Session Schedule

Find a specific presentation in the session by navigating to the timestamp indicated below.

0:00:00
GLPR1 agonists in OSA
Atul Malhotra (United States)

0:16:00
A combination of antimuscarinic agents with selective norepinephrine reuptake inhibitors to treat OSA
Ana Sanchez-Azofra (United States)

0:32:00
Carbonic anhydrase inhibitors to treat OSA
Jan Hedner (Sweden)

0:48:30
Treating sleepiness in OSA: Is it worth it?
Julia Chapman (Australia)

1:05:30
Drug development in OSA: What else in the pipeline?
Vsevolod Polotsky (United States)

1:21:00
Question and answer

Summary

Obstructive sleep apnea (OSA) affects approximately 936 million adults worldwide with 425 million having moderate to severe disease. Continuous positive airway pressure (CPAP) is highly effective treatment, but adherence to CPAP remains low. Oral appliances and hypoglossal nerve stimulation are accepted alternatives, but only in a subset of patients. Effective pharmacological treatment is desperately needed. There is no FDA approved pharmacotherapy for OSA, but several novel modalities are rapidly emerging. The goal of this symposium is to describe the current state of pharmacotherapy in sleep disordered breathing. Three classes of medications for OSA are rapidly being developed . A randomized placebo controlled clinical trial of a glucagon like peptide 1 receptor (GLPR1) agonist tirzepatide showed that it is highly effective for treatment of OSA, but it remains unknown if the drug efficacy is entirely attributable to weight loss. Alternatively, a combination of a norepinephrine reuptake inhibitor atomoxetine and a muscarinic blocker oxybutynin treats apnea by directly stimulating upper airway muscles and improving pharyngeal patency during sleep, but adverse effects on the sleep architecture may be a concern. Another promising direction is stabilization of the upper airway by decreasing a high respiratory loop gain. Investigators have shown that carbonic anhydrase inhibitors are effective drugs targeting this mechanism. Besides medications targeting the pathogenesis of OSA, pharmacotherapy can target symptoms of the disease. Specifically, hypersomnolence is a common complication of sleep apnea, which has a deleterious effect on the quality of life and a risk of motor vehicle and industrial accidents. The role of stimulants in treatment of excessive daytime sleepiness in OSA patients will also be discussed. The final talk will focus on experimental therapeutics at different preclinical and early clinical stages of development. In summary, the audience will receive a comprehensive update on the current state of pharmacotherapy in OSA.