Embargoed for release until 5:00 p.m. ET on Monday 20 April 2026
Follow @Annalsofim on X , Facebook , Instagram , Bluesky , and Linkedin
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine . The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
----------------------------
1. Implanted nerve stimulation for obstructive sleep apnea found to be safe and effective in new trial
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-04414
Summary for Patients: https://www.acpjournals.org/doi/10.7326/ANNALS-25-04414-PS
URL goes live when the embargo lifts
A randomized controlled trial evaluating the safety and efficacy of proximal hypoglossal nerve stimulation, or pHGNS, (an implanted stimulation therapy targeting specific sectors of nerves in the tongue) for obstructive sleep apnea (OSA) found that pHGNS significantly reduced breathing interruptions during sleep and improved patient-reported daytime sleepiness without any significant adverse events. The study is published in Annals of Internal Medicine .
Hypoglossal nerve stimulation (HGNS) is an FDA-approved alternative therapy for OSA in patients who cannot tolerate nasal positive airway pressure. pHGNS has emerged as a possible treatment option for OSA that offers more stimulation of the tongue and airway muscles and easier implantation without the need for drug-induced sleep endoscopy compared to HGNS. Researchers conducted the OSPREY (treating Obstructive Sleep aPnea using taRgEted hYpoglossal nerve stimulation) trial to better understand the safety and efficacy of pHGNS. The researchers randomly assigned 104 adults aged 22 and older with moderate-to-severe OSA at 23 U.S. health centers to receive pHGNS therapy immediately (treatment) or at month 7 (control). The primary endpoint was apnea–hypopnea index (AHI) below 20 events/h at month 7, and other outcomes measured included oxygen desaturation index (ODI), patient-reported outcomes, and safety.
After seven months, 58.2% of patients in the treatment group achieved the primary endpoint and patients reported feeling less sleepy during the day. In contrast, clinically meaningful improvements were not observed in the control group through month 7. Continued improvements were seen in the treatment group following a 6-month open-label extension of the trial. No serious complications related to the procedure were reported, suggesting pHGNS may be a reasonable option for patients who cannot tolerate traditional sleep apnea treatments, though longer and larger studies are still needed, according to the authors.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Atul Malhotra, MD please email Jeanna Vazquez at jbvazquez@health.ucsd.edu.
----------------------------
2. Physical therapy provides modest improvements for chronic low back pain
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-04645
A sequential, multiple assignment, randomized trial (SMART) found that people with chronic low back pain experienced slight improvement in daily function when starting treatment with physical therapy compared with cognitive behavioral therapy. While long-term pain relief was similar across different treatment approaches, small differences between the groups support physical therapy as a first-line treatment strategy consistent with practice guidelines for chronic low back pain. The study is published in Annals of Internal Medicine .
Researchers from the University of Utah and colleagues conducted the OPTIMIZE (Optimized Multidisciplinary Treatment Programs for Nonspecific Chronic Low Back) trial to compare the effectiveness of common nonpharmacologic treatments for persons with chronic low back pain and examine what works best when initial treatment does not help. They followed 749 adults across three health systems between March 2019 and September 2023 who were randomly assigned to eight weeks of either physical therapy or cognitive behavioral therapy. Those who did not improve were reassigned to a second treatment, either switching therapies or trying mindfulness-based care.
After 10 weeks, participants who started with physical therapy showed a small improvement in function, though pain levels were similar between groups. After one year, no meaningful differences were seen among second-stage treatments. The findings suggest physical therapy may be a reasonable first option for chronic low back pain, but switching or adding other therapies later may not change long-term outcomes.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Julie M. Fritz, PhD, PT please email Julie Kiefer at julie.kiefer@hsc.utah.edu.
3. ACP finds performance measure for migraine headache inadequate to improve patient care
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-04726
The American College of Physicians (ACP) supports meaningful, evidence-based performance measures for internal medicine that improve patient care but does not recommend a core measure for migraine treatment at this time, citing inadequacies in the existing measure. “Core Performance Measures for Migraine Headache: A Review by the American College of Physicians” is published in Annals of Internal Medicine .
Migraine affects roughly 15% of Americans and is the second leading cause of disability among all adults and the leading cause among females aged 15-59. Despite its prevalence and impact, it is often underdiagnosed and undertreated. As part of an initiative to recommend core performance measures for internal medicine physicians, ACP’s Performance Measurement Committee searched for existing U.S. performance measures related to migraine headache, identifying just one.
