The DOI matches its Crossref record; 92 of the 94 references it cites were found in a registry or an index; 1 of the 65 sources its claims cite were checked for support.
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
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.
Overview
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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.
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Claims the paper makes
19 No full text of the sources · 13 Own interpretation · 10 Not checked yet · 10 No basis given · 8 Sources not found · 2 Own result · 1 Partly supported · accuracy not yet measured
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In the paper
“Stimulant therapy leads to a small but statistically significant improvement in objective sleepiness.”
§ 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 > Abstract
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“Very few studies presented data on neurobehavioral, metabolic or cardiovascular outcomes.”
§ 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 > 3.0 RESULTS
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“Overall, most of the qualifying studies identified provided Level II or Level III evidence for the effectiveness of an intervention on improving the AHI”
§ 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 > 3.0 RESULTS
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In the paper
“Overall, weight reduction was associated with reductions in the AHI for both surgical and reduced calorie therapies.”
§ 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 > 1.1 Weight Reduction
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In the paper
“In addition, very few of the papers compare medical therapies to CPAP outcomes.”
§ 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 > 3.0 RESULTS
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None of the sources cited for this claim have been checked yet.
In the paper
“Importantly, subjects noted less sleepiness with supplemental oxygen.78,79”
§ 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 > 3.3 Supplemental Oxygen
What the sources say
- Not matchedcites [78] 78. Landsberg, R., Friedman, M., and Ascher-Landsberg, J. Treatment of hypoxemia in obstructive sleep apnea. Am J Rhinol 2001;15:311- 313
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [79] 79. Phillips BA, Schmitt FA, Berry DT, Lamb DG, Amin M, and Cook YR. Treatment of obstructive sleep apnea. A preliminary report comparing nasal CPAP to nasal oxygen in patients with mild OSA. Chest 1990;98:325-330 source
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None of the sources cited for this claim have been checked yet.
In the paper
“The adverse events attributed to modafinil include headaches, nervousness and rhinitis (5-10% higher likelihood than placebo).”
§ 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 > Growth hormone suppressant therapy for acromegaly.
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In the paper
“A two-week, placebo-controlled study with one dose (400 mg) of modafinil 72 demonstrated that patients using this stimulant had a modest but significant reduction in their nightly usage of nasal CPAP.”
§ 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 > Growth hormone suppressant therapy for acromegaly.
What the sources say
- Not checked — no full text of the sourcecites [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
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None of the sources cited for this claim have been checked yet.
In the paper
“Of the remaining two studies in which supplemental oxygen was administered nasally to adults with obstructive sleep apnea, the minimum oxyhemoglobin saturation significantly improved in both studies.”
§ 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 > 3.3 Supplemental Oxygen
plaindirect- Asserted: passes — The authors put it forward as true.
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A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“This negative effect was not found in the other two doubleblind studies of longer duration 71,72 or in the open-label continuation study (75).”
§ 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 > Growth hormone suppressant therapy for acromegaly.
What the sources say
- Not checked — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [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
plain- Asserted: passes — The authors put it forward as true.
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- Probably not a substantial claim. 6
- It may state two separate claims as one. 18
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“OBSTRUCTIVE SLEEP APNEA (OSA) IS A HIGHLY PREV-ALENT SYNDROME THAT IS ASSOCIATED WITH SUB-STANTIAL MORBIDITY AND INCREASED MORTALITY. 1-10”
§ 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 > OBSTRUCTIVE SLEEP APNEA (OSA) IS A HIGHLY PREV-ALENT SYNDROME THAT IS ASSOCIATED WITH SUB-STANTIAL MORBIDITY AND INCREASED MORTALITY. 1-10
What the sources say
- Not matchedcites [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.
- Not checked — no full text of the sourcecites [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
- Not matchedcites [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.
- Not checked — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [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
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
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)
- Not checked — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [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
plaincorrelational- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“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”
§ 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 > 3.3 Supplemental Oxygen
What the sources say
- Not checked — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [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
plaindirectn = 4 ·- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“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.”
§ 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 > 3.4 Medical Therapies Intended to Improve Nasal Patency
What the sources say
- Not checked — no full text of the sourcecites [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
hedgeddirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The question of the long-term effect of modafinil on the hemodynamic status of OSA patients treated with nasal CPAP remains unresolved.”
