Latest from WIRED
WIRED
27 minutes ago
- Business
- WIRED
The Trump-Crypto Honeymoon Is Over
Jul 30, 2025 11:00 AM The flood of crypto money in the 2024 election was one of the biggest breaks for the Trump campaign. Six months into the term, the relationship might be cooling. Photo-illustration: WIRED Staff; Getty Images As with any fledgling romance, Trumpworld and big money cryptocurrency interests were bound to have their first fight at some point. It was late June heading into July, and two highly anticipated bills were in the pipeline to help fulfill President Donald Trump's promises to make the US the 'crypto capital of the planet' and usher in what his supporters believed would be a 'golden age' of digital assets. Congress had one shot at passing something before the August recess. Coinbase, the cryptocurrency exchange, and Andreessen Horowitz, the venture capital firm known as a16z, were, according to two Republicans involved in the negotiations, calling around to members to see if they could combine components of the two bills, known as the GENIUS Act and the CLARITY Act. The former more narrowly covered the realm of stablecoins; the latter was a more ambitious overhaul of how crypto products are regulated more broadly. Joining them together would give the industry what it failed to get during President Joe Biden's term—a comprehensive framework that would give the industry regulatory certainty and a clear path to profit, legally, off of these digital assets for the foreseeable future. But the White House was not happy, and made sure to let the two power players know it. To the Trump administration, this attempt at political maneuvering was slowing down a much awaited win for crypto. 'We said, you're just fuckin' wrong,' a senior administration source involved in negotiations over crypto legislation tells me, requesting anonymity to describe private deliberations over the two most significant pieces of legislation for the industry. 'They were being hissy pissy about the way to do things,' the senior administration official says. 'But you know, it's not just their call.' The White House promised the firms they'd get their more prized regulatory overhaul—but it would be separate, and they'd have to wait. Coinbase, Andreessen Horowitz, and the White House did not return requests for comment. It's been pretty clear for quite some time: Trumpworld loves crypto. Almost everywhere you look in the second Trump administration, there's a crypto connection. The president, most notably, has his own memecoin, and his two eldest sons, Eric and Don Jr., are involved in a variety of crypto ventures, including World Liberty Financial and its stablecoin. Despite cryptocurrency being immensely profitable for the Trump family and vice versa, though, cracks are beginning to emerge in a key alliance that helped bring the president back to power. The dustup around stablecoin and market structure legislation could be the first preview of more fissures to come. It doesn't have the flair, the trappings, the egos, or the household name personalities of the Musk-Trump breakup, and the gripes involved aren't necessarily even about ideology or policy. But this brewing lovers' quarrel does say something about how power works in Trump 2.0, and it very well could have far-reaching implications for the global economy. You Can't Always Get What You Want At this time last year, Trump was successfully digging his campaign out of a fundraising cash crunch as former vice president Kamala Harris took over as the Democratic nominee. While Harris would revive sagging donor sentiment in her party, millions had been pouring into what was then known as the Save America PAC, which until then had covered many of Trump's legal expenses. Much of what shifted crypto's attitude towards the GOP was vibes based. Sources of mine in Trumpworld and in the crypto community said they felt the Biden administration and Democratic Party more broadly were overly hostile to blockchain-based businesses. 'The crypto community was almost libertarian and apolitical for a while,' my source tied into the donor space tells me. But as the business grew under the Biden administration, more regulation by enforcement occurred—the Securities and Exchange Commission, or SEC, brought at least 83 crypto-related enforcement actions, initiating lawsuits against companies like Coinbase and Kraken, according to Reuters, arguing that their products should be regulated like securities—and donors felt 'an animosity' from the White House that pushed them into Trump's coffers, they explained. (Months into the second Trump administration, those lawsuits were dismissed.) However, sources in both Trumpworld and on the blockchain side of the equation tell me crypto donors have become impatient with the return on their investment from the campaign, which came in at just under $250 million raised by