Obesity and obstructive sleep apnea: from pathophysiology to current clinical approaches

The prevalence of obesity and obstructive sleep apnea (OSA) has increased alarmingly over recent decades and is projected to continue to rise. These chronic disorders interact bidirectionally and increase cardiovascular and metabolic risks. OSA is a complex and heterogenous disease in which weight management plays a key role in achieving longlasting therapeutic success. Multiple mechanisms are associated with the link between obesity and OSA, including enlargement of upper airway soft tissue, pharyngeal lengthening, reduced lung volume, and leptin impairment. In this review, we describe the mechanisms linking obesity and OSA, and examine the impact of CPAP therapy on body weight. We also review current obesity treatment strategies and their effects on reducing OSA severity, comparing the efficacy of lifestyle modifications, surgical approaches, and pharmacological treatments in promoting weight loss. Finally, we explore the potential of recent advances in pharmacological obesity treatments as therapeutic options for OSA, as well as the promise of combination therapy for achieving better short- and long-term weight reduction.