Might We Treat Sleep Apnea With a Pill in the Future?

Much of the discussion about obstructive sleep apnea (OSA) focuses not just on the diagnosis, but its treatment options.

While positive airway pressure (PAP) may be considered the “gold standard” for therapy for this particular sleep-breathing disorder, not everyone wants to use PAP or can tolerate it.

Other options to treat OSA include oral appliance therapy, hypoglossal neurostimulation implant surgery, outpatient oral surgeries to remove parts of the tongue, and positional therapy.

Still, each of these treatment options faces its share of challenges, including cost, risks associated with surgical procedures, comfort, and effectiveness. It's not new for researchers to ponder the question, can we treat OSA with a pill?

Could a drug treat sleep apnea?

Indeed, research has sought pharmaceutical options for treating OSA in earnest since the mid-2000s.

A medical study published in Sleep in August 2006 provided a review going back to 1985 tracing research efforts that sought to identify a drug treatment for sleep apnea. The authors acknowledged the tremendous obstacles they’d need to overcome to make this happen, but concluded:

We should strive towards the development of universally effective pharmacotherapies for sleep apnea. To accomplish this, we require a greater knowledge of the neurochemical mechanisms underlying sleep apnea, and we must use this infrastructure of knowledge to design well-controlled, adequately powered studies that examine, not only effects on the apnea/hypopnea index, but also the effects of pharmacotherapies on all health-related outcomes shown beneficial with PAP therapy.¹

In other words, more research needs to take place before they can confirm that OSA-specific drugs are a viable option.

Research is ongoing, though the process has been slow. Breathing while asleep is a complex process. Any drug used to control that process must effectively manage several other processes that actively take place as we sleep.

What a sleep apnea drug might need to do

A more recent discussion centered on more recent trials examined possible drug interventions to treat OSA. In the Gaisl study, published in Sleep Medicine Reviews in 2019, the researchers acknowledged 4 different causes which contribute to sleep apnea:²

1. Impaired muscle activity during sleep

This describes the soft, floppy muscle tissue in the throat which can block the airway, creating an obstruction.

2. Restricted airway

The 2 chief causes of a narrowed airway are:

• Congestion and related respiratory problems (such as asthma)
• Obesity, which leads to collection of fatty tissue around the neck, contributing to obstruction

3. Unstable breathing control

This problem originates in the brain in the area charged with regulating breathing rhythms. It’s considered a neurochemical concern, as it relates to shifts in the balance between levels of oxygen and carbon dioxide in the bloodstream.

4. Low arousal threshold

Some people tend to awaken more easily when breathing is interrupted during sleep.

These causes for apnea were first categorized in a model published in 2011.³

However, it was Gaisl et al. who actively suggested that any future drug developed to treat sleep apnea should strive to address all 4 of these contributing factors.²

What does current research say?

There’s some progress to report regarding drugs that help with one or more of these causes.

A small study in 2018 reported that a combination drug reduced sleep apnea severity, improved overnight blood oxygen levels, and more actively engaged muscles in the jaw.⁴

Apnimed then launched clinical trials to further pursue this combination of oxybutynin and atomoxetine, which some now refer to as a potential “stop snoring drug.”⁵

Scientists at the IIT Research Institute in Chicago have isolated a family of compounds based on amino acids. These compounds have been shown to maintain the tone of the airway muscles during sleep and modulate breathing patterns. This novel category of drugs is in early research funded by a 5-year, $9.5-million grant provided by the National Heart, Lung and Blood Institute.⁶

Meanwhile, a cannabinoid-based drug, dronabinol, remains in early-stage research at the University of Illinois Chicago as they work out proof-of-concept, safety, and efficacy protocols for their formulation of a potential future sleep apnea drug.⁷

The bottom line

If you live with OSA, it may still be quite some time before approval for an actual sleep apnea pill takes place.

In the meantime, treat your sleep apnea the best that you can.

If you’re struggling with your current therapy, a pill may seem promising but it’s still the subject of scientific experimentation. You may need to talk to your sleep doctor about reviewing your current treatment options instead.