Sleep Apnea Devices: The Changing Of The Guard

Article preview from Start Up- October, 2010

The current specialty-dominated care paradigm for sleep apnea can't scale-up to meet the demands of an enormous and serious chronic disease. New companies help move diagnosis and treatment to the physicians that see patients first.

Sleep Apnea Devices: The Changing Of The Guard

Article preview from Start Up- October, 2010

Sleep apnea is a large market with room for both new diagnostics and therapies; it's a $4 billion global market today largely based on a single product area.

Because sleep apnea is associated with many important core disease areas – cardiovascular disease, obesity, and diabetes – companies have long looked at the condition as a strategic growth opportunity, but they haven't been able to realize the potential value.

Referral patterns, market fragmentation and the hegemony of clinical and commercial stakeholders – sleep physicians and the respiratory product companies that serve them – have made it difficult for companies with new products to break into this market.

Recently, innovation in sleep apnea has been accelerating in a new direction, one that breaks the logjams by including not only sleep specialists, but the frontline physicians – primary care docs and cardiologists – who see patients the most.

The 25-year-old field of sleep medicine, now covering some 80 different disorders, is still emerging, and the role of sleep itself remains shrouded in mystery. For the group of diseases categorized as sleep disordered breathing, however, the picture is becoming clearer. There is now widespread recognition that the breathing stoppages resulting from obstructive sleep apnea (OSA) do more than disrupt sleep. OSA has come to be viewed as a co-morbidity, a risk factor, a catalyst, or even a causal agent for many serious diseases.

Sleep apnea in all of its forms (OSA, central sleep apnea and mixes of the two) has strong links to cardiovascular conditions like atherosclerosis, myocardial infarction, hypertension, stroke, and heart failure. It also has a strong association with metabolic disorders, including obesity and diabetes. Whether sleep apnea itself brings on these other diseases or not, it's clear that no good can come of the intermittent hypoxia, release of stress hormones, and other noxious things that happen all night long when an apneiac gasps for breath numerous times per hour.

Obstructive sleep apnea, accounting for the majority of sleep disordered breathing, is essentially a mechanical problem. In certain patients, because of anatomic features (large tonsils, large tongue, excess fat in the neck, flabby tissue, a long soft palate or uvula, or a certain jaw structure) the breathing cycle will result in a narrowing of the upper airway. Specifically, when a person breathes in, he or she creates negative pressure in the upper airway (behind the tongue and soft palate), and in some people that negative pressure causes a collapse of the upper airway, resulting in the vibration that triggers snoring, or even the complete blockage of the airway and an episode of apnea.

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