§ 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 > Growth hormone suppressant therapy for acromegaly.
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
A claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“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]”
§ 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 > Growth hormone suppressant therapy for acromegaly.
What the sources say
- Not checked — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [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
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“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”
§ 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 > 3.4 Medical Therapies Intended to Improve Nasal Patency
What the sources say
- Not matchedcites [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.
plaindirectn = 23- Asserted: passes — The authors put it forward as true.
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- Not matched
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ 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 > 3.3 Supplemental Oxygen
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“Snoring was reduced or eliminated and the oxyhemoglobin saturation improved.”
§ 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 > 3.5 Positional Therapies
What the sources say
- Not matchedcites [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.
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“PAP provided greater improvements in AHI and minimum oxyhemoglobin saturation compared to positional therapy.”
§ 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 > 3.5 Positional Therapies
What the sources say
- Not checked — no full text of the sourcecites [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
plaindirectn = 13- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“(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).”
§ 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 > 3.5 Positional Therapies
What the sources say
- Not checked — no full text of the sourcecites [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
plaindirectn = 13- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
In the paper
“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”
§ 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 > 3.5 Positional Therapies
What the sources say
- Not matchedcites [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.
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
- Not matched
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > 4.0 CONCLUSIONS
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ 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 > OBSTRUCTIVE SLEEP APNEA (OSA) IS A HIGHLY PREV-ALENT SYNDROME THAT IS ASSOCIATED WITH SUB-STANTIAL MORBIDITY AND INCREASED MORTALITY. 1-10
What the sources say
- Not matchedcites [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.
- Not checked — no full text of the sourcecites [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
- Not checked — no full text of the sourcecites [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
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Abstract
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Presently, there are no widely effective pharmacotherapies for individuals with sleep apnea, with the important exceptions of individuals with hypothyroidism or with acromegaly.”
§ 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 > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > 3.2.2 REM sleep suppressant therapy.
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“This study was assigned Evidence Level I.”
§ 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 > 3.4 Medical Therapies Intended to Improve Nasal Patency
What the sources say
- Not matchedcites [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.
plainn = 23- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Weight loss has additional health benefits and should be routinely recommended to most overweight patients.”
§ 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 > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ 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 > Growth hormone suppressant therapy for acromegaly.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Nonetheless, residual sleepiness remains a significant health concern.”
§ 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 > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“This report was a randomized, controlled trial and was assigned Evidence Level II.”
§ 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 > 3.4 Medical Therapies Intended to Improve Nasal Patency
What the sources say
- Not checked — no full text of the sourcecites [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
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“In conclusion, patients with nasal congestion may benefit from nasal corticosteroids, but it is unlikely that this therapy alone would sufficiently treat OSA.”
§ 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 > 3.4 Medical Therapies Intended to Improve Nasal Patency
What the sources say
- Not checked — no full text of the sourcecites [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
- Not matchedcites [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.
hedgedconditionaln = 23 ·- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Nasal congestion contributes to obstructive sleep apnea severity such that nasal corticosteroids can benefit patients with nasal congestion.
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.”
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.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ 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 > 1.1 Weight Reduction
“Smith and associates 16 (level II) studied 23 obese patients with OSA randomized to either usual care (n=8) or weight reduction via a low calorie diet (n=15).”
§ 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 > 1.1 Weight Reduction
“This non-randomized controlled trial was assigned as level II evidence.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ 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 > Growth hormone suppressant therapy for acromegaly.
“A two-week, placebo-controlled study with one dose (400 mg) of modafinil 72”
§ 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 > Growth hormone suppressant therapy for acromegaly.
