Breaking Ground: From CPAP Treatment to the First Medicine for OSA Patients with Obesity

Purpose of Review Pharmacologic alternatives in management of obstructive sleep apnea (OSA) have been pursued for decades. Considering rapid development and promising findings in recent years, we provide an overview of novel agents and treatment targets, ongoing trials, as well as future perspectives.Recent Findings Several drugs demonstrate efficacy, though none is sufficient to cure the disease as a monotherapy. Instead, the main potential lies in applying drug therapy in specific subgroups or as an addition to established treatments (e.g., positive airway pressure, oral appliance therapy). Glucagon-like peptide-1 (GLP-1)/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists may be particularly beneficial in obese OSA patients. As a major breakthrough, terzipatide, a GIP analog and GLP-1 receptor agonist, has become the first FDA-approved and EMA-sanctioned pharmacologic treatment option of OSA in obese individuals. Beyond this, alerting drugs could help manage residual daytime sleepiness and improve daytime functioning. However, long-term studies on safety, adherence, and effectiveness are scarce and highlight certain limitations and challenges.Summary Incorporating pharmaceuticals along conventional OSA management may provide synergy benefit in certain patients, but side-effects and risk reduction of related adverse outcomes over time is yet to be assessed. Furthermore, guidelines/frameworks for mapping out applicable treatment targets are needed.