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Cited by 220Obstructive Sleep Apnea ResearchSleep and related disordersNeuroscience of respiration and sleep

Medical Therapy for Obstructive Sleep Apnea: A Review by the Medical Therapy for Obstructive Sleep Apnea Task Force of the Standards of Practice Committee of the American Academy of Sleep Medicine

Veasey, Sigrid C., Guilleminault, Christian, Strohl, Kingman P., Sanders, Mark H., Ballard, Robert D., Magalang, Ulysses J.·2006·SLEEP
DOI 10.1093/sleep/29.8.1036
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Abstract

A significant number of patients with obstructive sleep apnea neither tolerate positive airway pressure (PAP) therapy nor achieve successful outcomes from either upper airway surgeries or use of an oral appliance. The purpose of this paper, therefore, was to systematically evaluate available peer-reviewed data on the effectiveness of adjunctive medical therapies and summarize findings from these studies. A review from 1985 to 2005 of the English literature reveals several practical findings. Weight loss has additional health benefits and should be routinely recommended to most overweight patients. Presently, there are no widely effective pharmacotherapies for individuals with sleep apnea, with the important exceptions of individuals with hypothyroidism or with acromegaly. Treating the underlying medical condition can have pronounced effects on the apnea/hypopnea index. Stimulant therapy leads to a small but statistically significant improvement in objective sleepiness. Nonetheless, residual sleepiness remains a significant health concern. Supplemental oxygen and positional therapy may benefit subsets of patients, but whether these therapies reduce morbidities as PAP therapy does will require rigorous randomized trials. PAP therapy has set the bar high for successful treatment of sleep apnea and its associated morbidities. Nonetheless, we should strive towards the development of universally effective pharmacotherapies for sleep apnea. To accomplish this, we require a greater knowledge of the neurochemical mechanisms underlying sleep apnea, and we must use this infrastructure of knowledge to design well-controlled, adequately powered studies that examine, not only effects on the apnea/hypopnea index, but also the effects of pharmacotherapies on all health related outcomes shown beneficial with PAP therapy.

AI snapshot

Written from the paper’s full text.

TL;DR

This American Academy of Sleep Medicine task force review assessed adjunctive medical therapies for obstructive sleep apnea from 1985 to 2005, concluding that weight loss and treatment of endocrine causes can improve apnea severity, while pharmacotherapy remains largely limited. Positive airway pressure remains the best-established therapy for reducing cardiovascular and neurobehavioral morbidity, with oxygen, positional, and nasal therapies possibly helping selected patients.

Key findings

  • Weight reduction improved apnea severity across dietary and surgical approaches. A 10% weight reduction predicted a 26% fall in AHI; one dietary trial reduced AHI from 83 to 33 events/hour, another lowered non-REM AHI from 55 to 29 and REM AHI from 57 to 38, and a bariatric surgery meta-analysis reported OSA resolution in 87% of patients, alongside a 10% complication rate.
  • Drug therapy was generally not broadly effective. Paroxetine produced a small AHI reduction (36.3 to 30.2 events/hour), protriptyline lowered NREM AHI from 74 to 53 in one trial but was judged insufficient for OSA treatment, and modafinil improved objective sleepiness by about one minute without changing AHI; 75% of severely sleepy patients still had multiple sleep latency times under 10 minutes.
  • Treating endocrine disorders could substantially improve OSA. Thyroid replacement reduced AHI from 72 to 12 in one study, and octreotide for acromegaly reduced AHI from 39 to 19 events/hour.
  • Supplemental oxygen, positional therapy, and nasal therapies showed benefit in subsets. Transtracheal oxygen reduced AHI from 65 to 26 in one trial, positional therapy reduced AHI from 17.9 to 9.5, intranasal fluticasone lowered AHI to 12 versus 20 events/hour on placebo, and a cervical pillow reduced AHI by 17 events/hour in one nonrandomized study.