crypto-aligned and related PACs and super PACs when all was said and done. Getting their favorite parts of both the GENIUS Act and the CLARITY Act over the line—including what they viewed as more favorable regulation under the Commodity Futures Trading Commission, rather than the SEC—was an opportunity to cash in. This is where Coinbase and a16z got involved. Both firms have key connections in Trump's orbit—most notably, respectively, Chris LaCivita, the former 2024 Trump co-campaign manager, works on the global advisory council for Coinbase, while a16z is cofounded by Marc Andreessen, the Silicon Valley billionaire and cocreator of the modern web browser, who wields influence primarily through Vice President JD Vance. These power players wanted to effectively merge the stablecoin bill with the more ambitious and wide-reaching CLARITY Act, according to two sources familiar with the proceedings. Coinbase specifically ruffled feathers in the House GOP conference, another Republican operative in Trumpworld tells me. 'It was one of those things with, if you're gonna throw your weight around … at the end of the day they wasted two weeks of the legislative calendar by slowing everything down.' Another sticking point, the senior administration official and GOP operative tells me, is around Coinbase appearing too chummy with Democrats after bringing on David Plouffe, the former Obama and Harris strategist, to join the organization's global advisory council in addition to LaCivita and others. Even though plenty of industries depend on maintaining relationships with lawmakers in both parties, Trumpworld has grown increasingly wary of any perception of camaraderie between the crypto crowd and Democrats, with Plouffe being the most prominent example. 'If [Democrats] take power again, you're not getting shit,' says the senior administration source, 'and all of your bets are wasted.' The message from Trumpworld to the crypto community heading into the next phase of legislation is simple: Play by our rules, or good luck getting anything from a possible future Democratic-controlled Congress and White House. 'These guys just need to understand that if they stick with us they have a good chance of success—rowing against us will almost guarantee failure,' the administration source tells me. 'And they shouldn't play both sides beyond getting the bare minimum of Democrat votes on legislation … They should wake up.' Underneath all the wrangling is the substance of the legislation—even if the legislative gambit had been successful, it may have ultimately backfired. 'It's a case of be careful what you wish for,' says James Angel, a finance professor at Georgetown University. 'The problem with the CLARITY Act is this tremendous lack of clarity that it really gives us.' It's still unclear where the CFTC authority ends and the SEC's begins under the proposed law, according to Angel. And either way, he says, the evangelists shouldn't be surprised if the CFTC ultimately cracks down on crypto as well. As for the rough-and-tumble of getting legislation through Congress, the senior administration source says this is a welcome-to-the-club moment for the crypto community. 'Welcome to Congress,' the official says. 'You're just one of many who's been chewed up and spit out.' This is an edition of Jake Lahut's Inner Loop newsletter. Read previous newsletters here.
WIRED
an hour ago
- Politics
- WIRED
US Senator Urges DHS to Probe Whether Agents Were Moved From Criminal Cases to Deportations
Jul 30, 2025 10:19 AM US Senator Ron Wyden is demanding that the Department of Homeland Security investigate reports of agents being reassigned to bolster immigration enforcement. Photograph: Bloomberg/Getty Images Since February, multiple news reports have alleged that a significant number of agents at Homeland Security Investigations (HSI)—the Department of Homeland Security's investigative wing that focuses on transnational crimes like child exploitation, human trafficking, and drug cartels—have been pulled from child exploitation cases and reassigned to immigration enforcement and arrests. US senator Ron Wyden urged DHS Inspector General Joseph Cuffari on Tuesday to 'promptly' launch an investigation into the veracity and extent of these reports about HSI, in a letter shared exclusively with WIRED. Inspector General Cuffari has the authority to conduct audits or investigations into any activities or operations at DHS. 'Instead of locking up rapists, child predators and other violent criminals, [US president Donald] Trump appears to be diverting investigators to target cooks, farm workers and students,' Wyden says in the letter. 