waking, and unstable breathing control.<ref name="Dolgin">{{cite journal |last1=Dolgin |first1=Elie |date=29 April 2020 |title=Treating sleep apnea with pills instead of machines |url=https://knowablemagazine.org/article/health-disease/2020/treating-sleep-apnea-pills-instead-machines |url-status=live |journal=Knowable Magazine |doi=10.1146/knowable-042820-1 |archive-url=https://web.archive.org/web/20220530121424/https://knowablemagazine.org/article/health-disease/2020/treating-sleep-apnea-pills-instead-machines |archive-date=30 May 2022 |access-date=9 May 2022 |doi-access=free}}</ref><ref name="Wellman">{{cite journal |last1=Wellman |first1=Andrew |last2=Eckert |first2=Danny J. |last3=Jordan |first3=Amy S. |last4=Edwards |first4=Bradley A. |last5=Passaglia |first5=Chris L. |last6=Jackson |first6=Andrew C. |last7=Gautam |first7=Shiva |last8=Owens |first8=Robert L. |last9=Malhotra |first9=Atul |last10=White |first10=David P. |title=A method for measuring and modeling the physiological traits causing obstructive sleep apnea |journal=Journal of Applied Physiology |date=June 2011 |volume=110 |issue=6 |pages=1627–1637 |doi=10.1152/japplphysiol.00972.2010 |pmid=21436459 |pmc=3119134 }}</ref> Those who experience low waking thresholds may benefit from [[eszopiclone]], a sedative typically used to treat insomnia.<ref name="Dolgin"/><ref>{{cite journal |last1=Eckert |first1=Danny J. |last2=Owens |first2=Robert L. |last3=Kehlmann |first3=Geoffrey B. |last4=Wellman |first4=Andrew |last5=Rahangdale |first5=Shilpa |last6=Yim-Yeh |first6=Susie |last7=White |first7=David P. |last8=Malhotra |first8=Atul |title=Eszopiclone increases the respiratory arousal threshold and lowers the apnoea/hypopnoea index in obstructive sleep apnoea patients with a low arousal threshold |journal=Clinical Science |date=7 March 2011 |volume=120 |issue=12 |pages=505–514 |doi=10.1042/CS20100588 |pmid=21269278 |pmc=3415379 |url=https://doi.org/10.1042/CS20100588 |access-date=10 May 2022 |issn=0143-5221 |archive-date=8 March 2024 |archive-url=https://web.archive.org/web/20240308031502/https://portlandpress.com/clinsci/article-abstract/120/12/505/68829/Eszopiclone-increases-the-respiratory-arousal?redirectedFrom=fulltext |url-status=live }}</ref> The antidepressant [[desipramine]] may stimulate upper airway muscles and lessen pharyngeal collapsibility in people who have limited muscle function in their airways.<ref name="Dolgin"/><ref>{{cite journal |last1=Taranto-Montemurro |first1=Luigi |last2=Sands |first2=Scott A. |last3=Edwards |first3=Bradley A. |last4=Azarbarzin |first4=Ali |last5=Marques |first5=Melania |last6=Melo |first6=Camila de |last7=Eckert |first7=Danny J. |last8=White |first8=David P. |last9=Wellman |first9=Andrew |title=Desipramine improves upper airway collapsibility and reduces OSA severity in patients with minimal muscle compensation |journal=European Respiratory Journal |date=1 November 2016 |volume=48 |issue=5 |pages=1340–1350 |doi=10.1183/13993003.00823-2016 |pmid=27799387 |pmc=5437721 |url=https://erj.ersjournals.com/content/48/5/1340 |access-date=10 May 2022 |language=en |issn=0903-1936 |archive-date=8 August 2022 |archive-url=https://web.archive.org/web/20220808100210/https://erj.ersjournals.com/content/48/5/1340 |url-status=live }}</ref>

There is limited evidence for medication, but 2012 AASM guidelines suggested that [[acetazolamide]] "may be considered" for the treatment of central sleep apnea; [[zolpidem]] and [[triazolam]] may also be considered for the treatment of central sleep apnea,<ref name="Lambert">{{cite journal |last1=Lambert |first1=Mara |title=Updated Guidelines from AASM for the Treatment of Central Sleep Apnea Syndromes |journal=American Family Physician |date=15 November 2012 |volume=86 |issue=10 |pages=968–971 |url=https://www.aafp.org/afp/2012/1115/p968.html |access-date=10 May 2022 |issn=0002-838X |archive-date=10 May 2022 |archive-url=https://web.archive.org/web/20220510120148/https://www.aafp.org/afp/2012/1115/p968.html |url-status=live }}</ref> but "only if the patient does not have underlying risk factors for respiratory depression".<ref name="Efficacy of pharmacotherapy for OSA"/><ref name=2012review>{{cite journal | vauthors = Aurora RN, Chowdhuri S, Ramar K, Bista SR, Casey KR, Lamm CI, Kristo DA, Mallea JM, Rowley JA, Zak RS, Tracy SL | title = The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses | journal = Sleep | volume = 35 | issue = 1 | pages = 17–40 | date = January 2012 | pmid = 22215916 | pmc = 3242685 | doi = 10.5665/sleep.1580 }}</ref> Low doses of oxygen are also used as a treatment for [[Hypoxia (medicine)|hypoxia]] but are discouraged due to side effects.<ref name=PsychToday>{{cite web |url=http://www.psychologytoday.com/conditions/sleep-apnea |title=Sleep Apnea |work=Diagnosis Dictionary |publisher=[[Psychology Today]] |url-status=live |archive-url=https://archive.today/20130408080751/http://www.psychologytoday.com/conditions/sleep-apnea |archive-date=8 April 2013 }}</ref><ref name="pmid11181239">{{cite journal |last1=Mayos |first1=M. |last2=Hernández Plaza |first2=L. |last3=Farré |first3=A. |last4=Mota |first4=S. |last5=Sanchis |first5=J. |title=Efecto de la oxigenoterapia nocturna en el paciente con síndrome de apnea-hipopnea del sueño y limitación crónica al flujo aéreo |trans-title=The effect of nocturnal oxygen therapy in patients with sleep apnea syndrome and chronic airflow limitation |language=es |journal=Archivos de Bronconeumología |date=January 2001 |volume=37 |issue=2 |pages=65–68 |doi=10.1016/s0300-2896(01)75016-8 |pmid=11181239 }}</ref><ref name="pmid2609134">{{cite journal | vauthors = Breitenbücher A, Keller-Wossidlo H, Keller R | title = Transtracheale Sauerstofftherapie beim obstruktiven Schlafapnoe-Syndrom |trans-title=Transtracheal oxygen therapy in obstructive sleep apnea syndrome | language = de | journal = Schweizerische Medizinische Wochenschrift | volume = 119 | issue = 46 | pages = 1638–1641 | date = November 1989 | pmid = 2609134 |oclc=119157195 }}</ref>

