Where Sleep Medicine Is Heading After SLEEP 2026: Anita Shelgikar, MD, MHPE

The themes that dominated SLEEP 2026 continue to shape the field of sleep medicine heading into 2027. Held June 14-17 in Baltimore, Maryland, the conference marked the 40th annual meeting of the Associated Professional Sleep Societies, a joint venture of the American Academy of Sleep Medicine (AASM) and the Sleep Research Society. The meeting featured a wide range of programming, including sleep and neurodegeneration, technology and artificial intelligence (AI), women's sleep health, circadian science, and personalized approaches to sleep apnea treatment.¹

Among the most active areas is the effort to move obstructive sleep apnea (OSA) care beyond a one-size-fits-all model. Current management pathways largely do not account for the heterogeneity of OSA and carry treatment failure rates of approximately 50%. Endotypes offer targets for tailored therapy, including anatomic predisposition to pharyngeal collapse, low arousal threshold, high loop gain, and impaired pharyngeal dilator muscle function. However, establishing technical standards, clinical cutoffs, and clinical utility remains a research priority before these concepts can be used routinely.²

The shift toward mechanism-directed therapy has gained momentum since the meeting. In the phase 3 SynAIRgy trial (NCT05813275), published in July 2026, 646 adults with mild to severe OSA who were intolerant to or refused positive airway pressure therapy received either placebo or AD109 (Apnimed). AD109 is an investigational once-nightly oral combination of aroxybutynin and atomoxetine designed to target neuromuscular dysfunction. At 26 weeks, it reduced apnea-hypopnea index (AHI) by a model-estimated 44.1% from baseline, compared with 17.6% for placebo. Adverse events led 21.2% of AD109 recipients to discontinue, vs 3.1% of placebo recipients.³

The FDA has since accepted the new drug application for AD109, with a target action date of February 28, 2027.⁴ Women's sleep health remains a parallel priority. Data presented at the meeting came from 502 adults with moderate to severe OSA who were starting continuous positive airway pressure therapy. Women had a mean AHI similar to men's (36 vs 40 events per hour) but reported significantly greater symptom burden, including nocturia, headache, and nightmares. The investigators suggested this pattern may contribute to delayed diagnosis in women.⁵

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"Sleep is a fundamental pillar of health, just like movement and nutrition."

To discuss where the field is heading, NeurologyLive® spoke with Anita Shelgikar, MD, MHPE, professor of neurology at the University of Michigan Medical School. Shelgikar highlighted precision medicine, women's sleep health, and the integration of artificial intelligence (AI), wearables, and digital health technologies as major areas of focus at SLEEP 2026. She identified the intersection of precision sleep medicine and emerging technologies as particularly promising, pointing to research on obstructive sleep apnea (OSA) endotyping in pediatric and adult patients to inform risk stratification and treatment decisions involving pharmacologic therapy, positive airway pressure, and surgical intervention.

Shelgikar also discussed the work of the American Academy of Sleep Medicine's Women's Sleep Health Task Force, emphasizing the need for more individualized care across adolescence, preconception, pregnancy, menopause, and older adulthood. She raised questions about whether diagnostic tools and criteria should be tailored to different life stages and highlighted the importance of shared, data-driven decisions when counseling patients considering family planning and pharmacologic treatment. Looking ahead, she underscored the rapid expansion of sleep diagnostics and therapies, while reminding clinicians that restorative sleep remains essential to managing coexisting medical and neurological conditions.

SLEEP 2027 is scheduled for June 6-9 at the Colorado Convention Center, with registration opening in January 2027.

REFERENCES
1. SLEEP 2026 marks 40 years of advancing the sleep field at annual meeting in Baltimore. News release. Associated Professional Sleep Societies. May 12, 2026. Accessed October 9, 2026. https://www.sleepmeeting.org/sleep-2026-annual-meeting-40-years/
2. Tolbert TM, Schmickl CN, Gell LK, et al. Research Priorities for Translating Endophenotyping of Adult Obstructive Sleep Apnea to the Clinic: An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med. 2025;211(9):1562-1583. doi:10.1164/rccm.202507-1574ST
3. Strollo PJ Jr, Farkas R, Taranto-Montemurro L, Cronin J, Patel SR; SynAIRgy Investigators. Aroxybutynin and atomoxetine (AD109) for obstructive sleep apnea: a randomized phase 3 trial (SynAIRgy). Am J Respir Crit Care Med. 2026;212(7):1569-1584. doi:10.1093/ajrccm/aamag215
4. Apnimed announces FDA acceptance of new drug application for AD109, an investigational oral pill to treat adults with obstructive sleep apnea. News release. Apnimed. July 14, 2026. Accessed October 9, 2026. https://apnimed.com/article/apnimed-announces-fda-acceptance-of-new-drug-application-for-ad109-an-investigational-oral-pill-to-treat-adults-with-obstructive-sleep-apnea/
5. Women with sleep apnea report greater symptom burden than men. News release. Associated Professional Sleep Societies. June 8, 2026. Accessed October 9, 2026. https://www.sleepmeeting.org/women-with-sleep-apnea-report-greater-symptom-burden-than-men/