The Shifting Sands of Sleep Apnea
This article was originally published in Start Up
Lack of sleep is bad in its own right, but now the knowledge that obstructive sleep apnea is a risk factor for and even a possible cause of heart disease adds urgency to what the medical community has until recently viewed as a quality of life problem. However, the existing infrastructure for diagnosing and treating OSA can neither handle the current demand nor the expected influx of new patients coming in from the cardiology community. New companies hope to fill gaps in diagnosis and therapy, but they face all the challenges of establishing technological and business approaches in an evolving field, with the need to change practice patterns, educate patients and multiple groups of physicians, and win the buy-in of payers.
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Although more than 20 million people in the US are affected by obstructive sleep apnea (OSA), the standard of care for the disorder--a continuous positive airway pressure (CPAP) machine applied at bedtime with a nasal or facial mask to keep airways propped open--carries a noncompliance rate of almost 50%. ImThera Medical Inc. is developing a new implantable neurostimulation device that stimulates certain tongue muscles during sleep to open the upper airway and potentially help patients who are unable or unwilling to use CPAP or pursue surgical alternatives.
There's a reason why Philips paid $5 billion and a premium to buy Respironics. Sleep apnea is an enormous emerging opportunity: in the US, 38 million patients have the disease, and there are compelling clinical reasons to treat them. That's big business for device companies, if only they can access patients and establish new referral patterns in a highly fragmented market.
(Please see Start-Up, March 2008, for an expanded version of this article). Although the patient population is woefully undiagnosed, approximately 38 million in the US alone suffer from obstructive sleep apnea. There are a number of new technologies in development to improve on surgery and CPAP--traditional treatments for this silent killer--and device makers are casting about for wider markets in which to sell their goods. At its current rate of penetration, OSA will create close to a $3 billion worldwide market within two years.