Methods

  • The task force searched PubMed for English-language clinical studies published from 1985 through January 2005, with an April 2005 update, using terms related to sleep apnea and bariatric surgery, diet, oxygen, drug therapy, endocrine disorders, position, weight loss, and nasal therapy.
  • Inclusion required adult subjects, clinical trials, and polysomnographic apnea or hypopnea endpoints; exclusions were case reports, subjects under 20 years, and non-FDA-approved medications.
  • From 1,750 abstracts, 135 studies qualified and were grouped into weight loss, pharmacotherapy, supplemental oxygen, and positional therapy; evidence was graded I–V, with most studies providing Level II or III evidence and few reporting neurobehavioral, metabolic, or cardiovascular outcomes or comparisons with CPAP.

Limitations

  • The paper states that most weight-loss studies lacked control groups, randomization, or adequate alpha and beta error control, and that adverse outcomes and long-term effects were incompletely described.
  • The paper states that drug trials were often underpowered to detect AHI differences below 50%, did not account well for night-to-night AHI variability or dose response, and usually omitted neurobehavioral and cardiovascular endpoints.
  • The paper also notes that oxygen therapy’s optimal dose and likely responders are uncertain, and that positional pillow studies need larger randomized independent replication with placebo controls; evident from the text, many included studies had small samples, heterogeneous definitions, and possible selection bias in surgical and longitudinal follow-up.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1093/sleep/29.8.1036

Cites

92 of 92 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

1 of 65 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured

  • Findingnone given

    Stimulant therapy leads to a small but statistically significant improvement in objective sleepiness.

    “Stimulant therapy leads to a small but statistically significant improvement in objective sleepiness.”
    Quote in the paperSubstantial claim
  • Findingown data

    Very few qualifying studies presented data on neurobehavioral, metabolic or cardiovascular outcomes.

    “Very few studies presented data on neurobehavioral, metabolic or cardiovascular outcomes.”
    Quote in the paperSubstantial claim
  • Findingown data

    Most qualifying studies provided Level II or Level III evidence for the effectiveness of an intervention on improving the AHI.

    “Overall, most of the qualifying studies identified provided Level II or Level III evidence for the effectiveness of an intervention on improving the AHI”
    Quote in the paperNot a substantial claim
  • Findingreasoning

    Overall, weight reduction was associated with reductions in the AHI for both surgical and reduced calorie therapies.

    “Overall, weight reduction was associated with reductions in the AHI for both surgical and reduced calorie therapies.”
    Quote in the paperSubstantial claim
  • Findingnone given

    Very few papers compare medical therapies to CPAP outcomes.

    “In addition, very few of the papers compare medical therapies to CPAP outcomes.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 6
  • May combine two claims. 18

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Obstructive sleep apnea is a highly prevalent syndrome associated with substantial morbidity and increased mortality.

    “OBSTRUCTIVE SLEEP APNEA (OSA) IS A HIGHLY PREV-ALENT SYNDROME THAT IS ASSOCIATED WITH SUB-STANTIAL MORBIDITY AND INCREASED MORTALITY. 1-10”
    Quote in the paperNot a substantial claim1 of 10 sources checked
    • cites [1] 1. vascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046-1053

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [2] 2. Dhillon, S., Chung, S., Fargher, T., Huterer, N., and Shapiro, C. Sleep apnea, hypertension, and the effects of continuous positive airway pressure. Am J Hypertens 2005;18:594-600 source
    • cites [3] 3. Naughton, M. The link between obstructive sleep apnea and heart failure: underappreciated opportunity for treatment. Curr Cardiol Rep 2005;7:211-215

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [4] 4. Jung, H., Han, H., and Lee, J. Sleep apnea, coronary artery disease, and antioxidant status in hemodialysis patients. Am J Kidney Dis 2005;45:875-882 source
    • cites [5] 5. Amin, R., Kimball, T., Kalra, M., et al. Left ventricular function in children with sleep-disordered breathing. Am J Cardiol 2005;95:801- 804 source
    • cites [6] 6. Babu, A., Herdegen, J., Fogelfeld, L., Shott, S., and Mazzone, T. Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea. Arch Intern Med 2005;165:447- 452 source
    • cites [7] 7. Gami, A., Howard, D., Olson, E., and Somers, V. K. Day-night pat- tern of sudden infant death in obstructive sleep apnea. N Engl J Med 2005;352:1206-1214 source
    • cites [8] 8. Haas, D., Foster, G., Nieto, F., et al. Age-dependent associations be- tween sleep-disordered breathing and hypertension: importance of discriminating between systolic/diastolic hypertension and isolated systolic hypertension in the Sleep Heart Health Study. Circulation 2005;111:614-621 source

