SLEEP 2026 | Precision endotype-guided treatment of OSA

So as the field of sleep apnea is emerging in terms of these new therapies, so the main therapy is continuous positive airway pressure therapy, mask over the nose, blows that airway open, helps millions of people around the planet. The challenge is half or more of people that are prescribed CPAP therapy are unable to use it or unable to tolerate that CPAP mask. So the other therapies that are emerging or have been around for some time now, things like oral appliances, a mouth guard to pull the jaw forward and open up the airway. We’ve got surgery and hypoglossal nerve stimulation techniques. So effectively a pacemaker for the upper airway muscles to stimulate those muscles electrically around the airway. And excitingly now we’ve got things like drug therapies emerging. We’ve got weight loss drugs, tirzepatide for people with severe sleep apnea who are overweight and obese, as well as AD109, so a combination of adrenergic and muscarinic agents that are activating the muscles, so targeting that muscle endotype to open up the airway, and things like position sensors to keep people off their back where the airway tends to be worse. So what we know now from using those endotypes, we can, instead of most therapies beyond CPAP, roughly halve sleep apnea severity or thereabouts. There are other agents too that are emerging such as carbonic anhydrase inhibitors. They target the loop gain. So we’ve now got these drugs that can target each of the traits. Things like sleeping pills can help a little bit too for the light sleepers. The challenge there is they don’t actually change the arousal threshold very much. You can have next-day consequences. So if we know about each of those endotypes, we can use that information to decide which treatment or treatments we should be targeting. And we’re now doing studies to look at combinations of those different therapies so that we can really guide precision medicine. And instead of it being a toss of a coin or 50% reductions, we can get complete resolution of sleep apnea with this targeted approach using those endotypes. So the other thing that we’re learning with these endotypes is that they can give us clues to the disease consequences. So in addition to helping us guide therapy, for example, a low arousal threshold can be a biomarker to tell us that people are probably going to struggle on CPAP therapy. These are the people that are light sleepers. But in addition to that, we can now see there’s research that’s coming out showing us that people with a high arousal threshold, that might be associated with daytime consequences such as sleepiness. So it’s a marker of sleep disruption, or key or chronic sleep deprivation in people with severe sleep apnea. And that can indeed, recent research suggests that that might be a biomarker or a guide to tell us at the brain level what’s going on in terms of these people being chronically sleepy during the day, in that we see more sleepiness in people that have that high arousal threshold endotype compared to those light sleepers.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.