Obstructive Sleep Apnea: An Evolving Therapeutic Landscape with an Emerging Role for Incretin-Based Therapies

Obstructive sleep apnea (OSA) is a common sleep-related breathing disorder characterized by repetitive collapse of the upper airway during sleep, resulting in intermittent hypoxemia and sleep fragmentation. OSA is a highly prevalent condition, strongly associated with obesity and linked to an increased risk of cardiovascular disease. While traditional therapies such as positive airway pressure (PAP) devices are effective in treating OSA and alleviating daytime symptoms, they are often not well tolerated and have limited impact on long-term cardiovascular outcomes. As our understanding of the heterogenous factors driving OSA advances, novel therapies targeting specific physiological traits-such as arousal threshold, ventilatory instability, and upper airway muscle responsiveness-are being actively explored, with a promise to expand our therapeutic arsenal. Notably, the recent approval of tirzepatide for the treatment of obesity-related OSA marks a significant milestone in this evolving therapeutic landscape. This incretin-based drug, previously approved for diabetes and obesity management, offers dual benefits, promoting weight loss and improving OSA severity and symptoms. Given this therapeutic evolution in the OSA landscape over the last decade, this review provides a comprehensive overview of the current and emerging treatment strategies for personalized OSA management, with a particular emphasis on the growing role and promise of incretin-based therapies.