Obstructive sleep apnea (OSA) is a serious, chronic sleep-related breathing disease that impacts an estimated 80 million people in the United States and nearly 1 billion globally. Untreated OSA carries profound health and quality-of-life consequences. It increases the risk of cardiovascular disease, type 2 diabetes, depression, and cognitive decline. However, the effects extend further into daily activities; insights from a recent survey show that more than 70% of people with OSA experience significant fatigue and daytime sleepiness, while 92% cite negative impacts on their work productivity and 86% are limited in their ability to perform daily activities.

Despite its widespread prevalence and significant burden, a large majority of patients with OSA remain largely underdiagnosed and undertreated. More concerning, even among those who are diagnosed, the majority refuse, abandon or underutilize treatment often due to the complexity, invasiveness, or 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.

The recent FDA approval of the GLP-1 therapy tirzepatide for OSA represents a significant milestone in the treatment landscape for this complex disease. GLP-1 therapies have demonstrated efficacy in weight loss, including in patients with OSA. But as recent research confirms, the majority of patients with OSA do not have obesity, and in recent trials, even those who lost weight on a GLP-1 therapy had substantial residual OSA requiring further treatment. 

The complexity of OSA requires a comprehensive approach

The pathophysiology of OSA typically rests on two concurrent mechanisms. First, almost all patients with OSA have some degree of anatomic narrowing in the upper airway. This narrowing can result from various factors and obesity is just one of them. In addition, a narrow airway alone is insufficient to cause OSA. The disease is typically triggered by a neuromuscular dysfunction, characterized by an abnormal loss of muscle tone in the upper airway muscles at sleep onset. Treatment of this neuromuscular abnormality, whether by a pharmacologic approach or electrical stimulation, has been shown to be effective in addressing OSA in patients with and without obesity.

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

A patient-centric vision for the next five years

Imagine an OSA treatment paradigm where patients are not confined to a single path but can choose from a variety of 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 patient outcomes. Clinicians and patients will have more tools than ever to construct personalized treatment programs for OSA:

These therapies are not competitors — they are collaborators in the effort to ensure that all OSA patients, regardless of their unique situations, have access to effective, tailored care.

Ultimately, the category will evolve in a manner that is consistent with the way other common chronic diseases are treated. I expect multiple treatment approaches will soon be available to address the different mechanisms of the disease and the varying needs of the heterogeneous population of people living with OSA.   

The role of innovation in closing the gap

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 must be both effective and accessible to truly make an impact.

Developing novel pharmacological therapies, including once-nightly oral treatments designed to target the neuromuscular dysfunction underlying airway collapse, is one way to address this unmet need. Simplifying treatment with oral options has the potential to lower barriers to care, enhance adherence, and ultimately improve outcomes for millions of people.

A call to action

As we move forward, the mission 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.

Photo: viridian1, Getty Images

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