Technology is reshaping the treatment of "sleep apnea".

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Editor's note: For decades, bulky ventilators have been the mainstream treatment for sleep apnea. Now, a large number of brand - new therapies are beginning to come into the public eye. This article is from a compilation, hoping to inspire you.

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It has been more than a hundred years since the medical community first recorded sleep apnea in the literature, and it has also been decades since the disease was officially recognized as a clinical illness. Now, the relevant treatment methods have finally undergone a comprehensive innovation.

In 1981, Australian doctor Colin Sullivan invented continuous positive airway pressure (CPAP, ventilator) therapy. Patients wear a mask while sleeping, and the machine can keep the airway open continuously. To this day, it remains the gold standard for the treatment of sleep apnea.

However, not everyone can adapt to this treatment. The new generation of medical technology is breaking the traditional "one - size - fits - all" therapy and bringing more options.

Jörg Steier, a part - time professor of respiratory and sleep medicine at King's College London, said: "The ventilator is not ineffective; its efficacy is conclusive. The problem is that patients have difficulty using it consistently." Multiple studies have confirmed that ventilators can significantly reduce the overall mortality rate and the risk of cardiovascular diseases in patients.

However, many people can't sleep at all while wearing the mask and may experience a strong sense of stuffiness and claustrophobia. A study shows that after three months of treatment, only 38% of patients can reach the minimum standard usage time; after two years of continuous treatment, the proportion of patients who truly use it regularly in the long term is only 45%.

If sleep apnea is left untreated, it can significantly increase the risk of high blood pressure, heart disease, stroke, and dementia, and also make people feel chronically exhausted and listless in daily life.

There are nearly one billion patients with obstructive sleep apnea (OSA) globally, and about 80% of them have not been diagnosed yet. As more and more patients are admitted to the clinic, with different airway physiological structures and symptoms, the medical community has finally realized that a single therapy cannot be suitable for everyone.

Based on this need, Professor Steier developed the Zeus OSA treatment device. This device is worn under the chin at night and uses weak electrical pulses to stimulate the hypoglossal nerve, preventing the throat muscles from relaxing and collapsing during sleep and blocking the airway.

The device is expected to start recruiting for clinical trials in July this year. An early preliminary verification study found that patients with slender necks have particularly ideal treatment effects. Steier explained that this is because the device can act on the key throat muscles at a closer distance. This also makes the device particularly suitable for female patients, as the symptoms of female patients are quite different from those of male patients. Female patients are more likely to wake up completely during an apnea episode and generally cannot tolerate the ventilator mask.

The upcoming multi - center clinical trial will recruit male and female patients in a 1:1 ratio to ensure comprehensive data. Currently, there is also a physical correction plan as an alternative to the ventilator in clinical practice: a customized mandibular advancement device. It looks like a sports mouthguard and is worn while sleeping. It gently pulls the mandible forward to open the airway and reduce airway collapse. This therapy has authoritative medical evidence, but it is very difficult to popularize: it must be customized by a professional dentist during a face - to - face consultation, and ordinary doctors cannot operate it; in the United States, the price of a mouthguard ranges from $1500 to $4500.

Moreover, it is not suitable for everyone: advancing the mandible may not completely open the airway. If the collapse occurs deep in the throat, the correction device will not work; it is only effective for mild to moderate obstructive sleep apnea. Ama Johal, an orthodontic consultant at Barts Health NHS Trust in the UK and the clinical director of 32Co Medical Technology Company, admitted that the medical gap has left many patients in a desperate situation: "Some patients have severe symptoms and really cannot use the ventilator, and we currently have almost no other effective solutions."

Sonya Zamotsky, the founder and CEO of 32Co, explained that dental intervention plays an irreplaceable role: "This kind of correction device can only be customized and fitted by a licensed dentist. It must be tailored to the oral structure during a face - to - face consultation to be effective."

But she made it clear that this device is not intended to replace the ventilator: "We never advise patients to stop using the ventilator on their own and switch to the mouthguard. The final choice of treatment depends entirely on the patient's tolerance and personal preference."

There is also an implantable therapy: Inspire nerve stimulation therapy. This hypoglossal nerve stimulation implant device has long been approved by the US Food and Drug Administration (FDA) for marketing and has been in use for more than 11 years. It has treated more than 100,000 patients in Europe, America, and Asia.

Ruchir Patel, the senior medical director of Inspire Medical, introduced the clinical data: This therapy can significantly improve daytime sleepiness, reduce the severity of sleep apnea by 79%, and reduce snoring symptoms by 90%. Early US data shows that patients use the device for an average of more than 6.5 hours at night. He said: "Now there are more and more treatment options, which is a great opportunity for patients."

There has also been a breakthrough in drug treatment. In 2024, the US FDA approved semaglutide (Zepbound) for the treatment of moderate to severe obstructive sleep apnea in obese adults. This is also the first weight - loss drug specifically approved for this disease.

Meanwhile, Apneai, a startup pharmaceutical company in Cambridge, Massachusetts, USA, has developed a new daily oral drug that specifically acts on the neural pathway that regulates the muscle tone of the upper airway. Instead of opening the airway physically, it stabilizes the throat muscles from a physiological mechanism to prevent natural collapse.

John Cronin, the chief medical officer of Apneai, said: "For a long time, the medical community has only regarded this disease as a physiological structure problem, so it has always relied on physical means for treatment. As research deepens, we began to think: Can we directly target the root cause of the disease and develop drugs from the body's physiological mechanism instead of simply relying on external support?"

Currently, this new drug has completed two Phase III clinical trials, and the company plans to submit a marketing application to the US FDA this year.

Although there are an endless stream of innovative therapies, Professor Steier still maintains a pragmatic attitude: For typical sleep apnea patients, being able to use the ventilator consistently is still the best solution. Today's intelligent ventilators can automatically adjust the air pressure according to airway resistance, and often after one night of use, the symptoms can be significantly improved. Many patients look energetic during follow - up visits and say that they have finally regained a normal life.

Sleep medicine is still a young discipline, and the medical community has only just begun to understand the complexity and diversity of this disease. That's why the industry has not given up on the ventilator but has been optimizing the experience and improving patient compliance.

A study led by Amanda Satyapal, an associate professor at the Cardiopulmonary Research Institute of Imperial College London, found that 62% of patients do not use the ventilator for the required time, so it has no therapeutic effect at all.

Her team studied compliance from a psychological perspective and found that patients' awareness of disease risks and confidence in operating the device directly determine whether they can wear the ventilator consistently in the long term.

Relying on behavioral psychology, she developed an auxiliary app called "Ventilator Buddy", which provides video behavioral intervention guidance, peer - to - peer support and communication, and can answer patients' questions around the clock. This project received a £2.2 million grant from the UK Medical Research Council and strong support from the ventilator manufacturer Fisher & Paykel.

Satyapal said: "The ventilator blows air directly into the airway, and its efficacy is still the strongest among all therapies. As long as patients can use it consistently, it will always be the best choice. So we must find ways to help patients adapt and persevere."

In her opinion, the problem never lies with the device itself but with lifestyle habits: Wearing the ventilator consistently, like losing weight, quitting smoking, and exercising regularly, is a long - term behavioral change that deserves patient guidance and should not be easily abandoned.

Translator: Teresa