Could a nasal spray treat obstructive sleep apnoea?

A drug in development for obstructive sleep apnoea (OSA) has shown promising results, after researchers from Flinders University tested the treatment in people for the first time.

Designed to prevent the narrowing or collapse of the upper airways during sleep, a key factor in OSA, the treatment could prove to be a potential alternative for certain people with OSA to continuous positive airway pressure (CPAP) machines, which can only be tolerated by about half of all OSA sufferers.

“While further rigorous clinical evaluation and testing is required, this is a great first step and should offer some hope to the many people worldwide who suffer from sleep apnoea,” says study senior author Professor Danny Eckert, Director of Flinders’ sleep lab FHMRI: Sleep Health.

“OSA is one of the most common sleep-related breathing disorders, with an estimated one billion sufferers, and when untreated is associated with major health and safety consequences. While CPAP machines are effective, tolerance remains a major issue for many and other treatments such as dental splints and upper airway surgery don’t always work. This is why we need new treatment options for OSA.

“At the moment, there are no approved drug treatments for OSA. However, with advances in our understanding of the different reasons people get OSA, the potential for effective new medications is growing stronger each year.”

Published in the journal Chest, the study tested the drug on 12 people with OSA using either nasal drops, a nasal spray or via direct application using an endoscope, versus a placebo.

Monitoring for sleep and airway activity across several sessions, the team found consistent and sustained improvements in the patients’ airways staying open throughout sleep, compared to the placebo treatment, regardless of the delivery method used.

“Although a small study, our findings represent the first detailed investigation of this new treatment in people with OSA, with promising results,” says study lead author Dr Amal Osman from FHMRI: Sleep Health.

“The drug we tested is designed to target specific receptors that are expressed on the surface of the upper airways, triggering them more easily to activate the surrounding muscles to keep the airway open during sleep. While there’s still a long way to go in terms of clinical testing and development, our study shows targeting these receptors may be a promising avenue for future treatments.”

The paper – ‘Topical K+ channel blockage improves pharyngeal collapsibility: A translational, placebo-controlled trial’ by Amal M. Osman, Sutapa Mukherjee, Thomas J. Altree, Martina Delbeck, Doris Gehring, Michael Hahn, Tina Lang, Charles Xing, Thomas Muller, Gerrit Weimann and Danny J. Eckert – is published in the journal Chest. DOI: 10.1016/j.chest.2022.11.024.

Funding support: The study was sponsored by Bayer, manufacturer of the drug tested. Professor Eckert is funded by a National Health and Medical Research Council of Australia Leadership Fellowship.

Potential conflict of interest: DJE reports grants from Bayer, Apnimed, Invicta Medical, Takeda, serves as an advisor for Bayer, Invicta Medical, Mosanna, and Apnimed. TJA serves on a scientific advisory board for Jazz Pharmaceuticals. MD, DG, MH, TL, CX, TM and GW are employees (including stock options) of the study sponsor. AMO and SM do not have any potential conflicts to declare.

FHMRI: Sleep Health runs a large number of clinical sleep trials each year. For more information or to discuss your suitability for trials register as a research study volunteer at https://redcap.link/AISHResearchVolunteer or email aish.sleeplab@flinders.edu.au.