TABLE 1

Conservative and medical treatments for obstructive sleep apnea

Treatment	Indications	Reduction in apnea-hypopnea index	Caveats	Possible predictors of success
Weight loss⁷	BMI ≥ 26 kg/m²	26% per 10% weight loss	Weight loss and lifestyle changes difficult to maintain	Higher BMI, larger neck circumference
Positional therapy^13,14	Positional sleep apnea	7.4 fewer events per hour	10% have sleep disturbance, back or chest discomfort	Positional obstructive sleep apnea, no obesity, lower AHI
Drug therapy^15,16	No current labeling of specific drugs	Noradrenergic with antimuscarinic: 76%	Anticholinergic effects	Lower AHI and decreased collapsibility
Drug therapy^15,16	No current labeling of specific drugs	Carbonic anhydrase inhibitors: 45%	Paresthesia, dyspepsia	High loop gain
Oxygen therapy^17,18,21	Inability to tolerate positive airway pressure, failure of upper airway surgery	72.5% in responders (25% of patients)	Prolongs apnea, increases risk of hypercarbia, no effect on blood pressure or excessive daytime sleepiness	High loop gain, decreased collapsibility, and increased pharyngeal compensation
Oral appliances^19,22	Can be first-line, especially in mild to moderate obstructive sleep apnea	56%; effective in 68% of patients after 2 years of treatment	Temporomandibular joint dysfunction, occlusion changes; requires manual dexterity	Retracted maxilla and mandible, narrow airway, short soft palate, positional obstructive sleep apnea, lower BMI, female, smaller neck circumference, lower AHI
Myofunctional tongue stimulation²⁰	Alternative to CPAP, or adjunct to CPAP to improve adherence	50%	Not recommended as standard treatment	Ineffective upper-airway dilator muscles

AHI = apnea-hypopnea index; BMI = body mass index; CPAP = continuous positive airway pressure therapy