Skip to main content
Log in

A novel intermittent negative air pressure device ameliorates obstructive sleep apnea syndrome in adults

  • Sleep Breathing Physiology and Disorders • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript



Patients with obstructive sleep apnea syndrome (OSAS) have difficulties in compliance with continuous positive airway pressure (CPAP) and the treatment outcome is heterogeneous. We proposed a proof-of-concept study of a novel intermittent negative air pressure (iNAP®) device for physicians to apply on patients who have failed or refused to use CPAP.


The iNAP® device retains the tongue and the soft palate in a forward position to decrease airway obstruction. A full nightly usage with the device was evaluated with polysomnography. Subgrouping by baseline apnea–hypopnea index (AHI) and body mass index (BMI) with different treatment response criteria was applied to characterize the responder group of this novel device.


Thirty-five patients were enrolled: age 41.9 ± 12.2 years (mean ± standard deviation), BMI 26.6 ± 4.3 kg/m2, AHI 41.4 ± 24.3 events/h, and oxygen desaturation index (ODI) 40.9 ± 24.4 events/h at baseline. AHI and ODI were significantly decreased (p < 0.001) by the device. Patients with moderate OSAS, with baseline AHI between 15 to 30 events/h, achieved 64% response rate; and non-obese patients, with BMI below 25 kg/m2, achieved 57% response rate, with response rate defined as 50% reduction in AHI from baseline and treated AHI lower than 20. There were minimal side effects reported.


In a proof-of-concept study, the device attained response to treatment as defined, in more than half of the moderate and non-obese OSAS patients, with minimal side effects.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Remmers JE, deGroot WJ, Sauerland EK, Anch AM (1978) Pathogenesis of upper airway occlusion during sleep. J Appl Physiol Respir Environ Exerc Physiol 44:931–938.

    Article  CAS  PubMed  Google Scholar 

  2. Gharibeh T, Mehra R (2010) Obstructive sleep apnea syndrome: natural history, diagnosis, and emerging treatment options. Nat Sci Sleep 2:233–255.

    Article  PubMed  PubMed Central  Google Scholar 

  3. de Godoy LBM, Palombini LO, Guilleminault C, Poyares D, Tufik S, Togeiro SM (2015) Treatment of upper airway resistance syndrome in adults: where do we stand? Sleep Sci 8:42–48.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Weaver TE, Sawyer A (2009) Management of obstructive sleep apnea by continuous positive airway pressure. Oral Maxillofac Surg Clin North Am 21:403–412.

    Article  PubMed  Google Scholar 

  5. Certal VF, Zaghi S, Riaz M, Vieira AS, Pinheiro CT, Kushida C, Capasso R, Camacho M (2015) Hypoglossal nerve stimulation in the treatment of obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope 125:1254–1264.

    Article  PubMed  Google Scholar 

  6. Marklund M (2017) Update on oral appliance therapy for OSA. Curr Sleep Med Rep 3:143–151.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Epstein LJ, Kristo D, Strollo PJ Jr et al (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5:263–276

    Google Scholar 

  8. Yamaguchi Y, Kato M (2017) Pilot study of oral negative pressure therapy for obstructive sleep apnea-hypopnea syndrome. J Sleep Disord Ther 6:271.

    Article  Google Scholar 

  9. Iber C (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology, and technical specifications. J Clin Sleep Med IL, American Academy of Sleep MedicineWestchester

    Google Scholar 

  10. WHO (1998) Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Arch Intern Med 158:1855–1867.

    Article  Google Scholar 

  11. Pan WH, Yeh WT (2008) How to define obesity? Evidence-based multiple action points for public awareness, screening, and treatment: an extension of Asian-Pacific recommendations. Asia Pac J Clin Nutr 17:370–374

    PubMed  Google Scholar 

  12. Almeida FR, Bansback N (2013) Long-term effectiveness of oral appliance versus CPAP therapy and the emerging importance of understanding patient preferences. Sleep 36:1271–1272.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Sutherland K, Phillips CL, Cistulli PA (2015) Efficacy versus effectiveness in the treatment of obstructive sleep apnea: CPAP and oral appliances. J Dent Sleep Med 2:175–181.

    Article  Google Scholar 

  14. Schmidt-Nowara W, Lowe A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S (1995) Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep 18:501–510

    Article  CAS  PubMed  Google Scholar 

  15. Hoffstein V (2007) Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath 11:1–22.

    Article  PubMed  Google Scholar 

  16. Gray EL, McKenzie DK, Eckert DJ (2017) Obstructive sleep apnea without obesity is common and difficult to treat: evidence for a distinct pathophysiological phenotype. J Clin Sleep Med 13:81–88.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Farid-Moayer M, Siegel LC, Black J (2013) A feasibility evaluation of oral pressure therapy for the treatment of obstructive sleep apnea. Ther Adv Respir Dis 7:3–12.

    Article  PubMed  Google Scholar 

  18. Farid-Moayer M, Siegel LC, Black J (2013) Oral pressure therapy for treatment of obstructive sleep apnea: clinical feasibility. Nat Sci Sleep 5:53–59.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Colrain IM, Black J, Siegel LC, Bogan RK, Becker PM, Farid-Moayer M, Goldberg R, Lankford DA, Goldberg AN, Malhotra A (2013) A multicenter evaluation of oral pressure therapy for the treatment of obstructive sleep apnea. Sleep Med 14:830–837.

    Article  PubMed  PubMed Central  Google Scholar 

Download references


This study was sponsored by Somnics, Inc.

Author information

Authors and Affiliations



Conception and design of this manuscript: T.C. Hung, C. Guilleminault

Acquisition of data: T.J. Liu, W. Y. Hsieh, B.N. Chen, W.K. Su

Analysis and/or interpretation of data: T.C. Hung

Drafting and revision of the manuscript: T.C. Hung

Revising and reviewing the manuscript for final releasing: K.H. Sun, C. Guilleminault

Corresponding author

Correspondence to Kuang-Hui Sun.

Ethics declarations

Ethical approval

The study was approved by the MacKay Memorial Hospital Institutional Review Board and registered to the National Department of Health. The study was performed in accordance with applicable local regulations, International Conference on Harmonization Guidelines as well as the 1964 Declaration of Helsinki and its later amendments. All subjects were properly informed and consented to participate in this study.

Conflict of interest

T.C. Hung is employed by Somnics, Inc., and is currently a PhD student at National Yang-Ming University. Besides T.C. Hung, the other authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Dr. Tien-Jen Liu and Ms. Tzu-Chun Hung are considered as joint first authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hung, TC., Liu, TJ., Hsieh, WY. et al. A novel intermittent negative air pressure device ameliorates obstructive sleep apnea syndrome in adults. Sleep Breath 23, 849–856 (2019).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: