{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T23:02:56Z","timestamp":1791846176320,"version":"4.3.4"},"reference-count":187,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:00:00Z","timestamp":1761004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>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 1\u03b1), 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-1\u03b1 promoting insulin resistance, decreased SIRT1 levels, dysregulated microRNA-181a and microRNA-199a, increased inflammatory cytokines (TNF-\u03b1, 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\u201363% 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.<\/jats:p>","DOI":"10.3390\/ijms262010234","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T14:24:02Z","timestamp":1761056642000},"page":"10234","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Molecular Biomarkers and Therapeutic Approach of Patients with Diabetes and Obstructive Sleep Apnea"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9537-8051","authenticated-orcid":false,"given":"Viviana","family":"Elian","sequence":"first","affiliation":[{"name":"Diabetes, Nutrition and Metabolic Disease Unit, Department of Diabetes, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020475 Bucharest, Romania"},{"name":"Diabetes, Nutrition and Metabolic Disease Unit, National Institute of Diabetes, Nutrition and Metabolic Disease, Prof. N. C. Paulescu, 020475 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9696-5728","authenticated-orcid":false,"given":"Violeta","family":"Popovici","sequence":"additional","affiliation":[{"name":"Center for Mountain Economics, \u201cCostin C. Kiritescu\u201d National Institute of Economic Research (INCE-CEMONT), Romanian Academy, 725700 Vatra-Dornei, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru Tudor","family":"Steriade","sequence":"additional","affiliation":[{"name":"Department of Cardio-Thoracic Pathology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Pneumology & Acute Respiratory Care, \u201cElias\u201d Emergency University Hospital, 011461 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela","family":"Radulian","sequence":"additional","affiliation":[{"name":"Diabetes, Nutrition and Metabolic Disease Unit, Department of Diabetes, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020475 Bucharest, Romania"},{"name":"Diabetes, Nutrition and Metabolic Disease Unit, National Institute of Diabetes, Nutrition and Metabolic Disease, Prof. N. C. Paulescu, 020475 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma Adriana","family":"Ozon","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Technology and Biopharmacy, Faculty of Pharmacy, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020945 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Moro\u0219an","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory and Food Safety, Faculty of Pharmacy, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020945 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madalina","family":"Musat","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 020021 Bucharest, Romania"},{"name":"Department of Endocrinology, C. I. Parhon National Institute of Endocrinology, 011683 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,21]]},"reference":[{"key":"ref_1","first-page":"e37359","article-title":"Obstructive Sleep Apnea and Its Management: A Narrative Review","volume":"15","author":"Gomase","year":"2023","journal-title":"Cureus"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1016\/j.chest.2017.05.009","article-title":"Obstructive Sleep Apnea and Diabetes","volume":"152","author":"Reutrakul","year":"2017","journal-title":"Chest"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/cen.14685","article-title":"Endocrine Disorders in Obstructive Sleep Apnoea Syndrome: A Bidirectional Relationship","volume":"98","author":"Akset","year":"2023","journal-title":"Clin. 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