'Congress and the American people will not tolerate the Trump administration ignoring the ongoing sexual abuse of vulnerable children. Accordingly, we urge you to promptly investigate these troubling reports.' Wyden told WIRED in a written statement that there is 'no excuse for pulling investigators away from the most heinous cases involving child exploitation,' adding that 'nothing should be a higher priority than protecting kids in danger.' WIRED contacted several US-based child welfare and advocacy organizations to provide a comment for this article, however, they did not reply or declined to comment on the record. An official from one of these organizations, who requested anonymity, claimed that their organization could not provide a comment for this story due to fear of retribution from the Trump administration. In February, USA Today reported that the "entire investigations division" of HSI would be shifting its focus primarily to immigration arrests and deportations, as opposed to its typical range of work. Then, Reuters in March reported that HSI agents had been actively 'reassigned' from cases they had been working on related to child exploitation, money laundering cases, drug trafficking, and tax fraud. They were then tasked with immigration enforcement. At the time, Democratic senator Dick Durbin told the outlet that this shift was 'wasteful, misguided diversion of resources' that was 'making America less safe." The Atlantic reported in July that a veteran HSI agent said the division was putting major criminal investigations on hold, and sometimes choosing not to take on new cases—including drug cases, human trafficking cases, and child exploitation cases—in order to make agents available for routine predawn raids for immigration enforcement. HSI's reported shift in priorities comes after the National Center for Missing and Exploited Children (NCMEC) said that it had received 20.5 million tips of suspected child sexual exploitation in 2024. The risk to children involving AI-generated abuse material—which is also the domain of HSI—could also be reaching crisis levels. In 2024, NCMEC received about 67,000 tips about suspected AI-generated abuse material—a 1,325 percent increase from 2023, when it received 4,700 of these tips. 'We are inundated with victims, with offenders,' Detroit-based HSI special agent Dave Alley, who has historically focused on child exploitation cases, told his local ABC news outlet in January. 'There is just so much more access to both the internet and to materials.' (When reached by phone by WIRED, Alley declined to comment for this story.) According to its website, HSI has more than 10,000 employees, and more than 7,000 'Special Agents' charged with leading criminal investigations. Its work has been housed under Immigration and Customs Enforcement (ICE) since 2003. In the 2024 fiscal year, ICE said that HSI had 'made 32,608 arrests, identified and/or assisted 1,783 victims of child exploitation, and assisted 818 human trafficking victims.' DHS spokesperson Tricia McLaughlin did not answer questions about how many arrests have been made in connection to child exploitation in 2025, or how many agents have been assigned to such cases. 'HSI is leading efforts to conduct welfare checks on these children to ensure that they are safe and not being exploited,' McLaughlin tells WIRED. 'The Trump administration has located 13,000 children who were released into the country and either lost or placed with unvetted sponsors under President Biden.' McLaughlin did not provide evidence to back up this figure ahead of publication. When reached for comment, White House spokesperson Abigail Jackson said that the U.S. border with Mexico is 'more secure than it's ever been, which means fewer children are being trafficked and exploited,' Jackson says. 'Anyone who claims to care about ending child exploitation and smuggling should be celebrating President Trump's historically secure border.' HSI has not entirely halted its work on child exploitation investigations and other cases. On a news page published in April, ICE said that HSI had identified and rescued 56 victims of child exploitation in spring of 2025. The rescues were made as part of 'Operation Renewed Hope,' an annual initiative in which HSI goes through child sexual abuse material in which victims and offenders have not been identified. The goal is to 'create lead packages' that HSI or other law enforcement agencies can use to arrest offenders and bring victimized children to safety. In recent years, HSI has requested that DHS separate its operations from ICE, a change that would also require congressional approval. The majority of special agents in charge of HSI sent a letter to then-DHS Secretary Kirstjen Nielsen asking her to divorce the agency from ICE in 2018. HSI agents made another request to detach from ICE in a 2021 internal report submitted to then-DHS Secretary Alejandro Mayorkas. Both requests cited ICE's poor reputation, and the divisiveness of ICE's Enforcement and Removal Operations (ERO), claiming that ERO is politicized and fuels a lack of public trust in HSI.