      The Discussion (page not available) says sleep-disordered breathing is common in the general population and reports an association with hypertension in adults aged 40–59, supporting prevalence and a specific form of morbidity. It does not establish increased mortality or a general association with substantial morbidity; its hypertension finding is age-dependent. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [9] 9. Punjabi, N., Shahar, E., Redline, S., et al. Sleep-disordered breath- ing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study. Am J Epidemiol 2004;160:521-530 source
    • cites [10] 10. Shahar, E., Whitney, C., Redline, S., et al. Sleep-disordered breath- ing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med 2001;163:19-25 source

  • May combine two claims.

    Findingcitation

    One transtracheal supplemental oxygen trial found a significant reduction in AHI from 65 to 26 (p<0.05), and the other transtracheal trial with just 4 subjects trended towards a reduction.

    “Two of the supplemental oxygen trials examined the effectiveness of transtracheal supplemental oxygen, 76,77 and one found a significant reduction in the AHI from 65 to 26, p<0.05 72 and trended towards a reduction in the other study with just 4 subjects.77”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [76] 76. Chauncey, J., and Aldrich, M. Preliminary findings in the treat- ment of obstructive sleep apnea with transtracheal oxygen. Sleep 1990;13:167-174 source
    • cites [77] 77. Farney RJ, Walker JM, Elmer JC, Viscomi VA, and Ord RJ. Trans- tracheal oxygen, nasal CPAP and nasal oxygen in five patients with obstructive sleep apnea. Chest 1992;101:1228-1135 source

  • May combine two claims.

    Findingcitation

    In a randomized controlled trial of 20 males with OSA, postural therapy alone and in combination with oxymetazoline nasal spray significantly reduced AHI, but oxymetazoline nasal spray alone had no effect.

    “This study suggested that postural therapy alone and in combination with oxymetazoline nasal spray significantly reduced AHI, but oxymetazoline nasal spray alone had no effect.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [80] 80. Braver, H. M., and Block, A. J. Effect of Nasal Spray, Positional Therapy, and the Combination Thereof in the Asymptomatic Snorer. Sleep 1994;17(6):516-521 source

  • Classified as probably not a substantial claim.

    Findingnone given

    The long-term effect of modafinil on the hemodynamic status of OSA patients treated with nasal CPAP remains unresolved.

    “The question of the long-term effect of modafinil on the hemodynamic status of OSA patients treated with nasal CPAP remains unresolved.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Modafinil has no effect on the AHI but reduces objective sleepiness by approximately one minute.

    “This drug has no effect on the AHI, 71,72 but has been shown to reduce objective sleepiness by approximately one minute.[70][71][72][73][74][75]”
    Quote in the paperSubstantial claim0 of 6 sources checked
    • cites [70] 70. Arnulf, I., Homeyer, P., Garma, L., Whitelaw, W., and Derenne, J. Modafinil in obstructive sleep apnea syndrome: a pilot study in 6 patients. Respiration 1997;64:159-161 source
    • cites [71] 71. Kingshott RN, Venelle M, Coleman EL, Engelman HE, Mackay TW, and Douglas NJ. Randomized, double-blind, placebo-con- trolled crossover trial of modafinil in the treatment of residual ex- cessive daytime sleepiness in the sleep apnea-hypopnea syndrome. Am J Respir Crit Care Med 2001;163:918-923 source
    • cites [72] 72. Pack, A., Black, J., Schwartz, J., and Matheson, J. Modafinil as an adjunct therapy for daytime sleepiness in obstructive sleep apnea. Am J Respir Crit Care Med 2001:1675-1681 source
    • cites [73] 73. Heitmann, J., Cassel, W., Grote, L., et al. Does short-term treatment with modafinil affect blood pressure in patients with obstructive sleep apnea? Clin Pharmacol Therapy 1999;65:328-335 source
    • cites [74] 74. Black, J., and Hirshkowitz, M. Modafinil for treatment of residu- al excessive sleepiness in nasal continuous positive airway pres- sure-treated obstructive sleep apnea-hypopnea syndrome. Sleep 2005;28:464-471 source
    • cites [75] 75. Schwartz, J., Hirshkowitz, M., Erman, M. K., Schmidt-Nowara, W., and Group, U. M. O. S. Modafinil as adjunct therapy for daytime sleepiness in obstructive sleep apnea: A 12 weel open-label study. Chest 2003;124:2192-2199 source

  • May combine two claims.

