[The role of obesity and weight reduction in obstructive sleep apnea]

Obesity plays a central role in the pathomechanism of obstructive sleep apnea and is strongly associated with the severity of sleep-disordered breathing. Weight reduction in obese patients has been shown to decrease the apnea-hypopnea index (AHI), improve sleep architecture, and reduce cardiometabolic risk. However, traditional, specialty-specific models of care do not address sleep and metabolic disorders in an integrated manner, and weight management often receives less emphasis in obstructive sleep apnea care compared with positive airway pressure (PAP) therapy. Incretin-based therapies - particularly glucagon-like peptide-1 (GLP1) receptor agonists and dual GLP1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists - have demonstrated promising results in the treatment of obesity, thereby generating growing interest in their potential role in obstructive sleep apnea management. Based on an analysis of randomized clinical trials, our review indicates that GLP1/GIP receptor agonist therapy not only promotes weight loss but also alleviates sleep-disordered breathing in obstructive sleep apnea, as reflected by reductions in AHI. An additional benefit of weight loss is the concurrent reduction in cardiometabolic risk among obese patients, alongside the improvement in obstructive sleep apnea severity. Collectively, the combined application of GLP1/GIP receptor agonist pharmacotherapy and PAP therapy may represent a novel, comprehensive, and effective therapeutic approach for the management of obstructive sleep apnea. As the management of obesity requires consideration of multiple somatic, psychological, and lifestyle-related factors, the success of a multidisciplinary sleep-metabolic program depends on the coordinated involvement of relevant specialists (pulmonologists, internists, dietitians, psychologists, and physiotherapists) with clearly defined roles and responsibilities. Further studies are needed to evaluate the effectiveness of integrated sleep-metabolic programs and to determine their potential clinical benefits. Orv Hetill. 2026; 167(26): 1011-1017.