WIRED
2 hours ago
- WIRED
The Hero of My First Family Trip Was This Luggage Travel Stroller
I procrastinated flying anywhere with my son until he was almost 3. There were so many things needed—a car seat! Stroller! In-flight entertainment! His own luggage! A crib when we landed!—that it felt like too much to coordinate. And who can blame me? It's just parenting in a new location, after all, rather than a vacation. Still, a trip we wanted to take finally presented itself. We booked a long weekend in San Francisco and the nearby wine country to see family and friends we haven't seen since I was pregnant, and to relive a family tradition (though sans my grandmother, since she passed in 2020) for the first time since before the pandemic. Just in time, the perfect gadget presented itself to make the trip feel a little more manageable: the TernX Carry-On Luggage Stroller. The TernX is both a small carry-on suitcase and a travel stroller built into a single device. One less thing to carry as a parent is always a godsend, and being able to tote my son and his clothes with one device felt heaven-sent. The TernX was founded by two parents who brought the company to Shark Tank , so it's no surprise it has a parent-minded design, though the compact size makes it best for younger (or shorter) kiddos. It was no problem to wheel this around the airport and San Francisco streets as a stroller, and as a suitcase onto a plane (which not all travel strollers can do!). Stroller Stride Photograph: Nena Farrell As a travel stroller, the TernX is pretty solid. It's easy to unfold, has a five-point harness, and sports a storage basket underneath that fits a small bag (I stuffed my kid's backpack underneath it while we walked through the airport). The TernX is always 14 inches wide, while reaching 38 inches tall and 35 inches long in stroller mode, compared to 22 inches tall and just 9 inches long in luggage mode. This stroller can also hold kids up to 48.5 pounds—almost as much as a regular stroller. When it's empty, it weighs 17 pounds, only adding 3 pounds compared to my favored Nuna TRVL stroller. It's really best for small children since the seat is under 12 inches wide. It was a fine size for my tall, almost-3-year-old to sit in, but bigger kids won't fit into this. I also didn't realize on my trip that I could extend the height of the back of the seat. He's nearly 40 inches tall with a particularly tall torso, and his head and shoulders tower above the TernX's lowest setting. Mom-fail for not spotting I could raise that for him (but if that's the worst I did on my trip, I'll take it!). Still, being tall didn't seem to leave my toddler uncomfortable. He happily sat in the stroller both in the airport and while we walked around Sonoma and San Francisco. The wheels are small and can't handle rough terrain, so I recommend sticking to the smooth airport floors and well-paved sidewalks.
WIRED
4 hours ago
- Health
- WIRED
What Your Nighttime Breathing Says About Your Health
Jul 30, 2025 7:00 AM Once dismissed as just snoring, sleep apnea is now emerging as an early warning sign for serious conditions like Alzheimer's, heart disease, and depression. Brain scan images are displayed on a tablet. Photograph:For decades, sleep disturbance was a punch line: the cartoon dad snoring, the disgruntled partner burying their head under a pillow. But science is beginning to paint a less jovial picture. Sleep apnea—a relatively common disorder where breathing repeatedly stops and starts during sleep—is now being taken seriously as a potential biomarker for a host of major health conditions, from cardiovascular disease to Alzheimer's, even anxiety and depression. 'Sleep is just as important for health as diet and exercise,' says Marishka Brown, director of the US National Center on Sleep Disorders Research. 'Poor sleep affects both your mental and physical health; it contributes to cardiovascular disease, increases all-cause mortality, and raises risk factors like obesity, hypertension, and diabetes. And these impacts are independent—they're not just knock-on effects from something else. Sleep is foundational.' Obstructive Sleep Apnea (OSA) is one of the most common types of apnea, affecting an estimated 1 billion people worldwide. It occurs when the upper airway repeatedly collapses during sleep, interfering with breathing and lowering oxygen levels. The brain responds by jolting the sleeper awake—sometimes hundreds of times a night—before letting them drift off again, often unaware. Sufferers may feel exhausted during the day and can experience memory problems. But more than this, the latest research suggests that sleep apnea may play an early and direct role in serious long-term illnesses, especially those affecting the brain. 'Traditionally, sleep apnea was thought of as a disorder that increases with age—especially in men—and leads to heart problems, maybe stroke,' says Bryce Mander, associate professor of psychiatry and human behavior at UC Irvine. 'But over the last decade, it's become clearer that it's also a risk factor for neurological illnesses like Alzheimer's and other neurodegenerative diseases.' Each pause of breath triggered by apnea causes a drop in oxygen levels and a surge in adrenaline for the sleeper. 