Condition

Sleep Apnea

Breathing repeatedly stops and starts during sleep

1B
People Affected
50
Active Trials
50M
New Cases/Year
38K
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Continuous Positive Airway Pressure (CPAP)
90% Effectiveness• 95% Confidence• 85% Safety• 647 trials• 200K participants
HIGH EvidenceExcellent ValueDose: 4-20 cm H2O (titrated pressure)
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Comparative Safety Scale(Higher is safer)

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85
DangerousModerateSafe

Time to Effect

Immediate

Duration

Lifetime

Response Rate

75%

Remission Rate

75%

Number Needed to Treat (NNT)

2

Common Side Effects:

Mask discomfort/poor fit: 40%
Dry mouth/nose: 30%
Skin irritation/pressure sores: 15%
Aerophagia (swallowing air): 10%

Annual Cost of Care

Drug Cost

$0

Monitoring

$150

Side Effects

$50

Total Annual

$800

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.75

ICER

$35,000/QALY

Cost per Remission

$1,067

Cost per Responder

$1,067

Treatment Outcomes
Primary Outcomes
Apnea-Hypopnea Index (AHI)35 events/hour
-85.7% (-30 events/hour)
Epworth Sleepiness Scale (ESS)ESS score: 14/24
-28.57% (-4 points)
Minimum Oxygen Saturation (SpO2 nadir)78%
+15.38% (+12 percentage points)
Time Spent with SpO2 < 90%25% of Total Sleep Time
-80% (-20% of Total Sleep Time)
Secondary Benefits
Systolic Blood Pressure142 mmHg
-2.11% (-3 mmHg)
SF-36 Physical Component Summary (PCS) score40 points (0-100 scale)
+10% (+4 points)
Fatigue Severity Scale (FSS)5.5/7
-18.18% (-1.0 points)
Common Side Effects
Mask discomfort/poor fit
+40%
Dry mouth/nose
+30%
Skin irritation/pressure sores
+15%

Clinical Trial Phases:

Phase 4
2
Weight Loss (Lifestyle Modification)
85% Effectiveness• 90% Confidence• 95% Safety• 18 trials• 100K participants
HIGH EvidenceExcellent ValueDose: Sustained caloric deficit, regular exercise
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Comparative Safety Scale(Higher is safer)

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Meth💀
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95
DangerousModerateSafe

Time to Effect

6-12 months

Duration

Lifetime

Response Rate

70%

Remission Rate

40%

Annual Cost of Care

Drug Cost

$0

Monitoring

$100

Side Effects

$0

Total Annual

$250

Cost-Effectiveness

EXCELLENT

QALYs Gained

1.5

ICER

$10,000/QALY

Cost per Remission

$625

Cost per Responder

$357

Treatment Outcomes
Primary Outcomes
Apnea-Hypopnea Index (AHI)28 events/hr (moderate-severe OSA)
-35% (-9.8 events/hr)
Epworth Sleepiness Scale (ESS)15/24 points (significant sleepiness)
-40% (-6 points)
Oxygen Desaturation Index (ODI)22 events/hr
-30% (-6.6 events/hr)
Minimum Oxygen Saturation (SpO2 nadir)83%
+4.8% (+4%)
Secondary Benefits
Body Mass Index (BMI)34 kg/m2 (Obese Class I)
-10% (-3.4 kg/m2)
Systolic Blood Pressure138 mmHg
-6.5% (-9 mmHg)
Diastolic Blood Pressure88 mmHg
-6.8% (-6 mmHg)

Clinical Trial Phases:

Phase 4
3
Hypoglossal Nerve Stimulation (HGNS)
80% Effectiveness• 85% Confidence• 65% Safety• 14 trials• 5K participants
MODERATE EvidenceGood ValueDose: Device programmed settings
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Comparative Safety Scale(Higher is safer)

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65
DangerousModerateSafe

Time to Effect

2-3 months

Duration

Lifetime (with battery replacements)

Response Rate

65%

Remission Rate

45%

Number Needed to Treat (NNT)

2

Number Needed to Harm (NNH)

25

Common Side Effects:

Tongue weakness/discomfort: 15%
Lead infection/migration: 3%
Speech disturbance: 5%
Battery replacement surgery: 100%

Annual Cost of Care

Drug Cost

$0

Monitoring

$300

Side Effects

$100

Total Annual

$4,500

Cost-Effectiveness

GOOD

QALYs Gained

1

ICER

$75,000/QALY

Cost per Remission

$10,000

Cost per Responder

$6,923

Treatment Outcomes
Primary Outcomes
Apnea-Hypopnea Index (AHI)30 events/hour
-62.1% (-18.6 events/hour)
Oxygen Desaturation Index (ODI)25 events/hour
-60% (-15 events/hour)
Epworth Sleepiness Scale (ESS)12/24 points
-33.3% (-4 points)
Minimum Oxygen Saturation (SpO2 nadir)78%
+10.2% (+8%)
Secondary Benefits
Pittsburgh Sleep Quality Index (PSQI)10/21 points
-30% (-3 points)
Functional Outcomes of Sleep Questionnaire (FOSQ-10)14/40 points
+42.9% (+6 points)
Snoring Severity (Patient-reported VAS)8/10 points
-62.5% (-5 points)
Common Side Effects
Tongue weakness/discomfort
+15%
Lead infection/migration
+3%
Speech disturbance
+5%

