New treatments, including oral medications and GLP-1 therapies, are expanding options beyond CPAP for sleep apnea.
By
Lana Pine
| Published on January 27, 2025
6 min read
Larry Miller, M.D.
Credit: MedCity News
Obstructive sleep apnea (OSA) is a serious but often undiagnosed sleep disorder that affects millions of people worldwide. If left untreated, OSA can lead to serious health risks, including heart disease, stroke, diabetes and cognitive decline. Luckily, treatment options are rapidly evolving, from improved continuous positive airway pressure (CPAP) technology to new oral medications, including Apnimed’s AD109 and GLP-1 therapies, offering hope for better management of this widespread condition.
In an interview with The Educated Patient, Larry Miller, M.D., chief executive officer at Apnimed, explains that with nearly 1 billion cases globally and 80 million in the U.S. alone, raising awareness about this condition is crucial for improving diagnosis and treatment.
What is obstructive sleep apnea, and how common is it?
Larry Miller, M.D.: OSA occurs when your breathing is repeatedly interrupted during sleep. This occurs because of two main problems working together. First, most people with OSA have a narrower airway in the back of their throat, which can be due to various reasons — obesity is just one of them. But having a narrow airway alone doesn’t cause sleep apnea. The second issue is that the muscles in the throat, which normally keep the airway open, lose their tone or strength when you fall asleep. This combination leads to the airway collapsing, making it hard to breathe.
What’s the biggest myth about sleep apnea that you wish more patients understood?
LM: One of the biggest myths about OSA is that it primarily affects people with obesity. While obesity is a risk factor, recent epidemiologic research confirms that the majority of individuals with OSA do not have obesity. Airway narrowing can be linked to obesity, but airway muscle problems are not related to obesity.
Some people think snoring automatically means they have sleep apnea. How can patients differentiate between the two?
LM: While snoring can be a symptom of sleep apnea, not all snoring is due to sleep apnea. Sleep apnea involves periods of stopped or reduced breathing during sleep, often leading to gasping, choking, or restless sleep. Many people with sleep apnea snore, often loudly, but by no means everyone. If people have loud or problematic snoring, they should seek health care and perhaps have a diagnostic sleep study.
There’s a belief that using a CPAP machine is always uncomfortable or ineffective. Can you share how technology and treatment options have improved?
LM: CPAP technology has significantly improved in recent years, with more user-friendly and comfortable designs aimed at enhancing patient experience. When used properly and consistently, CPAP can be highly effective in treating OSA. However, the fact that many, in fact most, people with OSA still refuse or abandon CPAP highlights its limitations and emphasizes the need for a better tolerated treatment approach to meet the diverse needs of people with OSA.
New oral pharmacological treatments, such as AD109 that Apnimed is developing, address the neuromuscular problems causing airway collapse and offer a simpler, less invasive alternative. Additionally, GLP-1 therapies for obesity-related OSA and other device-based innovations are expanding the range of effective treatment options.
Can untreated sleep apnea really cause serious health problems like heart disease or stroke? How strong is the connection?
LM: Yes, untreated OSA significantly increases the risk of cardiovascular diseases, stroke, type 2 diabetes, hypertension and cognitive decline. The recent SHINE survey revealed that untreated OSA also has profound effects on daily life, including fatigue, decreased productivity and limitations in performing daily activities. The connection between untreated OSA and these health issues is well documented, highlighting the importance of timely diagnosis and treatment.
What signs and symptoms should patients watch out for if they suspect they have sleep apnea?
LM: Key signs and symptoms include loud, persistent snoring, episodes of gasping or stopping breathing during sleep (usually observed by others), excessive daytime sleepiness, morning headaches and difficulty concentrating. If these symptoms are present, individuals should consult a healthcare provider for evaluation.
Is there anything else you would like our audience to know?
LM: We are at the dawn of a new era in OSA care, with innovations poised to transform treatment for this complex condition. At the forefront of these advancements is Apnimed’s AD109 — a first-of-its-kind oral medication — currently in two large late-stage clinical trials with results expected midyear. In addition, progress in GLP-1 therapies and CPAP technology reflects a shift toward a more comprehensive and personalized approach to treatment. I’m optimistic that we’re moving toward a future with more effective, accessible and tailored options that truly address the diverse needs of people living with OSA, improving both their health and quality of life.