Thanks for joining Her House, where we celebrate innovations related to female biology and health. In this conversation, we gain insights into the connection between sleep and heart health, differences in how women may or may not be evaluated, diagnosed, and treated for sleep disorders, and new technology for those suffering from sleep apnea.
John:We're still trying to understand all of the pathophysiology for women, but they don't present as obviously as men. And we try to identify other things besides sleep first, but for men it's like, no, you gotta get sleep studies right away.
Melissa:I'm Melissa D'Elia, and today we have someone super brilliant and fun to chat with us. After completing a dual MD/MBA program, he spent decades between Wall Street and the hospital. Today, he is Managing Director at Aphelion Capital, a healthcare VC that's investing to improve patient outcomes and continues to practice as a doctor in the emergency department, keeping up with the latest medical trends.
Melissa:I'm excited to welcome Dr. John Kim. You have somewhat of a superhero story. ER doctor by night, venture capitalist by day, probably by night as well. How is Aphelion Capital structured? What types of deals are you doing?
John:Our main mission is to find interesting medical devices, health IT, med tech. The main point is to try to drive down health care costs. Our major fund is called Cardiation, where our anchor LP is the American Heart Association and we try to find opportunities that meets their mission statements around cardiovascular health. They're also finding associations with cardiovascular health and sleep and so they've been asking us to try to find really interesting opportunities in sleep because again that would down the road again help out with cardiovascular health as well.
Melissa:How does that research and product synergy really come into practice?
John:The partnership with us and the American Heart Association has been tremendous. You know, obviously they have a wealth of other physicians and networks that we can kind of tap into and really seeing how it may impact the leaders within cardiovascular health and their practices. We can talk to them, seeing what the opportunities are, what the challenges are, whether or not specific technologies are working or not working, and then go back and provide feedback to the companies that we're looking at or have already invested into and to try to help them along and creating a really nice ecosystem for our portfolio companies to thrive.
Melissa:We often talk about diet and exercise as it relates to our hearts, but what happens for our hearts as it relates to giving ourselves rest or not?
John:Rest and sleep is immensely important for everybody, especially as we age. We're finding a lot of correlations between really good sleep and cardiovascular health. We're finding that if you have increased episodes of apnea or hypopnea, meaning you stop breathing or you have very shallow breathing, your heart is straining to provide enough oxygen and blood flow to both your brain and the rest of your body. Sleep kind of provides that reset for the rest of your body to kind of relax and recuperate. And but if you stop breathing while you're sleeping and not getting good sleep, your heart is under a lot of strength to try to provide that rest of your body.
John:So that's why we we feel that opportunities in sleep and sleep medicine to improve sleep is immensely important, for everybody.
Melissa:And that stopping breathing, that's sleep apnea, correct?
John:Yeah.
Melissa:Commonly a subject for men, older men, overweight men, but the resources I came across did mention an increased risk for women after menopause.
John:You're at higher risk of stopping breathing or long term consequences if you're AHI, which is apnea hypopnea index, meaning you stop breathing or you have very shallow breathing above a level of five so if you have more than five episodes per hour every night you're at increased risk. When we say that you're very severely affected is when you're around 15 episodes per hour. As you said, it's easier to identify men because as you get older and and bigger, your anatomy and your neck anatomy changes and you snore more. For women, they present a little bit differently than men, and that's kind of on us as clinicians. We're trying to identify what the risk factors are for women.
John:They typically have probably lower AHIs than men, but they don't get referred to sleep studies as more frequently as men as they should be. They present more as fatigue, tiredness, and some of that gets wrapped into perception that, hey, maybe it's not sleep, maybe it's depression, or maybe it's because your hormones are changing, your perimenopausal, and we try to identify other things besides sleep first, and then eventually they may get down to a sleep study. But for men, it's like, no, you've got to get sleep studies right away, and so we refer them right away pretty quickly. I think that gender differences is something that we as clinicians have to try to identify much more quickly, and to get them into a sleep study and to say that, hey, know, for women, their HR may be not as high, but they're going to eventually develop symptomatic issues such as cardiovascular issues that we're identifying right now and that maybe we need to, try to tackle this, you know, much earlier than we are currently right now.
Melissa:Tired, headaches, those could be symptoms of so many things, but if sleep problems aren't at the forefront of a doctor's mind, there could potentially be an under diagnosis of women who could have sleep apnea.
John:Yeah, that historically has been the case, but postmenopausal women definitely have a higher prevalence of sleep apnea than premenopausal women. And again, that needs to be identified much more quickly in the pathophysiology, whether it's hormones and body changes, that really needs to be understood. There has been studies over the past decades trying to assess whether hormone treatment after a certain age would reduce the amount of obstructive sleep apnea. There are data showing that estrogen may be protective in women for sleep apnea. It may be that women, because of their anatomy, may not develop snoring as loudly or be as concerning to their spouses and therefore they won't be referred to sleep clinics as readily.
John:Overall, if you do have these episodes over time, it's all cumulative And if you have started starting to creep up into these episodes of hypopnea and and, apnea, the consequences in cardiovascular health will eventually occur in both, you know, men and women, but probably more silently in women if they don't get treated.
Melissa:That silence is what's scary and what I think is also compelling about this conversation in bringing to the forefront something that hasn't really been traditionally top of mind for women as they're thinking about their overall health. How is it treated? What is the landscape for those treatments?
John:The landscape for treatment for obstructive sleep apnea is pretty vast depending upon what stage apnea that, you're in. For mild cases, currently we try initially positional changes. There's beds that kind of rise and fall. There's like things that you can kind of wear to kind of turn you on to the side. As it gets worse, there are dental appliances that you can try to use to try to force your jaw up front, then it becomes a standard CPAP is what, you know, has been used and, what has been studied significantly.