'Over time, that raises the risk of high blood pressure, heart disease, and stroke,' says Atul Malhotra, a sleep medicine specialist and professor at UC San Diego. 'There's strong evidence now that sleep apnea is not just a marker of being unfit. Lean people get sleep apnea too,' he adds. Hypoxemia—when oxygen levels in the blood are lower than normal—increases inflammation and oxidative stress on cells, explains Mander. 'It's associated with vascular pathology in the brain. So, your blood vessels become damaged, and that can damage the surrounding brain tissue,' he says. This damage can accelerate the trajectory of a disease like Alzheimer's or make the brain more vulnerable to it—and researchers now know the effects may appear years before outward symptoms. A 2015 New York University study found that people with sleep-disordered breathing developed mild cognitive impairment, including Alzheimer's, up to 10 years earlier than those without. However, those who received treatment for their sleep apnea had the same onset age as those without sleep-disordered breathing. 'Duration of untreated illness is one of the biggest predictors of long-term damage,' says Mander. 'The longer you have OSA, the more havoc it can wreak on the body and the brain.' Notably, the research showed that apnea can manifest differently in REM sleep: 'A lot of the memory consolidation and emotional regulation … happens during REM,' Mander explains. 'If you're waking up during REM because of a breathing event, you're fragmenting that process. And if that's happening night after night for years, it adds up.' Early diagnosis, therefore, is critical—but it's currently falling short. Diagnosis frequently relies on a partner noticing loud snoring, an unreliable signal at best. 'The reality is, women—and especially pregnant women—have been overlooked when it comes to sleep disorders,' says Brown. 'Right now, our diagnostic standards for sleep apnea are based on a very narrow demographic—typically middle-aged men. But we know that women present differently.' 'What's classified as 'mild' apnea in a man could be moderate or even severe in a woman, particularly during pregnancy,' she adds. 'We've supported research in pregnant women that found even mild sleep-disordered breathing was an independent risk factor for maternal hypertension, preeclampsia, and gestational diabetes.' Wearable tech companies are racing to fill the diagnostic gap. Samsung's Galaxy Watch recently became the first wearable to receive De Novo authorization from the US Food and Drug Administration for detecting signs of OSA. But experts remain cautious. 'Wearables and home sleep tests are improving, but they're not yet a replacement for a full clinical diagnosis,' says Malhotra. 'They can give a false sense of security—people see a score and think they're fine when they're not.' Mander is also skeptical: 'They're not accurate enough to replace proper diagnosis,' he says. 'They might be better than nothing—as long as you treat them as one piece of information, not the full picture.' While smartwatches and rings can track metrics like heart rate variability, they're still not reliable at detecting breathing patterns, he adds. The gold standard in diagnosis is polysomnography, a clinical sleep study that monitors brain waves, oxygen, heart rate, and muscle activity. But this is expensive and time-consuming, and doesn't scale well. New home-based devices are now offering better options. Mander highlights WatchPAT, which uses finger, wrist, and chest sensors to detect apnea events by analyzing changes in blood vessels. There's also ARES, a wearable headband monitor that measures airflow, oxygen levels, and sleep position, and NightOwl, a fingertip device that received FDA approval in recent years. 'It's a big step forward, especially for reaching underserved populations who might not be able to access a sleep lab,' Mander says. Still, there are limitations. 'Right now, the home test doesn't know if you're awake or asleep, much less the sleep stage. It would probably miss people with REM-dominant OSA,' he says. 'If we have devices that can detect when these events are happening—in REM versus non-REM—that could help us pick up people earlier and reduce their risk.' Once diagnosed, CPAP—continuous positive airway pressure—remains the gold standard for treatment, despite being uncomfortable or claustrophobic for some users. It uses a small machine to deliver a steady stream of air through a mask, keeping the airway open during sleep. 'CPAP improves symptoms, blood pressure, and we now have emerging evidence that it may reduce cardiovascular risk,' says Malhotra. For those who can't tolerate CPAP, new tools such as nasal inserts are emerging on the market. Some interventions are more unconventional—and yet surprisingly effective. 'There's an Australian study that showed learning the didgeridoo helped strengthen throat muscles and reduce OSA severity,' says Mander. 'It's a fun example, but it works.' Ultimately, the most critical step is awareness. 'We used to think snoring was just annoying or funny,' Malhotra says. 'Now we understand that it can be a sign of a serious medical condition. If you snore heavily or feel constantly tired, don't just brush it off—go see your doctor.'
