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Conversely, in chronic treated patients the effects on volume changes are slightly reduced because a new steady state is reached, due to a counter-regulatory effect, resulting in a lower total body sodium concentration and blood volume (53)

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These alterations change the hypothalamic neuropeptide expression: the expression of CA-AMPK enhances the effect of fasting, increasing the expression of NPY and AgRP in the ARC and the melanin-concentrating hormone in the lateral hypothalamus, whereas the hypothalamic expression of DN-AMPK decreases the expression of orexigenic neuropeptides NPY and AgRP in ARC [88, 118]

Clinical Implications for Patient Selection The observed survival advantage implies that sleep apnea may serve as a marker of enhanced responsiveness to GLP-1 therapy in diabetes management