Clinical Trial Phases:

Phase 3Phase 4
4
Oral Appliance Therapy (OAT)
75% Effectiveness• 90% Confidence• 85% Safety• 2 trials• 50K participants
HIGH EvidenceGood ValueDose: Custom-fitted, adjustable appliance
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Comparative Safety Scale(Higher is safer)

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Meth💀
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85
DangerousModerateSafe

Time to Effect

1-4 weeks

Duration

Lifetime

Response Rate

60%

Remission Rate

50%

Number Needed to Treat (NNT)

3

Common Side Effects:

Jaw discomfort: 40%
Dry mouth/excessive salivation: 25%
Dental/occlusal changes (long-term): 15%
TMJ pain: 7%

Annual Cost of Care

Drug Cost

$0

Monitoring

$200

Side Effects

$50

Total Annual

$750

Cost-Effectiveness

GOOD

QALYs Gained

0.5

ICER

$60,000/QALY

Cost per Remission

$1,500

Cost per Responder

$1,250

Treatment Outcomes
Primary Outcomes
Apnea-Hypopnea Index (AHI)25 events/hour
-48% (-12 events/hour)
Epworth Sleepiness Scale (ESS)14/24 points
-35% (-5 points)
Oxygen Desaturation Index (ODI)20 events/hour
-45% (-9 events/hour)
Minimum Oxygen Saturation (SpO2 nadir)86%
+4.65% (+4%)
Secondary Benefits
Snoring Severity (Visual Analog Scale)8/10 points
-65% (-5.2 points)
Systolic Blood Pressure138 mmHg
-3.6% (-5 mmHg)
Diastolic Blood Pressure86 mmHg
-3.5% (-3 mmHg)
Common Side Effects
Jaw discomfort
+40%
Dry mouth/excessive salivation
+25%
Dental/occlusal changes (long-term)
+15%

Clinical Trial Phases:

Phase 4
5
Positional Therapy
70% Effectiveness• 85% Confidence• 90% Safety• 28 trials• 5K participants
HIGH EvidenceExcellent ValueDose: Avoid supine sleep (e.g., side-sleeping devices)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
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90
DangerousModerateSafe

Time to Effect

Immediate

Duration

Lifetime

Response Rate

75%

Remission Rate

65%

Number Needed to Treat (NNT)

2

Common Side Effects:

Minor sleep disturbance: 7%
Skin irritation from device: 5%

Annual Cost of Care

Drug Cost

$0

Monitoring

$50

Side Effects

$0

Total Annual

$100

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.6

ICER

$5,000/QALY

Cost per Remission

$154

Cost per Responder

$133

Treatment Outcomes
Primary Outcomes
Apnea-Hypopnea Index (AHI)25 events/hour
-50% (-12.5 events/hour)
Oxygen Desaturation Index (ODI)20 events/hour
-45% (-9 events/hour)
Minimum Oxygen Saturation (Min SaO2)80%
+6.25% (+5 percentage points)
Secondary Benefits
Epworth Sleepiness Scale (ESS)12/24 (moderate sleepiness)
-30% (-3.6 points)
Pittsburgh Sleep Quality Index (PSQI)10/21 (poor sleep quality)
-25% (-2.5 points)
Snoring Severity (VAS)7/10 (VAS score)
-40% (-2.8 points)
Common Side Effects
Minor sleep disturbance
+7%
Skin irritation from device
+5%

Clinical Trial Phases:

Phase 4
6
Uvulopalatopharyngoplasty (UPPP)
55% Effectiveness• 70% Confidence• 60% Safety• 8 trials• 10K participants
MODERATE EvidenceModerate ValueDose: Surgical procedure
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
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Morphine💊
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60
DangerousModerateSafe

Time to Effect

4-6 weeks (post-recovery)

Duration

One-time procedure

Response Rate

50%

Remission Rate

25%

Number Needed to Treat (NNT)

7

Number Needed to Harm (NNH)

30

Common Side Effects:

Post-operative pain: 85%
Swallowing difficulties/nasal regurgitation: 20%
Voice change: 10%
Bleeding/infection: 5%

Annual Cost of Care

Drug Cost

$0

Monitoring

$100

Side Effects

$200

Total Annual

$2,500

Cost-Effectiveness

MODERATE

QALYs Gained

0.4

ICER

$120,000/QALY

Cost per Remission

$10,000

Cost per Responder

$5,000

Treatment Outcomes
Primary Outcomes
Apnea-Hypopnea Index (AHI)45 events/hour
-44.4% (-20 events/hour)
Oxygen Desaturation Index (ODI)40 events/hour
-40% (-16 events/hour)
Minimum Oxygen Saturation (SpO2 nadir)80%
+7.5% (+6 percentage points)
Epworth Sleepiness Scale (ESS)15/24 points
-33.3% (-5 points)
Secondary Benefits
Snoring Severity (VAS)8/10 on VAS
-62.5% (-5 points)
Functional Outcomes of Sleep Questionnaire (FOSQ)12/20 points
+25% (+3 points)
Systolic Blood Pressure140 mmHg
-7.1% (-10 mmHg)
Common Side Effects
Post-operative pain
+85%
Swallowing difficulties/nasal regurgitation
+20%
Voice change
+10%

Clinical Trial Phases:

Phase 4