These findings challenge the concept that hypnotics reduce central drive to pharyngeal and other inspiratory muscles during sleep. Thus, the hypnotics tested in the current study are unlikely to worsen OSA via a reduction in drive. Similarly, the existing evidence does not indicate that these doses of common hypnotics systematically worsen hypoxaemia or OSA severity despite increases in the threshold for arousal. This is favorable from a safety perspective. Nonetheless, despite the present findings, caution remains warranted as some people with OSA do experience major reductions in
oxygenation with certain hypnotics. While there is currently limited evidence, poor outcomes tend to occur more commonly at high doses, in people who already have high thresholds for arousal and in obese individuals with very severe OSA. Thus, further work is required to identify which patients are most at risk of harm and with which agents and doses.