司美格鲁肽在绝经后女性中的应用：对减重、肌肉健康和睡眠呼吸障碍的临床意义。

文献信息

中文摘要

背景： 绝经后以激素变化为特征，使女性易出现睡眠障碍、身体成分改变以及肌少症风险增加。目前的研究表明，胰高血糖素样肽-1受体激动剂诱导的体重减轻与瘦体重减少相关，尽管这些变化的功能性后果，包括对肌肉和睡眠呼吸障碍的影响，尚不完全清楚。重要的是，瘦体重的减少并不一定反映具有临床意义的骨骼肌丢失或肌肉功能受损。本叙述性小型综述强调了在绝经后女性中平衡有效的药物诱导减重与保持肌肉健康和身体功能所面临的临床挑战。它回顾了关于司美格鲁肽在该人群中使用的当前证据，重点关注肌肉健康和睡眠呼吸障碍。在此背景下，通过充分摄入蛋白质和微量营养素以及抗阻运动来克服合成代谢抵抗可能有助于保持肌肉骨骼健康，尽管在司美格鲁肽治疗的绝经后女性中的证据仍是间接的。尽管减重通常预期可改善肥胖相关阻塞性睡眠呼吸暂停，但司美格鲁肽对绝经后女性睡眠呼吸障碍的具体影响及长期睡眠相关结局尚不充分。一种更综合的肥胖管理方法，将药物治疗与针对性的营养和生活方式策略相结合，可能有助于实现安全且可持续的减重，同时保持肌肉功能并优化整体代谢健康。

英文摘要

Postmenopause is characterized by hormonal changes that predispose women to sleep disturbances, alterations in body composition, and an increased risk of sarcopenia. Current studies indicate that weight reduction induced by glucagon-like peptide-1 receptor agonists is associated with decreases in lean body mass, although the functional consequences of these changes, including their implications for muscle and sleep-disordered breathing, are incompletely understood. Importantly, reductions in lean body mass do not necessarily reflect clinically meaningful skeletal muscle loss or impaired muscle function. This narrative mini-review highlights the clinical challenge of balancing effective pharmacologically induced weight loss with the preservation of muscle health and physical function in postmenopausal women. It reviews the current evidence regarding semaglutide use in this population, with a focus on muscle health and sleep-disordered breathing. In this context, overcoming anabolic resistance through adequate intake of protein and micronutrients, and resistance exercise may help preserve musculoskeletal health, although evidence in semaglutide-treated postmenopausal women remains indirect. Although weight reduction is generally expected to improve obesity-related obstructive sleep apnea, the specific effects of semaglutide on sleep-disordered breathing and long-term sleep-related outcomes in postmenopausal women are insufficiently characterized. A more integrated approach to obesity management, combining pharmacological treatment with targeted nutritional and lifestyle strategies, may help achieve safe and sustainable weight loss while preserving muscle function and optimizing overall metabolic health.