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Although continuous positive airway pressure remains the standard treatment, its efficacy is often limited by suboptimal patient adherence and its impact on cardiovascular outcomes has yet to be consistently established in major clinical trials. Treatments aimed at the underlying problem, excess adiposity, are therefore needed. Weight loss, whether achieved through lifestyle interventions or bariatric surgery is well\u2010known to improve obstructive sleep apnea. The recent introduction of highly effective weight loss medications, most notably incretin\u2010based agents, now offers a pharmacological approach to accomplish the same result. Recent randomized controlled trials in patients with obesity demonstrated that these medications significantly decrease the apnea\u2010hypopnea index and enhance oxygen saturation, with a significant proportion of disease remission. In light of these findings, we propose a therapeutic algorithm stratifying treatment according to symptoms and body mass index. For asymptomatic patients with obesity and obstructive sleep apnea, we suggest incretin\u2010based therapy as a first\u2010line option to concurrently address excessive weight and obstructive sleep apnea. Conversely, in individuals with impaired sleep\u2010related quality of life combining continuous positive airway pressure and incretin therapy may be more appropriate, pairing immediate symptom control with longer\u2010term weight loss. This integrated strategy, prioritizing weight management alongside symptom relief, may offer a comprehensive approach to treat obesity\u2010related obstructive sleep apnea and decrease its associated cardiovascular risks.<\/jats:p>","DOI":"10.1111\/obr.70238","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T13:15:40Z","timestamp":1791810940000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rethinking Obstructive Sleep Apnea Care in Obesity: Continuous Positive Airway Pressure, Incretin\u2010Based Therapy, or Both?"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6050-1155","authenticated-orcid":false,"given":"Giuseppe","family":"Maiolino","sequence":"first","affiliation":[{"name":"Clinica Medica 3, Department of Medicine \u2010 DIMED University of Padova  Padova Italy"},{"name":"Department of Neuroscience (DNS) University of Padova  Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7321-1891","authenticated-orcid":false,"given":"Miguel Angel","family":"Martinez Garcia","sequence":"additional","affiliation":[{"name":"Servicio de Neumolog\u00eda Hospital Universitario y Polit\u00e9cnico La Fe  Valencia Spain"},{"name":"Research Institute La Fe  Valencia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8195-6036","authenticated-orcid":false,"given":"David","family":"Gozal","sequence":"additional","affiliation":[{"name":"Office of the Dean and Departments of Pediatrics and Biomedical Sciences Joan C. 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