Ann: IHL-42X phase 2 clinical trial presentation, page-50

Many many resources out there regarding adherence to CPAP machines.

https://www.mdpi.com/2227-9032/10/5/943/htm

Although several treatment options are available, CPAP often remains the first choice for treating OSA. Although CPAP contributes to the improvement of the cardiovascular, metabolic, and inflammatory parameters of the patient, and seems to reduce the risk of cardiovascular morbidity and mortality [23,24,25], up to 50% of patients with OSA refuse CPAP, or discontinue it within the first week [26,27]. To be effective, CPAP therapy should be used for at least 4 h per night [28], and up to 60% of patients who initially accepted CPAP treatment are not fully adherent [26,27,29,30]. Furthermore, in experienced patients who self-monitor using a mobile application, CPAP use is more consistent than in novice and intermediate users. In fact, experienced users have a significantly higher average use than both novice and intermediate users. Only 19.5% and 32.2% of novice and experienced patients, respectively, use CPAP for >20 min daily [31].

Among the reasons for reduced compliance with CPAP are CPAP-induced discomforts, such as mouth dryness, headaches, irritation, or ulceration of the oral and nasal skin [32]. Thus, recent literature focused on the best ways to improve CPAP compliance, such as involving sleep healthcare workers and telemedicine [33,34,35].

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Alternatives for failed CPAP users?

CPAP is the accepted standard treatment for obstructive sleep apnea. Adherence to CPAP therapy is generally poor. Only 70% of CPAP-naïve patients continue to use CPAP regularly after 1 year.1 When CPAP therapy fails, both the doctor and the patient discuss the next alternative therapy choice. Surgery is not currently routine but may be useful in special conditions, such as tonsillar hypertrophy.2 An oral appliance is a good alternative therapeutic option and has relatively acceptable adherence and efficacy, particularly in patients with less severe obstructive sleep apnea and normal body mass index.3 Recently, upper airway stimulator therapy has emerged as an alternative therapy for those who fail CPAP.4 However, upper airway stimulator is currently restricted to select patients and is not applicable for those with body mass index > 35 kg/m2.The reasons for CPAP failure are multifactorial and include claustrophobia, poor mask fit, nasal obstruction, insomnia, and lack of motivation.5 These factors may evolve over time, which suggests that a new CPAP trial after a first failure may be successful.
https://rc.rcjournal.com/content/65/10/1541
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IMO the market for IHL-42x in failed CPAP users as an alternative therapy must be significant.

GLAH - Great conversation today!