“Obstructive sleep apnea (OSA) remains an incredibly common and underdiagnosed condition in medicine, and we’re entering a period of rapid innovation. For ENT surgeons, this represents a major opportunity to shape the future of how the disease is managed,” said Christopher Gouveia, MD, an otolaryngologist at Kaiser Permanente Santa Clara in California.
Emerging treatments for OSA encompass medical, surgical, and diagnostic innovations, with multimodal approaches playing a key role. As clinical trials progress, growth is expected across the therapeutic spectrum, while advances in biomarkers, AI-driven analysis, and wearable monitoring are enabling more personalized treatment strategies. Collectively, these developments are expanding the range of options available to ENT surgeons and improving care for their patients with OSA.
“Several emerging treatments in OSA are expanding our armamentarium,” Dr. Gouveia said, citing hypoglossal nerve stimulation, glucagon-like peptide-1 (GLP-1) agonists, and other novel pharmacological treatments, such as Apnimed’s AD109. “Beyond that, numerous companies are working to further expand our treatment capabilities. It’s an exciting time to be a sleep surgeon.”
Emerging Treatments
Within hypoglossal nerve stimulation, two new devices are available to patients beyond Inspire Medical’s platform, which gained U.S. Food and Drug Administration (FDA) approval in 2014.
Nyxoah’s Genio System was approved in August 2025 and is now being implanted in the U.S., and LivaNova’s aura6000 gained FDA approval more recently, with a planned launch in 2027 (https://investor.livanova.com/node/19136/pdf). “Both have clinical data to support their use in moderate-to-severe OSA, and the choice between systems is best made in discussion between the surgeon and the patient,” Dr. Gouveia said. “Looking ahead, several companies are developing novel technologies with unique form factors and also exploring novel neural targets—most notably the ansa cervicalis—which may expand candidacy or complement existing hypoglossal nerve stimulation approaches through a distinct anatomical mechanism.”
David Kent, MD, associate professor, director of sleep surgery, and director of translational research in the department of otolaryngology–head and neck surgery at Vanderbilt University Medical Center in Nashville, recently incorporated the Genio System into his practice. “It uses an external stimulator to power the implanted stimulator component, which may be an excellent option for patients wishing to avoid implantation of a power source that requires eventual reoperation for battery replacement,” he said. “Other treatments are still being translated from the research realm into clinical practice.”
As neuromodulation therapies continue to evolve, OSA treatment is also progressing with medical and diagnostic innovations. “The most interesting developments on the medical side are new positive airway pressure (PAP) modalities and pharmacologic treatments,” Dr. Kent said. A new form of PAP treatment called Kairos PAP (KPAP), the proprietary technology behind SleepRes’ Kricket PAP device, recently gained FDA clearance (BusinessWire. https://tinyurl.com/cz34zepm). The technology provides an “EPAP > IPAP [expiratory positive airway pressure greater than inspiratory positive airway pressure] approach with unique triggers within the respiratory cycle that are reported to reduce pressure-related discomfort without affecting efficacy,” Dr. Kent said. “From the pharmacology side, AD-109 (a combination of aroxybutynin and atomoxetine that increases muscle tone in the airway) has shown significant reductions in the apnea–hypopnea index (AHI) in a phase 3 trial, and the company is expected to seek FDA approval this year.”(Am J Respir Crit Care Med. doi:10.1164/rccm.202306-1036OC).
“Regarding diagnostic innovations, researchers continue to explore OSA endotype factors that may inform patient responses to different therapies for OSA. The most developed of these approaches uses the PALM (Passive critical closing pressure of the upper airway, Arousal threshold, Loop gain, and Muscle responsiveness) scale to assess pathophysiologic factors driving OSA development in a particular patient. While not yet routinely used in the clinical realm, the hope is that endotyping may help better personalize therapy decisions for patients in the near future,” Dr. Kent said.
Kathleen L. Yaremchuk, MD, MSA, chair emeritus in the department of otolaryngology–head and neck surgery at Henry Ford Health, a professor at Wayne State University School of Medicine and a professor at Michigan State University School of Human Medicine, all in Michigan, and past president of the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS), highlighted pharmaceuticals as exciting emerging treatments for OSA.
Trizeptide (Zepbound; Eli Lilly), a GLP-1 and GIP receptor agonist, was approved by the FDA for OSA in December 2024. “About 60-70% of OSA patients are obese, and there is significant data that demonstrates that an increase in the body mass index (BMI) increases the occurrence of OSA. If we accept that obesity is a chronic condition, the common narrative that patients gain their weight back when they stop the medication becomes irrelevant. We don’t consider antihypertensives or other medications ineffective when the patient stops taking them,” Dr. Yaremchuk said. She cited a 2025 study demonstrating that patients with OSA “who lost at least two BMI points after hypoglossal nerve implantation showed the greatest reduction in AHI.” (Otolaryngol Head Neck Surg. doi:10.1002/ohn.1317).