    Findingcitation

    Fluticasone nasal spray reduced nasal resistance but produced no change in oxygenation, subjective sleepiness, or sleep quality for subjects with AHI >10 events/hr.

    “There was also a reduction in nasal resistance, but no change in oxygenation, subjective sleepiness or sleep quality for subjects with AHI's >10 events/hr.81”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [81] 81. Kiely, J., Nolan, P., and McNicholas, W. Intranasal corticosteroid therapy for obstructive sleep apnoea in patients with co-existing rhi- nitis. Thorax 2004;59

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    The sleep-related oxyhemoglobin saturation nadir improved on oxygen, and in the one study where hypopneas were examined separately from apneas, a reduced hypopnea index was identified.

    “The sleep-related oxyhemoglobin saturation nadir improved on oxygen, and in the one study where hypopneas were examined separately from apneas, a reduced hypopnea index was identified.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Use of the triangular pillow was associated with reduced or eliminated snoring and improved oxyhemoglobin saturation.

    “Snoring was reduced or eliminated and the oxyhemoglobin saturation improved.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [86] 86. Zuberi, N., Rekab, K., and Nguyen, H. Sleep apnea avoidance pil- low effects on obstructive sleep apnea syndrome and snoring. Sleep Breath 2004;8:201-207

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    PAP provided greater improvements in AHI and minimum oxyhemoglobin saturation compared to positional therapy.

    “PAP provided greater improvements in AHI and minimum oxyhemoglobin saturation compared to positional therapy.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [82] 82. Jokic, R., Klimaszewski, A., Crossley, M., Sridhar, C., and Fitz- patrick, M. F. Positional Treatment vs Continuous Positive Airway Pressure in Patients With Positional Obstructive Sleep Apnea Syn- drome. Chest 1999;115:771-781 source

  • May combine two claims.

    Findingcitation

    The mean difference in the decline in AHI was 6 between positional therapy and CPAP; positional therapy itself decreased the AHI by 8 events/hr (from 17.9 to 9.5).

    “(The mean difference in the decline in AHI was 6 between positional therapy and CPAP; but positional therapy itself decreased the AHI by 8 events/hr (from 17.9 to 9.5).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [82] 82. Jokic, R., Klimaszewski, A., Crossley, M., Sridhar, C., and Fitz- patrick, M. F. Positional Treatment vs Continuous Positive Airway Pressure in Patients With Positional Obstructive Sleep Apnea Syn- drome. Chest 1999;115:771-781 source

  • May combine two claims.

    Findingcitation

    In a pillow study examining cervical position, Kushida et al. found improvements in the AHI in subjects with mild OSA, but no effect in individuals with more severe apnea.

    “In another pillow study examining the effects of cervical position, Kushida et al., found improvements in the AHI in subjects with mild OSA, but no effect in individuals with more severe apnea.84”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [84] 84. Kushida, C. A., Rao, S., and al, e. Cervical positional effects on snoring and apneas. Sleep Research Online 1999;2:7-10

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingnone given

    Presently it is uncertain which patients will benefit from supplemental oxygen, what the optimal dose is, and what the long-term consequences and benefits of supplemental oxygen use are.

    “presently it is uncertain which patients will benefit from supplemental oxygen, what the optimal dose is, and what the long-term consequences and benefits of supplemental oxygen use are.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Positive airway pressure is the most uniformly effective therapy for OSA and the only intervention shown to favorably impact both cardiovascular and neurobehavioral morbidities.

    “Positive airway pressure (PAP) is the most uniformly effective therapy, and to date this is the only intervention for OSA shown to have a favorable impact on both cardiovascular and neurobehavioral morbidities.1,2,6”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [1] 1. vascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046-1053

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [2] 2. Dhillon, S., Chung, S., Fargher, T., Huterer, N., and Shapiro, C. Sleep apnea, hypertension, and the effects of continuous positive airway pressure. Am J Hypertens 2005;18:594-600 source
    • cites [6] 6. Babu, A., Herdegen, J., Fogelfeld, L., Shott, S., and Mazzone, T. Type 2 diabetes, glycemic control, and continuous positive airway pressure in obstructive sleep apnea. Arch Intern Med 2005;165:447- 452 source

  • May combine two claims.

