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Despite the widespread prevalence and significant burden of obstructive sleep apnea (OSA), a large majority of people living with OSA remain underdiagnosed and undertreated^1,2. This is especially concerning given both the incidence of OSA – impacting more than 80 million Americans, and a billion people worldwide – and its profound health risks, including cardiovascular disease, type 2 diabetes, depression, and cognitive decline^3,4.

The SHINE survey (n=1500), the largest-ever psychosocial survey of those living with OSA, reveals that 59% of people with OSA identify long-term health consequences as their primary concern about OSA⁵. Fifty seven percent share that living with OSA negatively impacts their relationships with family and friends. Additionally, 92% cite negative impacts on their work productivity and 86% are limited in their ability to perform daily activities.

Given these whole-life impacts, it should be deeply concerning to all who work in the sleep medicine field that the majority of those diagnosed with OSA refuse, abandon or underutilize treatment often due to their complexity or invasiveness, or due to discomfort with existing options. This stark reality underscores the urgent need for innovative therapies that not only address the physiological causes of OSA but also fit seamlessly into patients’ lives.

Addressing the complexity of OSA with a comprehensive approach

The pathophysiology of obstructive sleep apnea (OSA) is generally attributed to two interconnected mechanisms^6-9. Firstly, nearly all individuals diagnosed with OSA exhibit some level of anatomic constriction in the upper airway. This constriction can arise from a variety of factors, with obesity being one contributing element. However, a narrowed airway on its own is not sufficient to lead to OSA. The condition is often initiated by a neuromuscular dysfunction, which is marked by an abnormal loss of muscle tone in the upper airway muscles during sleep. Interventions targeting this neuromuscular dysfunction, whether through pharmacological treatments or electrical stimulation, have demonstrated effectiveness in managing OSA across all weight classes and in those unable or willing to use PAP therapy. 

To truly transform OSA treatment and care, we must adopt an expansive approach to treatment – one that addresses the diverse needs of patients and targets the specific mechanisms of this multifaceted disease. The goal is to reach a paradigm where individuals with OSA have a variety of treatment options to try, and perhaps to use concurrently, to help them get the oxygen and sleep they need. It is this diverse approach that will provide the greatest chance of improving the lives of over 80 million Americans with OSA.

A patient-centric vision to drive diagnosis and treatment forward

There is a profound need for diverse treatment options. The rapid pace of enrollment in OSA research and trials underscores this need. This enthusiasm is a reminder that innovation and more treatment options are needed to truly make an impact for these patients.

Imagine an OSA treatment paradigm where patients are not confined to a single path but can choose from a variety of safe and effective options tailored to their unique needs. Many serious chronic illnesses are managed this way, and over the next five years, I believe we have the potential to reach this vision, driven by innovation, collaboration, and a commitment to improving outcomes. Clinicians and patients will have more tools than ever to construct personalized treatment programs for OSA:

Weight loss therapies – GLP-1 therapies represent an important advancement for patients with obesity-related OSA. While weight loss has long been an adjunctive therapy for OSA, this approach to medical weight loss has delivered a realistic solution to improve OSA in a subset of patients.¹⁰

Neuromuscular therapies – Innovations targeting the neuromuscular dysfunction of OSA, such as the investigational agent AD109¹¹ and hypoglossal nerve stimulator devices¹², represent an exciting frontier in OSA treatment. These therapies address the root cause of airway collapse during sleep, offering a potential solution for patients across a broad spectrum of the disease.

PAP therapy – These devices will continue to play a crucial role, especially for those who respond well to mechanical airway support.¹³

All of these therapies could play a role in the effort to ensure that the heterogeneous population of people living with OSA has access to effective, tailored care.

As we move forward, our mandate as sleep health professionals is clear: we must think beyond one-size-fits-all solutions and embrace the diversity of OSA. This means continuing to innovate, collaborating across sectors, and keeping patients at the center of every decision.

This is an exciting moment for the OSA community – a moment to reflect on progress, recognize ongoing challenges, and double down on the work needed to transform care. Together, we can make that vision a reality. 

<sup>References
1. American Academy of Sleep Medicine. Hidden Health Crisis Costing America Billions. Published 2016. Accessed January 2, 2025. https://aasm.org/resources/pdf/sleep-apnea-economic-crisis.pdf.</sup> 

^{2. Sterling KL, et al.  J Sleep Res. 2024;33(4):e14099.} 

^{3. Sonmez I et al. Respiratory Medicine. 2025: 108348.} 

^{4. Dewan NA, et al. Chest. 2015;147(1):266-274.} 

^{5. Apnimed, Inc., Sleep Health Inquiries on Needs and Emotions (SHINE) Survey. August 2024.​} 

^{6. White DP. Younes MK. Compr Physiol. 2012;2(4):2541-2594.} 

^{7. Taranto-Montemurro L, et al. J Clin Med. 2019;9(11):1846.}  

^{8. Dempsey JA, et al. Physiol Rev. 2010;90(1):47-112.}  

^{9. Perger E, Taranto-Montemurro L. Curr Opin Pulm Med. 2021;27(6):505-513.} 

^{10. Zepbound (tirzepatide. Prescribing Information).} 

^{11. Schweitzer PK, et al. Am J Respir Crit Care Med. 2023; 208(12):1316-1327.} 

^{12. Alrubasy WA, et al. Respiratory Medicine. 2024; 234: 107826.} 

^{13. McEvoy RD, et al. N Engl J Med. 2016; 375(1): 919-931.}