In December 2024, the FDA approved [[tirzepatide]], an anti-diabetic and weight loss medication, as a component in the combination treatment of adults with obesity suffering from moderate to severe obstructive sleep apnea. Other components of the therapy are a reduced-calorie diet and increased physical activity.<ref>{{Cite web |last=Commissioner |first=Office of the |date=2024-12-20 |title=FDA Approves First Medication for Obstructive Sleep Apnea |url=https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-obstructive-sleep-apnea |access-date=2024-12-25 |website=FDA |language=en}}</ref>

====Oral appliances====
An oral appliance, often referred to as a [[mandibular advancement splint]], is a custom-made mouthpiece that shifts the lower jaw forward and opens the bite slightly, opening up the airway. These devices can be fabricated by a general dentist. Oral appliance therapy is usually successful in patients with mild to moderate obstructive sleep apnea.<ref>{{cite journal | vauthors = Machado MA, Juliano L, Taga M, de Carvalho LB, do Prado LB, do Prado GF | title = Titratable mandibular repositioner appliances for obstructive sleep apnea syndrome: are they an option? | journal = Sleep & Breathing = Schlaf & Atmung | volume = 11 | issue = 4 | pages = 225–31 | date = December 2007 | pmid = 17440760 | doi = 10.1007/s11325-007-0109-y | s2cid = 24535360 }}</ref><ref name="ReferenceA">{{cite journal | vauthors = Chen H, Lowe AA | title = Updates in oral appliance therapy for snoring and obstructive sleep apnea | journal = Sleep & Breathing = Schlaf & Atmung | volume = 17 | issue = 2 | pages = 473–86 | date = May 2013 | pmid = 22562263 | doi = 10.1007/s11325-012-0712-4 | s2cid = 21267378 }}</ref> While CPAP is more effective for sleep apnea than oral appliances, oral appliances improve sleepiness and quality of life and are often better tolerated than CPAP.<ref name="ReferenceA"/>

====Nasal EPAP====
[[Nasal EPAP]] is a bandage-like device placed over the nostrils that uses a person's own breathing to create positive airway pressure to prevent obstructed breathing.<ref name=Riaz2015rev>{{cite journal | vauthors = Riaz M, Certal V, Nigam G, Abdullatif J, Zaghi S, Kushida CA, Camacho M | title = Nasal Expiratory Positive Airway Pressure Devices (Provent) for OSA: A Systematic Review and Meta-Analysis | journal = Sleep Disorders | volume = 2015 | pages = 734798 | date = 2015 | pmid = 26798519 | pmc = 4699057 | doi = 10.1155/2015/734798 | doi-access = free }}</ref>

====Oral pressure therapy====
[[Oral pressure therapy]] uses a device that creates a vacuum in the mouth, pulling the soft palate tissue forward. It has been found useful in about 25% to 37% of people.<ref>{{cite journal | vauthors = Nigam G, Pathak C, Riaz M | title = Effectiveness of oral pressure therapy in obstructive sleep apnea: a systematic analysis | journal = Sleep & Breathing = Schlaf & Atmung | volume = 20 | issue = 2 | pages = 663–71 | date = May 2016 | pmid = 26483265 | doi = 10.1007/s11325-015-1270-3 | s2cid = 29755875 }}</ref><ref>{{cite journal | vauthors = Colrain IM, Black J, Siegel LC, Bogan RK, Becker PM, Farid-Moayer M, Goldberg R, Lankford DA, Goldberg AN, Malhotra A | title = A multicenter evaluation of oral pressure therapy for the treatment of obstructive sleep apnea | journal = Sleep Medicine | volume = 14 | issue = 9 | pages = 830–7 | date = September 2013 | pmid = 23871259 | pmc = 3932027 | doi = 10.1016/j.sleep.2013.05.009 | url = http://www.escholarship.org/uc/item/3cd5x9qk | access-date = 7 October 2018 | archive-date = 24 January 2019 | archive-url = https://web.archive.org/web/20190124152318/https://escholarship.org/uc/item/3cd5x9qk | url-status = live }}</ref>