Clinical Use and Knowledge
“ENT surgeons performing surgeries for OSA need to understand the benefits of multimodality therapy such as the combination of surgical procedures, oral appliances, exercise, and weight loss,” Dr. Yaremchuk said. “The opportunity for collaboration with our sleep colleagues in pulmonary, endocrinology, and other specialties that cross paths with patients who suffer from sleep breathing disorders makes this a team sport and one that will benefit the patient.”
Megan Durr, MD, chief of otolaryngology–head and neck surgery at the Zuckerberg San Francisco General Hospital and professor in the department of otolaryngology–head and neck surgery at the University of California, San Francisco, said, “At UCSF, we are discussing all options with patients, and we are set to start implanting Nyxoah Genio soon, with Livanova aura6000 hopefully following soon after.”
For ENT surgeons, “it is important to know that we have three FDA-approved hypoglossal nerve stimulation devices for OSA, and each works slightly differently. They have different battery options (implanted versus non-implanted), different ways of nerve stimulation (unilateral versus bilateral), differences in timing of stimulation, and MRI compatibility, among others. While many patients are candidates for all options, some may be better candidates for certain devices given their specific situations,” Dr. Durr said.
Having more treatment options “is a really good thing for patients struggling with OSA. It will, even more than before, stress the importance of shared decision making with patients as otolaryngology–head and neck surgery providers discuss the various nerve stimulation options,” Dr. Durr said.
For Phillip Huyett, MD, director of sleep surgery at Massachusetts Eye and Ear and assistant professor at Harvard Medical School, both in Boston, the most notable recent OSA treatment additions to his practice are the fifth generation of the Inspire device (Inspire V implant) and the Genio System this past year. “We are always open-minded to other new devices and medications, often those we hear about from patients,” he said.
OSA is a highly heterogeneous condition without a perfect one-size-fits-all treatment, Dr. Huyett explained. “The field is rapidly evolving from CPAP [continuous positive airway pressure] and UPPP [uvulopalatopharyngoplasty] to now dozens of different medical and surgical treatment options. It’s important to avoid becoming complacent with current treatments and always be willing to consider newer treatments. As we learn more about the pathophysiology of OSA and how to determine it clinically, customized treatment planning is going to become increasingly more precise.”
Dr. Kent believes surgeons must stay informed of the new OSA treatment options. “The medical and surgical options for OSA are rapidly expanding, and change is coming. It’s important for surgeons to stay informed of these options as they come online.” He recommends attending the International Surgical Sleep Society (ISSS) annual meeting that immediately precedes that of the AAO-HNS.
“Patients (and providers) will soon have more treatment options than have ever been previously available. The goal is to ultimately be able to personalize care to direct patients to the most efficacious and preferable therapy for them from the beginning,” Dr. Kent said.
When incorporating new OSA treatments into clinical practice, Robson Capasso, MD, a professor of otolaryngology–head and neck surgery at Stanford University in California, is focused on a balanced, multimodal model of care.
Dr. Capasso and Dr. Gouveia co-author a sleep apnea newsletter, called “Night Shift,” which is published weekly and focuses on the practice, technology, and finance of sleep health (Sleepdocs.substack.com).
“Sleep apnea represents a chronic disease that requires ongoing management aimed at improving health outcomes and quality of life, with careful weighing of the pros and cons of each treatment,” Dr. Capasso said. “As surgeons, we are often among the first providers patients see when CPAP hasn’t worked out—and because of that, we are often the first to review all available options. Our deep knowledge of upper airway anatomy and physiology uniquely positions us to evaluate the full picture. We routinely discuss the complete menu of options—CPAP, oral appliances, weight-loss interventions, other non-surgical modalities, surgery, and hypoglossal nerve stimulation—rather than defaulting to any single approach. The goal is always to match the therapy to the patient’s anatomy, physiology, and preferences.”
“For patients, the biggest shift is choice—OSA is increasingly becoming a condition with multiple viable treatment pathways rather than a single therapy that many people struggle to tolerate. For surgeons, it means developing expertise not only in surgery but also in selecting and coordinating among a growing ecosystem of therapies,” Dr. Capasso said.
Clinical Trials
Clinical research has been a core part of Dr. Capasso’s practice. “One of the more exciting projects I’m currently involved in is an industry-sponsored trial in partnership with Samsung. The intersection of consumer electronics and potential clinical deployment is a fascinating space, and this kind of work has real potential to change how we identify and monitor patients at scale,” he said.