    Interpretationnone given

    Supplemental oxygen and positional therapy may benefit subsets of patients.

    “Supplemental oxygen and positional therapy may benefit subsets of patients, but whether these therapies reduce morbidities as PAP therapy does will require rigorous randomized trials.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    Presently, there are no widely effective pharmacotherapies for individuals with sleep apnea, with the important exceptions of individuals with hypothyroidism or with acromegaly.

    “Presently, there are no widely effective pharmacotherapies for individuals with sleep apnea, with the important exceptions of individuals with hypothyroidism or with acromegaly.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    While protriptyline may reduce sleepiness and the AHI, there is insufficient improvement in the AHI to justify use of protriptyline as a therapy for OSA.

    “In conclusion, while protriptyline may reduce sleepiness and the AHI, there is insufficient improvment in the AHI to justify use of protriptyline as a therapy for OSA.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The Kiely and associates study was assigned Evidence Level I.

    “This study was assigned Evidence Level I.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [81] 81. Kiely, J., Nolan, P., and McNicholas, W. Intranasal corticosteroid therapy for obstructive sleep apnoea in patients with co-existing rhi- nitis. Thorax 2004;59

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Weight loss has additional health benefits.

    “Weight loss has additional health benefits and should be routinely recommended to most overweight patients.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Without an obvious benefit of hormonal replacement therapy for OSA and with an increasingly recognized number of adverse effects, hormonal replacement therapy solely for the treatment of OSA in postmenopausal women cannot be justified.

    “However, without an obvious benefit of hormonal replacement therapy for OSA and with an increasingly recognized number of adverse effects, hormonal replacement therapy solely for the treatment of OSA in postmenopausal women cannot be justified.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    Residual sleepiness remains a significant health concern.

    “Nonetheless, residual sleepiness remains a significant health concern.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The Braver and Block report was a randomized, controlled trial and was assigned Evidence Level II.

    “This report was a randomized, controlled trial and was assigned Evidence Level II.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [80] 80. Braver, H. M., and Block, A. J. Effect of Nasal Spray, Positional Therapy, and the Combination Thereof in the Asymptomatic Snorer. Sleep 1994;17(6):516-521 source

  • May combine two claims.

    Interpretationcitation

    Patients with nasal congestion may benefit from nasal corticosteroids, but it is unlikely that this therapy alone would sufficiently treat OSA.

    “In conclusion, patients with nasal congestion may benefit from nasal corticosteroids, but it is unlikely that this therapy alone would sufficiently treat OSA.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [80] 80. Braver, H. M., and Block, A. J. Effect of Nasal Spray, Positional Therapy, and the Combination Thereof in the Asymptomatic Snorer. Sleep 1994;17(6):516-521 source
    • cites [81] 81. Kiely, J., Nolan, P., and McNicholas, W. Intranasal corticosteroid therapy for obstructive sleep apnoea in patients with co-existing rhi- nitis. Thorax 2004;59

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • Rests on an assumption: Nasal congestion contributes to obstructive sleep apnea severity such that nasal corticosteroids can benefit patients with nasal congestion.
22 of 22

  • The paper relies on this without support.

    OSA is a sleep state-dependent disorder with generally normal ventilation and upper airway function during wakefulness.

    “OSA is a sleep state-dependent disorder with generally normal ventilation and upper airway function during wakefulness.”

  • The paper relies on this without support.

    Oral appliances and surgical procedures are successful in certain subsets of patients, but a notable proportion of patients do not receive adequate clinical benefit from these approaches.

    “Oral appliances and surgical procedures to improve upper airway patency are successful in certain subsets of patients, but a notable proportion of patients do not receive adequate clinical benefit from these approaches.”

  • The paper relies on this without support.

    There are subsets of patients who experience obstructive apnea and hypopnea events almost exclusively in REM sleep.

    “There are subsets of patients who experience obstructive apnea and hypopnea events almost exclusively in REM sleep.”

