Nocturnal polygraphy in neuromuscular disorders: is it a useful diagnostic tool?

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are synthetic analogues of the endogenous incretin hormone glucagon-like peptide-1 (GLP-1), which plays a central role in regulating postprandial glucose excursions, enhancing satiety, and slowing gastric emptying []. Since the approval of the first GLP-1RA, exenatide, nearly two decades ago, several additional agents—including dulaglutide, liraglutide, lixisenatide, and semaglutide—have been developed and approved for clinical use []. GLP-1RAs have since become integral to the management of type 2 diabetes and obesity, with increasing evidence supporting their role as adjunctive therapies in cardiovascular disease. The glucagon-like peptide-1 receptor (GLP-1R) is widely expressed across multiple tissues and organ systems, including the gastrointestinal tract, central nervous system, cardiovascular system, lungs, kidneys, skin, and vagus nerve, reflecting the pleiotropic effects of GLP-1 signalling [,]. In the cardiovascular system, GLP-1R activation is associated with reduced atherosclerotic progression, improvements in lipid profiles, lowering of blood pressure, enhancement of vascular endothelial function, and reductions in major adverse cardiovascular events []. In the central nervous system, GLP-1R activity has been shown to reduce neuroinflammation, enhance synaptic transmission, and support neuroprotection and neural regeneration []. Consistent with these widespread receptor-mediated effects, GLP-1RAs may be classified according to their pharmacokinetic properties and chemical structure. Based on duration of action, they are categorised as short-acting or long-acting agents []. Irrespective of duration, GLP-1RAs delay gastric emptying, improve glycaemic control through glucose-dependent stimulation of insulin secretion and suppression of glucagon release, and regulate appetite by promoting satiety. Short-acting agents include exenatide and lixisenatide, while long-acting agents include dulaglutide, exenatide long-acting release, liraglutide, and semaglutide [,]. GLP-1RAs may also be classified by chemical structure into GLP-1–based derivatives and exendin-4–based derivatives [].