“When deciding which trials to participate in, I look for a few things: scientific merit, alignment with my clinical and research interests, the credibility of the sponsor or academic partner, and—critically—whether the work could genuinely move the needle for patients. Clarity and the feasibility of enrollment within my patient population and state-of-the-art operational support are key. Not every opportunity is the right fit, and being selective is important,” he said.
For surgeons interested in getting involved in clinical research, Dr. Capasso’s advice is to start by identifying the needs that genuinely keep you up at night clinically, and don’t underestimate the infrastructure required to run a trial well. Having a strong team of research managers, coordinators, legal and financial support, and clear operational resources is essential.
Dr. Huyett participates in clinical trials primarily to help shape future treatment options and stay informed about the latest developments in the field. “Obviously, clinical trials are time-consuming commitments for surgeons who already have overbooked schedules and personal lives, but I would encourage everyone to consider trying it at least once,” he said. “I am a full-time clinical, whereas others have significant research time. If you are fully clinical, I can’t recommend surrounding yourself with great research support staff strongly enough.”
Dr. Kent continues to participate in several clinical trials and runs his own translational research trials. “I am personally most interested in developing new surgical neurostimulation targets as I believe the ability to expand the net of treatable patients will be of highest value to our field, but it is certainly worthwhile to invest effort to refine patient selection with our currently available treatments as well.”
Otolaryngologists and sleep surgeons must be a part of device development and clinical trials, according to Dr. Durr. “We have a detailed understanding of the airway anatomy and real-world experience with these devices. We understand what patients are struggling with and what they are looking for, and we can help translate new devices into patient-centered care.”
Looking Ahead
Over the next decade, Dr. Durr anticipates continued updates and improvements in nerve stimulations, “both of the hypoglossal nerve and likely other nerves that could contribute to airway patency at night. I think this will lead to better patient outcomes and better tolerance of the devices. I also think we will continue to develop better options for identifying and treating specific OSA endotypes—loop-gain, arousal threshold, hypotonia, etc.—via medications, devices, and even behavioral therapies for a more personalized treatment plan.”
Similarly, Dr. Huyett foresees additional neurostimulation targets and multiple systems to target existing nerves (i.e., hypoglossal nerve, ansa cervicalis). He also anticipates “medications to augment treatments and an increased ability to phenotype/endotype patients for better customization of non-PAP treatment options. Practicing sleep surgery in the GLP-1 receptor agonist era also brings a lot more patients into the BMI range where surgical interventions become appropriate.”
Almost a third of patients have a non-anatomic cause for their OSA, Dr. Yaremchuk said. “This means that these patients have physiologic components such as genioglossus muscle responsiveness during sleep, low arousal threshold, or high loop gain,” she said. “Pharmaceuticals are in the pipeline that will work at the level of the brainstem to increase muscle responsiveness of the upper airway. OSA is a heterogeneous disorder, and the challenge will be to identify those patients who will benefit from surgery.”
“It is an exciting time to be involved in sleep medicine, and there are multiple sleep fellowships available that include otolaryngologists as faculty and time in the operating room for surgery. This enables the fellows to achieve sub-certification in sleep medicine through the American Board of Internal Medicine (ABIM),” Dr. Yaremchuk said.
According to Dr. Capasso, OSA care will likely become far more personalized over the next decade. “A critical part of that evolution will be a deeper understanding of when upper airway narrowing during sleep is truly pathological versus a normal physiological variant—and developing the biomarkers and clinically meaningful endpoints needed to make that distinction reliably. Moving beyond AHI alone toward metrics that reflect cardiovascular, metabolic, and neurocognitive impact will be essential to guiding treatment decisions and demonstrating real-world value. Advances in diagnostics, phenotyping, wearable monitoring, and AI-driven analysis of sleep data will help match patients to the therapies most likely to work for them. We’ll also see continued growth across the full therapeutic spectrum: surgical and implantable devices, less invasive modalities, and medical therapies. The convergence of better biology, smarter technology, and more precise endpoints should meaningfully raise the bar for what we can offer patients.”
ENT surgeons are uniquely positioned to lead in the OSA treatment space, Dr. Gouveia concluded. “As champions of the airway, we have a unique ability to understand the root cause of a patient’s OSA and design treatments accordingly. As [sleep medicine is] a truly multidisciplinary field, surgeons need to understand sleep testing, medical therapies, device-based treatments, and patient phenotyping. The surgeons who thrive will be those who think of themselves as sleep physicians with surgical expertise, not just proceduralists.”
Katie Robinson is a freelance medical writer based in New York.
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