Editing Sleep apnea (section)

===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>