Obstructive sleep apnoea (OSA) remains a common and often underdiagnosed disorder with important health consequences. The review emphasises that continuous positive airway pressure (CPAP) is the established first-line therapy and reference standard. However, real-world CPAP success is constrained by practical challenges — including access, cost, patient tolerance, the need for education and early troubleshooting, and difficulties with long-term adherence. These limitations motivate the need to expand therapeutic options beyond CPAP and to familiarise clinicians with available pharmacologic alternatives.
The authors conducted an extensive literature review of published studies evaluating non-CPAP pharmacotherapeutic modalities for OSA. The article is presented as a narrative review that summarises mechanisms of action, clinical trial evidence, and approaches to selecting therapy based on OSA endotypes. The abstract does not provide exhaustive methodological details, individual study designs, or numerical trial outcomes; those details are available only in the full text and referenced literature.
The review highlights several drugs and drug classes that have been studied in OSA, noting varying degrees of evidence and promise:
The atomoxetine-oxybutynin combination is identified as an emerging therapy that shows promise for reducing OSA severity and improving sleep quality.
Topiramate is mentioned among agents with potential benefit in lowering severity of OSA.
GLP-1 receptor agonists such as liraglutide and tirzepatide are noted to offer benefits beyond OSA severity reduction, implying combined metabolic and respiratory advantages.
Additional agents cited as having demonstrated efficacy in studies include sulthiame, solriamfetol, and pitolisant.
To address the cardinal symptom of daytime sleepiness in OSA, the review includes wake-promoting drugs modafinil and armodafinil as targeted symptomatic therapies.
The authors state that these therapies were reviewed with attention to mechanisms of action and the available clinical trial evidence. The abstract characterises several agents as "showing promise" rather than providing definitive efficacy statements; specific trial endpoints, effect sizes, and safety profiles are not described in the abstract.
A central theme of the review is the application of endotype- or phenotype-guided selection of pharmacologic therapy in OSA. The review summarises the current landscape through the lens of pathophysiology-driven treatment: aligning drug mechanism with the predominant pathophysiologic contributors in an individual patient. The abstract indicates that the review focuses on these endotype-based strategies, but specific endotype definitions, diagnostic approaches, or treatment algorithms are not detailed in the abstract and would require consultation of the full article and referenced studies.
The review provides a practical summary intended for clinicians considering pharmacologic alternatives or adjuncts to CPAP. It recognises that adding pharmacotherapy to the therapeutic armamentarium can be helpful, especially when CPAP is not accessible, tolerated, or adhered to. Important caveats from the abstract include:
The narrative format summarises existing trials and mechanisms but does not present comprehensive trial data or head-to-head comparisons in the abstract.
The language in the abstract describes several therapies as "emerging" or "showing promise," indicating that further data may be required to define roles, indications, dosing, and safety considerations for routine clinical practice.
Clinicians are encouraged to consult the full review and primary studies for detailed efficacy, safety, and patient-selection information before implementing pharmacotherapy.
This is a review article published in Sleep Breath (2026 Aug 6;30(4):231) with PMID 42557390 and DOI 10.1007/s11325-026-03724-w. The authors — Shashank Shastry, John R Kimoff, and Lancelot Mark Pinto — contributed equally. Affiliations include the Department of Pulmonary Medicine, P. D. Hinduja Hospital & Medical Research Centre, Mumbai, India, and the Division of Respiratory Medicine and Sleep Medicine, McGill University Health Centre, Montréal, Canada. The abstract reports that the study received no funding and that the authors declare no conflicts of interest.
Notes on use: The abstract summarises the scope, key agents, and the endotype-based approach to pharmacotherapy in OSA. For clinical decision-making, clinicians should review the full article and referenced trials to obtain detailed outcome data, dosing regimens, contraindications, and safety profiles, which are not provided in the abstract.