Sleep & breathing
Nasal valve (nasal EPAP) for obstructive sleep apnea
Apnea-hypopnea index and Epworth sleepiness in obstructive sleep apnea.
Grade C: human trials exist, but they are small, mixed or not yet repeated. This is not a finding that it does not work. How to read a grade →
At a glance
A nasal valve is a small disposable patch over each nostril. Air flows in easily but is slowed on the way out, which may help hold the throat open. In one large study paid for by the maker, it cut breathing pauses and sleepiness. In a later study of people with worse sleep apnea, it did no better than a fake valve.
As studied, and the trials
In a sham-controlled trial of 250 adults funded by the device maker, the valve cut the apnea-hypopnea index by 43 percent at 3 months against 10 percent on sham, and Epworth scores fell (Berry et al., Sleep, 2011; PMID 21461326). In 67 people with moderate to severe sleep apnea taken off CPAP, it did no better than a placebo An inactive substitute made to look like the real treatment, so participants cannot tell which one they received. valve on breathing, oxygen or sleepiness (Rossi et al., Thorax, 2013; PMID 23723343), and after stroke it made no significant difference (Wheeler et al., J Clin Sleep Med, 2016; PMID 27306393). Positive and null controlled trials: C.
Read the grade that matches your goal. How EBL grades by use →
A letter describes the human evidence, not the product, the manufacturer, or the intervention's worth.
See the full evidence record →Graded on Apnea-hypopnea index and daytime sleepiness in obstructive sleep apnea.
Why this letter
Why this gradeGrade C, small or unreplicated trials. The reasoning, and what the grade does not cover.
Grade C on the apnea-hypopnea index and daytime sleepiness: one maker-funded sham-controlled trial was positive (Berry et al., 2011; PMID 21461326) and an independent placebo-controlled trial in moderate to severe disease was null (Rossi et al., 2013; PMID 23723343).
WHY NOT Bthe second controlled trial did not repeat the first.
WHAT THIS GRADE DOES NOT COVERsnoring without sleep apnea, mouth taping and other nasal devices, cardiovascular outcomes, and long-term use beyond the open-label Everyone in the trial knows which treatment they are receiving, so expectations can shape the results, especially for symptoms people report themselves. extension in people who had already responded.
A grade describes the human evidence for a named use. It is not advice, and it is not a judgment on any individual prescription. How the letters are decided →
Evidence notes: randomized trial
Endpoint The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score. graded: Apnea-hypopnea index and daytime sleepiness in obstructive sleep apnea (surrogate)
Last reviewed: October 2026
The trial that would change this grade.
A positive trial of this shape, supported by further trials, would move this entry to B.
Why the current trials fall short
The two controlled trials disagree, and the positive one was run with the maker. An independent trial that repeats it is what B requires.
Why people believe itOne human source; no published case reports of benefit; one report of harm.
The case for nasal valves is that they are small, cheap and need no machine, and that in the first large trial most users wore them every night.
What supporters point to, and what each source actually shows. None of it is enough to move this letter higher; the trial described above under Evidence wanted is what would.
- Population study, not a trialAmong 41 people who had responded in the first trial and kept using the valve for a year, breathing pauses fell from about 16 to 5 an hour. They were chosen because they responded, and there was no control group. PMID 22003339
A case report describes what happened to one or a few patients. It cannot show the treatment caused the change, and reports of success are published more often than reports of failure.
A PubMed search in October 2026 found no published case report of benefit for this use.
- A patient at the Mayo Clinic developed central pauses in breathing while using a nasal valve, a pattern known as complex sleep apnea; the authors describe it as one case. PMID 24812544
Searched PubMed, October 2026: 2 case report record(s) returned. One report of complex sleep apnea with the valve, shown as a harm report; the other concerns oxygen readings in ventilated patients and is unrelated.
Dose, form and timing
Apnea-hypopnea index on a home sleep study with the valves in place, and the Epworth Sleepiness Scale.
Safety
Breathing out against resistance can feel uncomfortable, and mouth breathing defeats the valve. In moderate to severe sleep apnea taken off CPAP, the valve did no better than placebo. One case of central sleep apnea appearing with the valve has been reported (PMID 24812544).
Grade history
How this letter has changedLatest: No. 373 · October 2026 · First graded.
Nostril valves that resist breathing out now have a record. A maker-funded sham-controlled trial in 250 adults cut breathing pauses and sleepiness (Berry et al., Sleep, 2011; PMID 21461326); a placebo-controlled trial in 67 people with moderate to severe sleep apnea taken off CPAP found no difference (Rossi et al., Thorax, 2013; PMID 23723343). Grade C.PMID 21461326 PMID 23723343
Every change to a letter on this site is dated and published. The full evidence log →
Sources
- Citations
- Every paper cited on this page is matched to its PubMed record on every build.
- Retractions
- None of these papers is retracted or under a journal expression of concern. PubMed is checked again on every build.
- Read against the papers
- October 2026. By a language model (AI-assisted reading), not yet reviewed by a clinician.
- Outside review
- Not yet done. No reviewer outside EBL has checked this record.
What each of these checks can and cannot show: evidence integrity.
Primary evidenceFive papers, each linked to its PubMed record.
Berry et al. (Sleep, 2011; PMID 21461326): AERO, multicenter sham-controlled double-blind Neither the participants nor the people assessing them know who received the real treatment until the trial ends. trial, 250 randomized, 3 months, funded by the device maker. Kryger et al. (J Clin Sleep Med, 2011; PMID 22003339): single-arm 12-month extension in 41 responders, shown as context. Rossi et al. (Thorax, 2013; PMID 23723343): placebo-controlled trial during CPAP withdrawal, null. Wheeler et al. (J Clin Sleep Med, 2016; PMID 27306393): crossover A trial design in which each participant receives both the treatment and the comparison, one after the other, and serves as their own control. in acute stroke, null. Chopra et al. (J Clin Sleep Med, 2014; PMID 24812544): case report of complex sleep apnea with the valve.
Evidence Based Longevity, Inc. is owner-operated and edited by Arnold Sandlow, D.C., a California-licensed chiropractor. Evidence Based Longevity publishes in English only · Machine translations are not produced or reviewed by EBL for accuracy
How EBL searched for the trials (1 search)
The search that was run, what it returned, and what was left out and why, so the absence of evidence can be checked as well as its presence.
("nasal expiratory positive airway pressure"[tiab] OR Provent[tiab] OR "nasal EPAP"[tiab]) AND "sleep apnea"[tiab] AND (randomized controlled trial[pt] OR meta-analysis[pt])Disclosure
Educational use only · Not medical advice · EBL grades published human evidence and does not recommend treatment. Stopping a prescription is a decision for your physician.
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