iNAP is a new oral negative pressure device for the treatment of obstructive sleep apnea (OSA) in adults. The iNAP device uses a mouthpiece that fits over the tongue and creates a gentle vacuum. This negative pressure pulls the soft palate forward and the tongue upward, preventing them from obstructing the airway. This is in contrast to CPAP, which uses positive pressure to splint the airway open.

Because of this unique mechanism, there are certain patient characteristics that make iNAP a suitable treatment, while others are contraindications. For example:

• iNAP requires patients to breathe through their nose while sleeping. Patients with allergies, congestion, or other nasal issues may have trouble using iNAP. But our Zeebud nasal expander, shipped with the iNAP device, helps address these issues.
• iNAP can be difficult to use with mandibular advancement devices. However, braces and Invisalign are unlikely to interfere with iNAP's function, and some mouth guards may be compatible with iNAP.

The efficacy of iNAP is similar or superior to other CPAP alternatives, such as oral appliances and hypoglossal nerve stimulation. These alternatives have all shown an AHI reduction of approximately 60–75%. Although CPAP is considered the gold standard for treating sleep apnea, there are no head-to-head comparisons of iNAP and CPAP efficacy. iNAP comes with a lot less side effects and inconveniences compared to CPAP and alternatives.

Some patient characteristics can predict the success or failure of iNAP therapy, such as anatomical features and patient motivation. Highly motivated patients tend to be more successful with iNAP therapy. Some anatomical features associated with iNAP success or failure include BMI, the amount of airway tissue, and Mallampati grade. For example, patients with a higher BMI (greater than 35) are less likely to respond well to iNAP therapy. Additionally, patients whose sleep apnea is primarily due to tongue collapse are more likely to respond to iNAP than those whose sleep apnea is primarily due to concentric collapse (occlusion occuring down the patient's throat).

iNAP is FDA-cleared to treat all severities of obstructive sleep apnea in adults, but it is not effective for central sleep apnea. It is not cleared for use in children or adolescents.