“This negative effect was not found in the other two doubleblind studies of longer duration 71,72”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ 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 > 1.1 Weight Reduction
“BMI, weight (kg)/height, (m 2 )”
§ 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 > 1.1 Weight Reduction
“32.3 + 1.2 kg/cm 2 to 31.7 + 1.3 kg/cm 2”
Citations
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Research works printed but not linked: 1
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Cited by
Sorted by citations
Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine, Epstein, L. J., Kristo, D., Strollo, P. J., Friedman, N., Malhotra, A., Patil, S. P., Ramar, K., Rogers, R., Schwab, R. J., et al. (2009) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.27497 · Cited by 3,360
Sleep Apnea and Cardiovascular Disease
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Lifestyle Intervention with Weight Reduction: First-line Treatment in Mild Obstructive Sleep Apnea
Tuomilehto, H., Seppä, J., Partinen, M., Peltonen, M., Gylling, H., Tuomilehto, J., Vanninen, E. J., Kokkarinen, J. I., Sahlman, J., Martikainen, T., et al. (2008) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200805-669oc · Cited by 454
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Sleep-disordered breathing and type 2 diabetes
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“little high quality evidence exists to support this concept. Randomised controlled trials are especially lacking, prompting questions about selection bias and residual confounding in available studies.”
BackgroundEpstein, L. J., Kristo, D. A., Strollo, P. J., Friedman, N. R., Malhotra, A., Patil, S. P., Ramar, K., Rogers, R. R., Schwab, R. J., Weaver, E. M., et al. (2009) · Cited by 276
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“SSRIs have not, however, been found to be particularly effective for treating sleep apnea (Veasey et al., 2006).”
BackgroundObesity and obstructive sleep apnea – Clinical significance of weight loss
Tuomilehto, H., Seppä, J., & Uusitupa, M. (2013) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2012.08.002 · Cited by 215
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“During these visits, physicians should manage CPAP treatment and a patient’s OSAS condition as well as use this opportunity to discuss weight loss, a reduction of alcohol consumption and other associated recommendations to decrease the severity of OSAS [94].”
BackgroundDrug therapy for obstructive sleep apnoea in adults
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“The 2006 review of medical therapy for OSA by the AASM indicates that antidepressants need further long-term study in much larger, randomized, controlled trials [27] .”
MethodMechanisms of breathing instability in patients with obstructive sleep apnea
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Acetazolamide for OSA and Central Sleep Apnea
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Sleep-disordered breathing, type 2 diabetes and the metabolic syndrome
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“8 However, although most patients with OSA undergoing CPAP treatment are obese, only a few manage to lose weight.”
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“Positional therapy for patients with POSA was first developed in the 1980s [60–62, 65–67] and has since been included in clinical practice guidelines [68].”
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Testosterone Conversion Blockade Increases Breathing Stability in Healthy Men during NREM Sleep
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“logical [12, 13] or surgical treatment [14, 15], continuous positive airway pressure (CPAP) therapy is the first-line treatment in moderate to serious OSAHS [16, 17].”
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“Methylxanthine derivatives (theophylline, aminophylline, and caffeine) reduce TST and sleep efficiency and do not significantly change the frequency or duration of obstructive apneas (Veasey et al. 2006).”
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“In fact, the American Academy of Sleep Medicine now recommends CBT-I as the first-line treat-ment for chronic insomnia.”
InfluentialFoster, G. D., Borradaile, K. E., SANDERS, M. H., Millman, R. P., Zammit, G. K., Newman, A. B., Wadden, T. A., Kelley, D. E., Wing, R. R., Pi-Sunyer, X., et al. (2017) · Cited by 15
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“Modafinil has been approved by the US Food and Drug Administration and is recommended by the AASM for the management of residual ES in patients with OSA as adjunctive therapy to nasal CPAP.76,77 In addition, armodafinil, the R-enantiomer of modafinil (which is a racemic mixture of the R- and S-enantiomers) has been ev…”
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Therapeutic Targeting of the Carotid Body for Treating Sleep Apnea in a Pre-clinical Mouse Model
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Self-citationStratégie thérapeutique du SAHOS intégrant les traitements associés ?
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“Positional therapy, which involves changing the sleep position to reduce AHI, has been proven effective for OSA patients [180–183] and has been included in clinical guidelines [184].”
Treatment of obstructive sleep apnoea.
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Self-citation
Metadata
- 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.
- Venue
- SLEEP
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-08
- Volume
- 29
- Issue
- 8
- Pages
- 1036-1044
- ISSN
- 0161-8105 (ISSN-L)
- 1550-9109
- 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 (medical) › 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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