WIRED
6 hours ago
- Health
- WIRED
The Hyperflexible People Who May Help Unlock Better Sleep Apnea Treatments
Jul 30, 2025 5:00 AM Patients with Ehlers-Danlos Syndrome are six times more at risk for the sleeping disorder. Now scientists are studying them in hopes of finding remedies beyond the CPAP machine. A CPAP machine with a clear mask ready for sleep therapy. Photograph: Getty Images In 2023, Mitchell Miller, a sleep medicine doctor based in Clearwater, Florida, received a visit from an unusual patient. While Miller is accustomed to seeing people with sleep apnea—a persistent condition in which people stop breathing dozens or even hundreds of times during the night, causing disturbed sleep and daytime exhaustion—it is most common in men, particularly those who are overweight or obese and in their forties and fifties. This patient was a 33-year-old woman of slight build who was also suffering from the telltale signs of daytime fatigue. Unlike Miller's usual patients, she had Ehlers-Danlos Syndrome (EDS), the medical term for a group of genetic disorders that affect the strength and elasticity of various muscles, joints, and tissues, often bestowing individuals with exceptional flexibility. EDS is estimated to affect 1.5 million people worldwide, with symptoms ranging from mild to severe. One of the lesser-known health conditions associated with the disorder is sleep apnea: Patients with EDS face a sixfold increased risk compared to the general population. 'We rely on muscle tone and elasticity to maintain our airway while asleep,' says Miller. 'EDS causes increased laxity or looseness in various tissues, including the throat or the tongue, which makes them more prone to blocking the airway during sleep.' Tests revealed that Miller's patient was experiencing up to 24 apnea events per hour. While five or fewer events per hour is considered normal, patients with moderate to severe apnea can experience 15 to 30 or more disruptions. But knowing the underlying cause of her trouble gave Miller an idea: by implanting a device in the patient's chest, he could send mild electrical pulses to a nerve controlling tongue movement—pushing it forward and keeping the airway open during sleep. The results of this experimental therapy, known as hyperglossal nerve stimulation (HGNS), were so remarkable that Miller felt compelled to publish the case study. One of the advantages of HGNS is that once implanted, a patient can turn the device on themselves before going to sleep using a remote control, then switch it off in the morning. Miller's patient 'had a complete resolution of her sleep apnea,' he says. Two years on, she remains symptom-free. In recent years, the need for better approaches to treating sleep apnea has become increasingly apparent. Studies have linked uncontrolled apnea in midlife to a range of chronic diseases including stroke, sudden heart failure and hypertension, type 2 diabetes, and even dementia. While the gold standard therapy is a ventilator-like device known as a continuous positive airway pressure (CPAP) machine—which pumps air into the throat to keep the airway open—research suggests only 30 percent of people are able to keep using CPAP long term due to factors including claustrophobia from needing to wear a mask in bed or difficulty sleeping due to the machine's persistent hum. Miller says that his patient initially tried CPAP therapy but could not tolerate it. 'There's definitely a need for less cumbersome treatments,' says Thomas Gaisl, a pulmonologist at University Hospital Zurich studying sleep apnea. 'Most people would be more willing to take a pill than use CPAP on a daily basis.' But the search for such a pill—or indeed any treatment as effective as CPAP—has proved challenging. Dozens of drugs have failed to show efficacy in clinical trials, and while HGNS was first approved by the US Food and Drug Administration in 2014, Miller says that its rollout has been limited, as many doctors are uncertain about the risk-to-benefit trade-off. 'The device is quite costly, and the implantation requires a surgical procedure,' he explains, which comes with added risk to the patient. 