Obstructive sleep apnea pharmacology

Obstructive sleep apnea (OSA) is a common and heterogeneous disorder with multiple underlying mechanisms (endotypes) and variable clinical expression of disease (phenotypes). It is associated with various adverse clinical outcomes but continuous positive airway pressure (CPAP) can provide major benefits for some patients, particularly among those who are adherent with therapy. There is, however, general acknowledgment that new treatments for OSA are required for the subset of patients who are intolerant of CPAP. This review provides an overview of OSA pharmacotherapies. Various pharmacotherapeutic approaches have been reported to improve PAP adherence either via improving nasal patency or by facilitating sleep when initiating CPAP. In OSA patients with obesity, anti-obesity medications are now the most effective pharmacotherapy in improving OSA severity: tirzepatide is FDA-approved for moderate-to-severe OSA in individuals with obesity. There is increasing excitement regarding the possibility of endotype targeted pharmacotherapies in OSA but how this conceptual framework used in research translates into real world clinical practice remains to be determined.