# Molecular Biomarkers and Therapeutic Approach of Patients with Diabetes and Obstructive Sleep Apnea

## TL;DR

This review explores the molecular links between diabetes and sleep apnea, highlighting key biomarkers and new therapies like GLP-1 agonists for managing sleep apnea.

## Contribution

The paper introduces the first FDA-approved medication for OSA and emphasizes personalized treatment based on molecular biomarkers.

## Key findings

- Elevated HIF-1α and dysregulated microRNAs contribute to insulin resistance in OSA and T2DM.
- GLP-1 receptor agonists like tirzepatide reduce apnea-hypopnea index by 55–63% in obese adults with OSA.
- SGLT2 inhibitors offer therapeutic benefits through weight loss and cardiovascular protection in OSA patients.

## Abstract

The bidirectional relationship between obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) represents a critical intersection in metabolic medicine. Therefore, the present review examines the most recent data regarding molecular mechanisms linking OSA and T2DM, analyzing key biomarkers including hypoxia-inducible factors (HIF 1α), inflammatory mediators, adipokines, microRNAs, hormones, and neuropeptides that serve as both diagnostic indicators and potential therapeutic targets. Key molecular findings from the scientific literature report elevated HIF-1α promoting insulin resistance, decreased SIRT1 levels, dysregulated microRNA-181a and microRNA-199a, increased inflammatory cytokines (TNF-α, IL-6, CRP), and altered adipokine profiles with reduced adiponectin and elevated leptin and resistin. Current clinical evidence reveals significant therapeutic potential for modern antidiabetic medications in the management of OSA. GLP-1 receptor agonists, particularly tirzepatide, received FDA approval as the first medication for moderate-to-severe OSA in obese adults, showing a 55–63% AHI reduction. SGLT2 inhibitors also demonstrate promising results through weight loss and cardiovascular protection mechanisms. This integrated approach represents the evolution toward comprehensive OSA management beyond traditional mechanical ventilation strategies. Future research should focus on developing personalized treatment algorithms based on individual molecular biomarker profiles, investigating combination therapies, and exploring novel targets, including chronotherapy agents.