'As with any new technology, there is often a lag in acceptance from both the medical community and insurers.' It's unlikely that a single therapy will be found as an alternative to CPAP, Gaisl argues, because sleep apnea isn't one single disease—rather, a diverse cluster of conditions. Obesity is known to be one of the major risk factors—and the weight-loss drug tirzepatide has recently been licensed as a sleep apnea therapy—because excess fat around the neck and upper body can obstruct the airway and cause pauses in breathing. But there are many other causes, some of which are only recently coming to light. Researchers are now beginning to understand the impact of ethnicity on sleep apnea, for example, with patients in Asia at heightened risk. Sleep apnea is resultant of 'a mosaic of different things, not just obesity,' says Gaisl. 'We're increasingly seeing that different subgroups benefit most from more personalized approaches.' This recognition has led researchers to focus more on the EDS population. Gaisl estimates that simply having EDS is equivalent to increasing your BMI by 11 points in terms of the likelihood of developing sleep apnea. That's because the genes linked to EDS affect the structure of so-called 'matrix proteins' like collagen and elastin, which provide the framework for the body's connective tissues—everything from skin to tendons, muscles, and ligaments. 'Collagen is an integral part of almost all tissues, including those which form the airway,' says Karim Ghobrial-Sedky, an adjunct professor at Drexel University and a sleep specialist who has treated EDS patients with sleep apnea. 'In EDS, it's this abnormality in collagen which makes the airway more prone to collapsing when the person is taking a breath.' Because of this, researchers believe that EDS sleep apnea patients are especially suited to treatments targeting muscles in the tongue and throat—like Miller's HGNS, or a newer drug combination under development by a company called Apnimed. Based on the discovery that two compounds, atomoxetine and aroxybutynin, could work in synergy to improve upper airway muscle tone and reduce airway muscle relaxation during sleep, Apnimed has been shown in a clinical trial to reduce instances of sleep apnea by 56 percent. 'People with hypermobility are a prime target cohort for these kinds of therapies,' says Gaisl. While EDS was long considered rare, recent studies suggest genetic hypermobility may affect as many as 1 in 500 people, with women disproportionately affected. Gaisl believes the underlying biology behind these conditions also offers clues for explaining other subtypes of sleep apnea. In his view, the genetics of EDS actively mirrors the damage which other people are inadvertently inflicting on their matrix proteins through behaviors and environmental stresses like smoking, chronic inflammation, excessive dietary sugar and the aging process itself, heightening their risk of sleep apnea through midlife. 'EDS is a kind of natural experiment which is giving us insights into some of the key biological mechanisms behind sleep apnea that are masked in the general population,' says Gaisl. Such individuals could benefit more from targeted therapies like HGNS or Apnimed's drug combination, compared with patients whose apnea is primarily driven by weight gain or underlying breathing abnormalities. Newer diagnostics are applying AI algorithms to patients' sleep data, pinpointing key patterns that suggest a specific type of airway collapse. In the future, these tools could help clinicians to identify such people both faster and more accurately, as well as individuals with undiagnosed hypermobility. These insights could then be used to tailor their treatment. As researchers learn more about the role of matrix proteins in EDS-related sleep apnea, it could even pave the way for entirely new treatments in future. Matrix proteins 'really point to the importance of collagen in maintaining the airway during sleep,' says Gaisl. 'This opens up a new avenue for therapeutics which perhaps target how the connective tissues are impacted over time, causing sleep apnea—treatments which could ultimately benefit a much broader range of patients.'
