The treatment of sleep apnea, a condition that affects nearly one billion people worldwide, is undergoing a significant transformation, driven by advances in technology and a deeper understanding of the disorder. As Joerg Steier, adjunct professor of respiratory and sleep medicine at King's College London, notes, “The issue with CPAP is not that they don’t work—they do—but adherence.”
Continuous positive airway pressure (CPAP) therapy, which has been the gold standard for sleep apnea treatment since its introduction in 1981, is not without its limitations. Many patients struggle to tolerate the mask and find it claustrophobic, leading to poor adherence rates. According to Steier, studies have shown that CPAP can reduce overall mortality and cardiovascular risk “quite substantially.”
Inside the Platform
A new wave of technologies is expanding treatment options beyond the traditional CPAP therapy. Steier is developing ZeusOSA, a device worn under the chin that delivers mild electrical pulses to stimulate the hypoglossal nerve, aiming to counteract the loss of muscle tone that occurs during sleep and causes the airway to collapse. Other alternatives, such as custom-made mandibular advancement devices (MADs) and Inspire therapy, a hypoglossal nerve stimulation implant, are also gaining traction.
Pharmaceutical approaches are also emerging, with the US Food and Drug Administration approving Zepbound (tirzepatide) for moderate to severe OSA in adults with obesity in 2024. Meanwhile, startups like Apnimed are developing nightly pills targeting neuromuscular pathways that influence upper airway tone, aiming to stabilize the airway biologically rather than relying on mechanical support.
The Infrastructure Question
As the sleep apnea treatment landscape evolves, it is becoming clear that a single treatment is unlikely to work for everyone. With widely varying anatomy and symptoms, patients require personalized approaches. The development of new technologies and treatments is driven by the need for more effective and tolerable options. As Ruchir Patel, Inspire’s senior medical director, notes, “This is an exciting time because there are more treatment options available than in the past.”
However, the problem of adherence remains a significant challenge. Amanda Sathyapala, an associate professor at Imperial College London’s National Heart and Lung Institute, has developed CPAP Buddy, an app offering video-based behavioral therapy, peer support, and round-the-clock answers to patient questions, to improve CPAP use. As she notes, “CPAP is likely to be the most effective treatment that you can get because it's giving air directly into the airway.”
The Security Tradeoff
The rise of new sleep apnea treatments raises important questions about the tradeoffs between effectiveness, tolerability, and cost. While CPAP therapy remains the most effective treatment, its limitations have led to the development of alternative approaches. As the sleep apnea treatment landscape continues to evolve, it is essential to consider the potential risks and benefits of each option, as well as the need for personalized approaches that prioritize patient choice and tolerability.
