Persistent obstructive sleep apnea (OSA) is common in people treated with mandibular
advancement device (MAD) or hypoglossal nerve stimulation (HGNS). For most patients, these
treatments are the last line of defense. If MAD or HGNS do not work, then patients are left
to suffer the consequences of undertreated OSA. In this study, the investigators want to test
the addition of a drug treatment to their regimen. Endotypes will be targeted
pharmacologically with one of the following drugs: acetazolamide for a high loop gain,
atomoxetine-plus-eszopiclone for poor pharyngeal muscle compensation, or trazodone for a low
arousal threshold.
This aim is expected to provide treatment strategies for rescuing non-responders to MAD or
HGNS therapy.