Continuous positive airway pressure (CPAP) is the first-line treatment for obstructive sleep apnoea (OSA), primarily due to the vast amount of short-term evidence in the medical literature it has accrued. The enduring obstacle to CPAP from becoming a treatment option for all is its non-compliance rate, which is as high as 50-85% in some long-term studies. Subsequently, there have been a plethora of therapeutic options to capture the non-compliant OSA patient market. The newest contender entering the ring is an Intermittent Negative Air Pressure (iNAP) device, which has opted to down-case the initial ‘I’, presumably to capture the hearts of the Apple generation. The company website is found at The device creates a localised negative pressure zone within the oral cavity, drawing the tongue and soft palate anteriorly, thereby allowing for a non-impeded airway. This 35-patient feasibility study looked at OSA patients intolerant of CPAP. It was not completely clear how long the trial continued for, and over how long the data was collected. It did however show that, particularly for the non-obese moderate OSA patients, the results were quite good (approximately 55-60% of patients achieving a successful response to treatment). Again, there was no clear information about tolerability, but a table shows that 57.1% of patients reported some oral/dental discomfort, excessive salivation or other irritation. Although there is no cost per unit information available, I suspect it will be cheaper than CPAP, and this is likely to be an important marketing decision for the Somnics team. Clearly more careful studies are required, but this might represent a useful CPAP alterative.

A novel intermittent negative air pressure device ameliorates obstructive sleep apnea syndrome in adults.
Hung TC, Liu TJ, Hsieh WY.
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Vik Veer

Royal National Throat, Nose & Ear Hospital and Queens Hospital, Romford, UK.

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