Anti-obesity medications for the management of obstructive sleep apnoea

Obstructive sleep apnoea (OSA) is a common sleep disorder for which obesity is a major modifiable risk factor that can drive both its onset and chronicity. Accordingly, weight reduction should be a key component of management in individuals with co-existing obesity and OSA. Anti-obesity medications (AOMs) are one potential approach and have long been investigated for this purpose. This narrative review briefly examines the complex mechanisms linking obesity and OSA and critically appraises AOMs as a treatment strategy for individuals with OSA, focusing on agents evaluated for their effects on OSA related outcomes. In this regard, the GIP/GLP-1 receptor agonist, tirzepatide, has shown particular promise in the SURMOUNT-OSA trials, which reported significant reductions in both the apnoea-hypopnoea index and body weight. Other agents, including the GLP-1 receptor agonist liraglutide, phentermine/topiramate, and SGLT2 inhibitors, may confer some benefit, although the effects appear more modest. However, not all individuals with obesity have OSA, nor do all with OSA have obesity. Non-obesity risk factors abound, alongside distinct pathophysiological endotypes that arise in the absence of excess adiposity. Weight loss is thus unlikely to be universally effective as a standalone strategy. Furthermore, weight loss interventions, including AOMs, may be limited by cost, accessibility, and the requirement for long-term use or follow-up. As such, while weight management remains an important component of care for individuals with obesity and OSA, treatment should be individualised and evidence informed.