  • The paper relies on this without support.

    Menopause is an independent risk factor for OSA.

    “Although menopause is an independent risk factor for OSA, a randomized prospective study examining the effects of hormonal replacement therapy on the prevention of OSA has not been performed.”

  • The paper relies on this without support.

    Multiple sleep latency times of <10 min on modafinil indicate continued risk for sleepiness-related driving motor vehicle accidents.

    “the vast majority (75%) of subjects with severe sleepiness at baseline still had multiple sleep latency times of <10 min on modafinil, despite effective CPAP and good compliance with therapy.Therefore, prescribing modafinil should not lessen the concerns of continued risk for sleepiness and driving-related motor vehicle accidents related to sleepiness in patients with OSA.”

  • The paper relies on this without support.

    Nasal congestion contributes to obstructive sleep apnea severity such that nasal corticosteroids can benefit patients with nasal congestion.

    “In conclusion, patients with nasal congestion may benefit from nasal corticosteroids, but it is unlikely that this therapy alone would sufficiently treat OSA.”

  • The paper relies on this without support.

    Hypothyroidism and acromegaly can cause or worsen obstructive sleep apnea.

    “When these disorders are treated, OSA may be significantly improved or even reversed.”

  • The paper relies on this without support.

    Reduction in hypoxemia during sleep from supplemental oxygen translates into clinical benefit in OSA.

    “Oxygen therapy may be helpful in patients who decline the opportunity to use CPAP, but presently it is uncertain which patients will benefit from supplemental oxygen, what the optimal dose is, and what the long-term consequences and benefits of supplemental oxygen use are.”
8 of 8

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Weight-loss trial is described as both randomized and nonrandomized

    Minor

    The Smith study is first described as randomized, then as a nonrandomized controlled trial.

  • The same modafinil study is described as both two weeks and longer-duration

    Minor

    Reference 72 identifies the two-week study in the first passage, but is also listed among the other, longer-duration studies in the second.

  • BMI formula and reported units disagree

    Minor

    The stated BMI formula uses height in square meters, but the resulting BMI values are given in kilograms per square centimeter.

3 of 3

Cites

Flagged first, then by citations

2 of the 94 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. [1]1. vascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046-1053

Cited by

Sorted by citations

Related

Authors
Veasey, S. C., Guilleminault, C., Strohl, K. P., Sanders, M. H., Ballard, R. D., & Magalang, U. J.
Affiliations
  • University of Pennsylvania (US)
  • Stanford Medicine (US)
  • United States Department of Veterans Affairs (US)
  • University of Pittsburgh Medical Center (US)
  • National Jewish Health (US)
  • The Ohio State University (US)
Corresponding author
Veasey, Sigrid C.
ORCID
Venue
SLEEP
Publisher
Oxford University Press (OUP)
Published
2006-08
Volume
29
Issue
8
Pages
1036-1044
ISSN
  • 0161-8105 (ISSN-L)
  • 1550-9109
DOI
10.1093/sleep/29.8.1036
OpenAlex
W2101884932
Cited by
217
References
94
Citations by year
2026: 2 · 2025: 3 · 2024: 3 · 2023: 7 · 2022: 2 · 2021: 9 · 2020: 9 · 2019: 7 · 2018: 10 · 2017: 16 · 2016: 11 · 2015: 14 · 2014: 16 · 2013: 22 · 2012: 14
FWCI
1.70
Type
journal article
Language
en
Open access
closed
Locations
  • SLEEP (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Pfizer
  • Sanofi
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroscience of respiration and sleep
Keywords
obstructive sleep apnea, medical therapy, adjunctive therapy, pharmacotherapy, weight loss, positive airway pressure, stimulant medication, supplemental oxygen, positional therapy, hypothyroidism, acromegaly, apnea-hypopnea index, daytime sleepiness, upper airway surgery, oral appliances
MeSH terms
Modafinil, Benzhydryl Compounds, Combined Modality Therapy, Humans, Oxygen Inhalation Therapy, Posture, Protriptyline, Weight Loss, Randomized Controlled Trials as Topic, Treatment Outcome, Practice Guidelines as Topic, Serotonin Agents, Evidence-Based Medicine, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure

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