Clinician reference tool — not medical advice. This is a clinical decision-aid intended for healthcare professionals: it gives deterministic suggestions to think with, not a diagnosis or a prescription. If you’re a patient, you’re welcome to look around — but please review anything here with your own doctor; it isn’t a substitute for personalized medical care.
Clinician reference tool — not a prescriber, not a diagnosis, not medical advice. A two-stage aid: safety gates (get a sleep study first; central/complex apnea routes to a specialist), then an evidence-RIGOR-graded comparison of OSA therapies across five discipline lenses. Every therapy leads with an explicit evidence-rigor rating and its study base. The treating clinician’s judgement and the live guidance are always required. Runs entirely in your browser — no data is collected.

Evidence: Health Canada approval of ZEPBOUND (tirzepatide) for mode… 2026 · sources last checked 2026-08-20

Obstructive sleep apnea management selector

Confirm the diagnosis and screen for central/complex apnea first; then, for obstructive OSA, compare therapies across five discipline lenses — sleep medicine, dental sleep medicine, surgery, weight & metabolic, and behavioral/positional. Each therapy leads with a transparent evidence-rigor rating (how good is the science) and a concise study-base line — the whole point of the tool.

Stage 1 — Safety gates

Check any that apply. Either gate routes the case out and suppresses the therapy comparison below.

Guideline lens

Stage 2 — Clinical profile

OSA severity (AHI)· key driver

Symptoms & safety· key driver

CPAP history· key driver

Body weight

Positional & anatomy

Comorbidities

Population

Preference & access

Safety & guideline notes

  • • AASM lens (default anchor): CPAP is the evidence-anchored first-line for moderate–severe OSA (PAP CPG 2019); a custom oral appliance is the first-line alternative for mild–moderate or CPAP-intolerant OSA (oral-appliance CPG 2015); surgery is reserved and patient-selected (surgery CPG 2021). Every therapy is shown with its own evidence-rigor rating.
  • • Safety gates first: confirm the diagnosis and severity (AHI) on PSG/HSAT and screen for central/complex apnea before selecting therapy. Every therapy below carries its own evidence-rigor rating and study base.
  • • CPAP expectation-setting: highly effective for sleepiness, quality of life and blood pressure, but SAVE (2016) and other RCTs did NOT show it reduces cardiovascular events — benefit is adherence-dependent.
  • • Canadian access: PAP and oral-appliance coverage vary by province and insurer; hypoglossal nerve stimulation (Inspire) has limited availability and is largely uninsured; tirzepatide (Zepbound) is now Health-Canada-approved for OSA (2026) but is costly with evolving coverage. Confirm coverage live per province.

No safety gates — select the clinical profile to compare therapies.

e.g. Moderate (AHI 15–30) + CPAP not yet tried, or CPAP tried, intolerant + Obesity to open the appliance / weight / surgical pathways. Therapies are grouped by their discipline lens; each leads with its evidence-rigor rating and study base.

References

  1. [1]Patil SP, et al. Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure — AASM Clinical Practice Guideline. J Clin Sleep Med 2019 (CPAP/APAP/BiPAP; CPAP first-line for moderate–severe OSA). link
  2. [2]AASM PAP CPG (2019) — APAP is non-inferior to fixed CPAP for most uncomplicated OSA; PAP improves sleepiness, quality of life and blood pressure. link
  3. [3]Ramar K, et al. Clinical Practice Guideline for the Treatment of OSA and Snoring with Oral Appliance Therapy: An Update for 2015 — AASM/AADSM. J Clin Sleep Med 2015 (custom titratable appliance; smaller AHI reduction than CPAP but better adherence). link
  4. [4]Kent D, et al. Referral of Adults with OSA for Surgical Consultation — AASM Clinical Practice Guideline. J Clin Sleep Med 2021 (UPPP, maxillomandibular advancement, nasal surgery, positional and adjunctive options; patient selection). link
  5. [5]Strollo PJ, et al. Upper-Airway Stimulation for Obstructive Sleep Apnea (STAR trial). N Engl J Med 2014;370:139–49 (prospective cohort + randomized therapy-withdrawal; eligibility AHI ~15–65, BMI ≤32, CPAP-intolerant, no complete concentric palatal collapse on DISE). link
  6. [6]McEvoy RD, et al. CPAP for Prevention of Cardiovascular Events in Obstructive Sleep Apnea (SAVE). N Engl J Med 2016;375:919–31 (n=2,717; CPAP did NOT reduce cardiovascular events, HR 1.10; mean adherence ~3.3 h/night). link
  7. [7]Foster GD, et al. A randomized study on the effect of weight loss on OSA among obese patients with type 2 diabetes (Sleep AHEAD / Look AHEAD). Arch Intern Med 2009 (dose-dependent AHI reduction with lifestyle weight loss); bariatric-surgery evidence largely observational. link
  8. [8]Marcus CL, et al. A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea (CHAT). N Engl J Med 2013;368:2366–76 (adenotonsillectomy first-line for paediatric OSA with adenotonsillar hypertrophy). link
  9. [9]Cowie MR, et al. Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure (SERVE-HF). N Engl J Med 2015;373:1095–105 (ASV INCREASED all-cause and cardiovascular mortality, 34.8% vs 29.3%; ASV contraindicated in symptomatic HFrEF). link
  10. [10]Malhotra A, et al. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity (SURMOUNT-OSA). N Engl J Med 2024 (two phase-3 RCTs, with/without concurrent PAP; AHI reduced by ~20–25 events/h vs placebo in obese moderate–severe OSA). link
  11. [11]Health Canada approval of ZEPBOUND (tirzepatide) for moderate-to-severe OSA in adults with obesity, 2026-06-16 — the first medication approved for OSA in Canada (adjunct to reduced-calorie diet and increased physical activity). Verify current Product Monograph and coverage. link