Applying ACP’s measure review criteria, ACP found the measure lacks appropriate testing and key exclusions, relies on outdated guidance, and addresses a minimal performance gap. Further, ACP concluded that the measure adds unnecessary reporting burden for individual physicians. For these reasons, ACP does not recommend adopting a core performance measure for migraine at this time and urges measure developers to continue refining and testing the measure to ensure it becomes reliable, valid, and minimally burdensome for physicians.
ACP also explored potential performance measure concepts derived from the ACP clinical guidelines on preventing episodic migraine and treating acute migraine but decided against proposing a concept because most recommendations were conditional based on low-certainty evidence, making them unsuitable for measurement, or had measure feasibility issues related to documentation, making accurate measurement unrealistic.
The proliferation of low value measures, and the administrative workload they create, risks worsening primary care workforce shortages and reducing time available for direct patient care. ACP’s core performance measures initiative aims to identify high quality, evidence-based performance measures for internal medicine to be used nationally across all payers and systems to improve care for patients in the U.S.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To speak with someone at ACP, please email Angela Collom at acollom@acponline.org.
4. ACP says 340B Drug Pricing Program must be reformed to better patient health
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-05154
The 340B Drug Pricing Program must be reformed to better patient health and disincentivize institutional profit-seeking behaviors, says the American College of Physicians (ACP). In a new policy, “Reforming 340B to Promote Program Integrity and Better Serve Vulnerable Populations: An American College of Physicians Policy Brief,” published today in Annals of Internal Medicine , ACP issues recommendations to preserve the health and longevity of the program and its patients through policy changes.
The 340B Drug Pricing Program (340B Program) is part of a federal agreement that gives select health care entities that serve low-income and uninsured patients the opportunity to purchase heavily discounted drugs. The program exists to maximize federal resources while expanding treatment options for underserved populations, but shortcomings in its design, complexity, implementation and oversight have created inadvertent incentives for some health care organizations to undertake profit-seeking behaviors.
In the paper, ACP urges policy changes to protect the program and ensure it meets the intended mission of helping medically indigent populations. Evidence suggests that this mission is being undermined by some organizations’ profit-seeking behaviors, such as using 340B revenues to open outpatient physician practices in higher-income communities. These practices can obtain discounted drug prices, and profits are increased because the patients are more likely to have insurance coverage that will reimburse the covered entity at a higher rate. The paper advocates for legislative and regulatory efforts to ensure the program has demonstrated benefits for the population it is intended to serve. Benefits realized by the program should be directly used toward further serving those patients. Participating health care systems who do not benefit their patients or meet program requirements should have their 340B Program eligibility revoked.
ACP supports using contract pharmacies to further the program’s goals and provide sufficient access to 340B drugs. At the same time, ACP urges better oversight, scrutiny and auditing of those pharmacies to evaluate their potential impact and ensure they do not impose excessive payment pressure on participating organizations. Finally, the paper recommends that federal regulators be empowered with the resources and clear statutory authority necessary to engage in meaningful oversight of all 340B Program participants.
“The U.S. market sees some of the highest drug prices in the world. We have patients skipping doses and foregoing filling prescriptions because they cannot keep up with the rising cost of drugs. We must prioritize public policy that protects the health of vulnerable patient populations and expands their access to affordable care, including prescription medications,” says Jan K. Carney, MD, MACP, president of ACP. “The 340B Drug Pricing Program is an important program used by most community health clinics around the country to help low-income and uninsured patients afford care. ACP's recommendations are a roadmap for reforming the program so it can continue its mission more effectively and equitably.”
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To speak with someone at ACP, please email Jacquelyn Blaser at jblaser@acponline.org.
Also new this issue:
Reframing Social Drivers of Health in Patient Quality and Safety
Sahil Sandhu, MD, MSc; Michael Liu, MD, MPhil; and Laura M. Gottlieb, MD, MPH
Ideas and Opinions
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-05118
Automatic Tenure-Clock Extensions as a Safeguard Against Defunding
Bismarck Christian Odei, MD; and Charles R. Thomas, Jr., MD
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-04743
Annals of Internal Medicine
News article
People
Proximal Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea in the OSPREY Study: A Randomized Controlled Trial
21-Apr-2026