Raman Malhotra, MD

“Things are changing rapidly in the field of sleep medicine, and in medicine, in general.”

This year has shaped up as one full of advances, particularly in the realm of Alzheimer and dementia, with Biogen’s aducanumab slated for an FDA decision that may offer the first approved therapeutic for Alzheimer disease. However, some advancing science in that realm flew somewhat under the radar at the American Academy of Sleep Medicine (AASM)’s annual meeting, SLEEP 2020.

As Raman Malhotra, MD, associate professor of neurology, Washington University in St. Louis, and board of directors, American Academy of Sleep Medicine, pointed out in an interview with 

, some of the highlights of that meeting included some preclinical work that suggested that sleep may actually play a role in the progression and/or onset of dementia. This implies that some sleep interventions might hold promise in the fight against dementia, he noted.

Additionally, Malhotra detailed a number of presentations on novel medications in the sleep space, including positive data for solriamfetol (Sunosi; Jazz Pharmaceuticals) and pitolisant (Wakix; Harmony Biosciences), and offered insight into the mechanisms of these therapies and their potential impact.

 He also shared his perspective on the overall advances that have been made in sleep medicine, including the steps taken in diagnostics and sleep measurements.

REFERENCES
1. Winter W, Wanaski SP, Patroneva A, Dayno JM. Cardiac safety profile of pitolisant in patients with narcolepsy. SLEEP 2020. Abstract 0744.
2. Vinckenbosch F, Asin J, De Vries N, et al. Effects of solriamfetol on driving performance in participants with excessive daytime sleepiness associated with obstructive sleep apnea. Presented virtually at SLEEP 2020. Poster 0673.

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The associate professor of neurology at Washington University in St. Louis detailed a number of key presentations on advances and novel medications in the sleep space.

Raman Malhotra, MD: Highlights From Sleep 2020

“We’ve never had [medications for obstructive sleep apnea] shown to be effective, and there are different combinations that will work to keep the airway a little more patent and open at nighttime, as an oral medication. That would be groundbreaking.”

Sleep specialists have long been waiting for a major step forward in the pharmacologic realm of therapeutic development, and in the last few years, a number of therapies have successfully made their way through the pipeline toward the market. Additionally, after years of challenges in acquiring sleep measurements and conducting sleep studies, new devices have offered a promising look for the future.

One such therapeutic advancement includes a possible successful agent for the treatment of obstructive sleep apnea (OSA), a widely common condition with an effective treatment—continuous positive airway pressure (CPAP)—that is plagued by adherence obstacles. For Raman Malhotra, MD, associate professor of neurology, Washington University in St. Louis, and board of directors, American Academy of Sleep Medicine, an oral agent to help these patients’ airways stay open would be a game-changer.

, Malhotra explored the potential of such a therapy, and detailed some of the advances he’s been looking forward to. In the diagnostic area, he touched on progress being made in allowing for better at-home sleep measures, done with contactless monitoring. He also shared some insight into the possibility of devices that can measure and deliver temperature and sound changes during the night, building on recent literature that suggests these interventions might have success.

The associate professor of neurology at Washington University in St. Louis discussed a number of recent advances in therapeutics, as well as diagnostic and measurement devices, in sleep medicine.

Raman Malhotra, MD: What to Look Forward to in Sleep Medicine

“Many would argue that insomnia is more common than obstructive sleep apnea, but unfortunately, I think most patients who have problems either getting to sleep or staying asleep at night will self-medicate.”

Obstructive sleep apnea (OSA) is often pointed to as an under-diagnosed and under-treated sleep disorder, and is considered widely prevalent, with some estimates claiming it occurs in approximately 3 to 7% of adult men and 2 to 5% of adult women in the general population.

 Additionally, the challenges faced by patients in adherence and treatment with continuous positive airway pressure (CPAP) can often dominate the conversations about unmet needs in sleep.

However, for sleep specialists such as Raman Malhotra, MD, associate professor of neurology, Washington University in St. Louis, and board of directors, American Academy of Sleep Medicine, another disorder that requires just as much attention is insomnia. Many of these patients turn to self-medication with over-the-counter therapies or illicit drugs and alcohol, he said, and when they do see non-sleep specialists for these sleep issues, they can be prescribed medications that carry habit-forming risks.

, Malhotra offered some insight into the available nonpharmacologic therapeutics for insomnia, such as cognitive behavioral therapy, and detailed a number of other advances that have been made in the care of patients with sleep disorders in the past several years.

REFERENCE
1. Pubnjabi NM. The Epidemiology of Adult Obstructive Sleep Apnea. 

. 2008 Feb 15; 5(2): 136–143. doi: 10.1513/pats.200709-155MG

The associate professor of neurology at Washington University in St. Louis spoke to the need to improve the awareness for insomnia, which remains one of the most common sleep disorders.

Raman Malhotra, MD: Increasing the Attention on Insomnia

“What’s been so exciting in the state of sleep medicine is we’ve had technology and innovation breakthroughs that are allowing us to learn more about sleep in our patients, including patients’ sleep at home.”

Over the past couple of years, the state of care in sleep medicine has been bolstered by a number of critical advances that have been made. Of course, the approval of a number of novel treatments has made a positive impact, but particularly, technological steps forward have allowed for a drastic overhaul in how—and where—sleep can be measured.

For Raman Malhotra, MD, associate professor of neurology, Washington University in St. Louis, and board of directors, American Academy of Sleep Medicine, the ability to measure patients’ sleep in their own homes has been a great step forward for the field. As well, in this interview with 

, he cited that the improved awareness and education around sleep’s impact on health, in general, has been excellent.

Although, these advances have not left every stone unturned, as a number of challenges remain unaddressed. Malhotra expanded on some of these, exploring the obstacles in providing proper care for patients with obstructive sleep apnea (OSA) and adherence to continuous positive airway pressure (CPAP), as well as touching on the lack of objective measures for daytime sleepiness.

The associate professor of neurology at Washington University in St. Louis discussed the challenges that sleep specialists continue to face despite a number of recent advances in the space.

Raman Malhotra, MD

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