Review synthesizes Obstructive Sleep Apnea mechanisms, diagnostics, and emerging anti-obesity pharmacotherapies for cardiovascular risk reduction

Obstructive Sleep Apnea (OSA) is a prevalent sleep disorder characterized by recurrent upper airway collapse during sleep, leading to intermittent hypoxia and sleep fragmentation. This chronic stress significantly contributes to the development and progression of cardiovascular disease (CVD), including hypertension, atrial fibrillation, heart failure, and stroke. Current standard-of-care, continuous positive airway pressure (CPAP), while effective, faces adherence challenges. Given the strong association between obesity and OSA, and the limitations of existing treatments, there's a critical need to understand novel therapeutic strategies, particularly those targeting weight loss and underlying pathophysiological mechanisms.

This comprehensive review systematically analyzed current literature on the multifaceted relationship between Obstructive Sleep Apnea (OSA) and cardiovascular disease (CVD). The authors synthesized findings related to the pathophysiological mechanisms linking OSA to CVD, advancements in diagnostic methodologies, and the landscape of emerging therapeutic interventions. A particular focus was placed on the role of anti-obesity pharmacotherapy and other novel multimodal approaches in managing OSA and its cardiovascular sequelae, evaluating their potential to address the underlying disease burden beyond traditional CPAP therapy.

The review elucidates that OSA drives CVD through several key mechanisms, including chronic intermittent hypoxia, increased sympathetic nervous system activity, systemic inflammation (e.g., elevated IL-6, TNF-α), oxidative stress, and endothelial dysfunction. Diagnostic approaches are evolving beyond polysomnography, incorporating home sleep apnea testing and biomarker identification. > The review highlights anti-obesity pharmacotherapies, such as GLP-1 receptor agonists (e.g., semaglutide, liraglutide) and dual GIP/GLP-1 receptor agonists (e.g., tirzepatide), as promising emerging interventions. These agents not only promote significant weight loss but also demonstrate potential to reduce OSA severity by decreasing fat deposition in the upper airway and improving metabolic parameters. Other multimodal interventions, including targeted neuromodulation and novel drug targets, are also discussed for their potential to stabilize upper airway patency and mitigate cardiovascular risk.