Semaglutide, Tirzepatide, and Other Agents Emerge as Pharmacological Options for Obstructive Sleep Apnea Syndrome

Obstructive Sleep Apnea Syndrome (OSAS) is a prevalent and potentially life-threatening condition with significant healthcare burden. Current treatments, including continuous positive airway pressure (CPAP) and intraoral devices, often suffer from low patient compliance, while surgical options are reserved for strict indications. Until recently, pharmacological management was largely limited to symptomatic relief like nasal decongestants or modafinil for daytime sleepiness. This gap highlights an urgent need for effective drug treatments that can improve adherence and address the underlying pathophysiology of OSAS, especially considering the role of factors like obesity and specific OSAS endotypes.

This review synthesized recent advances in Obstructive Sleep Apnea Syndrome (OSAS) drug therapy, primarily by summarizing findings from randomized clinical trials conducted over the past 6-7 years. It specifically focused on emerging agents such as semaglutide, tirzepatide, atomoxetine-oxybutynin, solriamfetol, sultiame, and acetazolamide, alongside established drugs. The authors emphasized the growing importance of OSAS endotype randomization in clinical study design to tailor treatments more effectively. The review also highlighted the necessity for combining different therapeutic approaches for optimal OSAS management.

The review identified several agents demonstrating efficacy in treating Obstructive Sleep Apnea Syndrome (OSAS), marking a significant shift in pharmacological management. It highlighted semaglutide and tirzepatide, incretin-based therapies, as particularly promising due to their established weight-loss effects, which directly address a primary driver of OSAS pathology. Beyond weight management, the review detailed other emerging pharmacological interventions. Atomoxetine-oxybutynin was noted for its potential to improve upper airway muscle tone, while solriamfetol addressed residual daytime sleepiness. Sultiame and acetazolamide were discussed for their effects on ventilatory drive and chemosensitivity, targeting specific OSAS endotypes such as high loop gain or low arousal threshold.

The synthesis confirmed that these newer agents, alongside established drugs like modafinil (for daytime sleepiness) and nasal decongestants (for rhinitis exacerbation), offer a broader therapeutic landscape, moving beyond the previous limitations of only symptomatic relief. The evaluation, primarily based on randomized clinical trials, underscored the potential for these drugs to improve patient outcomes and compliance, which has historically been low with non-surgical therapies like CPAP. This comprehensive overview indicates a new era for OSAS treatment, emphasizing targeted pharmacological approaches.