John:And the mask technology has continued to improve over time to be, you know, as comfortable as they can be. There's a lot of patients that really gets a little claustrophobic, so if you can't tolerate within, I would say, like the first couple of weeks, it's going be really difficult for you to continue to tolerate it and because of compliance issues with the CPAP machines, which is currently around 50, newer therapies have been developed and evolved. The first one was Inspire, which is a hypoglossal nerve stimulator. So it's, there's a battery pack attached to a wire and the end of the wire is attached around your hypoglossal nerve which forces your tongue to kind of protrude forward while you're sleeping. Some of the issues is it's a big procedure, there is a little bit of cut down you know, along the neck.
John:This has been a therapy I think more favorable for men than women. A lot of women kind of balk a little bit at a cut down along the neck. The newer stuff that are coming down are trying to stimulate but less invasive smaller cut downs. And what we invested into is a company that's working through the development process of which would be a needle based system that's targeting specifically at the hypoglossal nerve and other areas of the body to provide stimulation that's not necessarily needing to have a battery pack placed in but can be charged at night. And so those are coming down the road and which would provide a lot more opportunities for both men and women and to be done possibly down the road in an office based setting rather than currently right now, which is in either ambulatory surgery center or within the hospital.
Melissa:That's what makes me excited about what you guys are investing in, in trying to provide a product that people don't have that three week hurdle to start to get comfortable with it and can start finding relief right away. I mean, if you have sleep apnea, you've probably been suffering, especially as you're saying women may be suffering silently longer.
John:They're still in a little bit of stealthy mode, but the results have been, spectacular. The therapy eventually can be tailored, to provide opening of the airways that may be able to differentiate between the requirements for men versus women. The opportunity for differentiation is post implant, is that you can turn on certain areas of the stimulation and or have multiple injections into areas of the neck and chin and then tailor the therapy down the road, which is the hope to provide the best means of reducing the AHI over time. Because again, I think personalization is going to be a benefit to everybody and to have something that's kind of one size fits all for everybody initially, but then adjusted down the road, I think patients, physicians would be pretty jazzed about technology like that.
Melissa:Personalized medicine is a huge topic, and driving sex differentiation into the conversation early makes a lot of sense. We've talked before that there's pushback about investing in women's health, saying it's only 50% of the market. But in this case, it sounds like the company that you invested in and even some of the existing players would be able to expand their patient market.
John:This is, you know, again something that we really like, not necessarily coming in and saying that this is a device or an opportunity specifically for women. What we like is an opportunity that's both for men and women, but because women have been so underrepresented or under identified trying to come at it a different way saying this is for everybody, you know, men and women, tailor the therapy or do something or do some additional studies to expand the market into women for investors to quickly grasp, oh, what's the return? What, you know, I can see it growing, it's not going to be cut in half and that's, you know, one of the reasons why we feel that this, you know, this company that we invested into, Restera, is it has a unique opportunity to, again, find a better technology and expand the market by addressing some of the issues that are specific for what we need.
Melissa:What would it take to get this new technology into the hands of people? Or in this case, into the beds of people?
John:What's great about this is that there's already technologies available out there that have already paved the road in terms of reimbursement. You know, how do you pay for this? To get this level of technology into the hands of a larger population, it does require possibly a little bit of a better marketing. Current marketing for simulators like Inspire have mostly been geared towards men. It was always about, hey, you know, your partner is snoring.
John:If your partner has been on CPAP, here's a different technology that was, you know, quieter and so it felt more kind of geared towards men. I think marketing the newer technologies that expands it and say, you know, it's this is a problem not just for men, but for women as well. That is aesthetically more appealing than what's available right now. Something that's very silent, you don't notice that it's there, but it still does the same thing in terms of trying to open up the airway.
Melissa:Exactly. It's something that helps patients and also is an opportunity for the companies and its investors. Your LinkedIn profile mentions always trying to make those around be better. How does that way of thinking and being apply to you now as an investor?
John:For me, that means my colleagues around me, whether or not they're in, you know, in at Aphelion or in the hospital, and the companies that we invest into and the folks that are really trying to build these companies up. Because at some point, they will also try to make me better. The more you give, the more you get back. And it they'll help me out by providing a really good environment to work with and also insights into technologies opportunities that I've been seeing. And I'm gonna be receiving a return on that two, three times that much.
Melissa:I hope to find many examples of that mindset on this show. Our closing ask is for you to give a shout out to another innovator in the women's health space.
John:I'd love to give a shout out to Andy Doraiswamy. He is the CEO of Koya. What they have developed is a sleeve for lymphedema. The issue is that a lot of women with breast cancer, know, have their lymph nodes taken out. When you remove the lymph nodes, you're developing significant amounts of lymphedema to that arm.
John:Treatment has always been other sleep stocking and pneumatic compression, but with this device you can get out of the house and wear as much as you want and you're not confined to having this plugged into the wall which has resulted in significant improvements in comfort, fit, compliance.
Melissa:Allowing people to live their lives and be healthier at the same time is the goal. Thank you much for joining us today. If people want to follow your work or get in touch, what's the best way to do so?
John:Go on to our company website, aphelioncapital.net , and I'll be kind of going around through all the circuits of meetings and again, I'll be at all the American Heart Association conferences, so it would be great to meet you guys there if you are available.
Melissa:Thank you, John.
John:Thanks, Melissa.
Melissa:Join us next time to learn about another innovation in women's health. And if you have ideas for the show or an experience you'd care to share, we'd love to hear from you. Please reach out.
John:If I start a conversation, he starts barking, wanting a treat