Rather than applying positive pressure to the upper airways, a novel device that applies gentle oral suction sufficient to anteriorly and superiorly displace the soft palate and the tongue has been developed. Malhotra et al32 studied the efficacy of this oral pressure therapy (OPT) device, known as Winx (ApniCure, Inc) (Fig 4). While their results have only been published in abstract form, they showed that mean AHI among 30 subjects decreased from 31.8 to 19.7, with further reduction to 17.1 after 28 days of use. However, during their poster presentation, they suggested that the AHI had actually decreased in 60 subjects from 31 to 14.7 (A. Malholtra, MD, oral communication, May 2012). When success was defined as at least a 50% reduction in AHI and AHI < 20, 25 of the 60 subjects responded. In this group of responders, AHI decreased from 28 to 5.3. Even among those with severe OSA, AHI decreased from 45.6 to 9.1. Unfortunately, they did not provide any subject characteristics that predicted success. However, in this cohort of 60 subjects, median nightly use was 6 h, with use > 4 h on 87.5% of nights.