Incretins for management of obesity and obstructive sleep apnea

Recent trials have demonstrated the efficacy of incretin-based pharmacotherapy in obstructive sleep apnea (OSA) in obese patients. In addition to improving sleep indices, these agents also led to sustained weight loss and improvements in cardiometabolic profile. Given cardiovascular mortality remains the most common cause of death among patients with OSA, these agents represent a potential paradigm shift toward more holist management approach toward patients with OSA.

This article provides an overview of OSA pathophysiology, in particular, its overlapping risk factors with obesity. The physiology of the incretin axis is covered with reference to molecular targets of current therapies. Key trials in the use of incretins for diabetes and OSA are presented with critical discussion of knowledge gaps and scope for future research. The article focuses on newer incretin agents which appear to have dual activity against obesity and its cardiometabolic complications. Comparisons between incretin-based agents and current treatment modalities are explored including identification of knowledge gaps and future directions for research.

Incretin-based pharmacotherapy has the potential to transform the therapeutic landscape for OSA through their dual action on sleep-disordered breathing and obesity-related complications. Scope for future research remains to optimize patient selection, drug delivery, dosing, and equitable access and identify future molecular targets for OSA.