GLP-1 RAs Improve Sleep Apnoea Outcomes in People With Obesity
Key Takeaways:
- GLP-1 receptor agonists (GLP-1 RAs) reduced the apnoea-hypopnoea index (AHI) by 5.7 to 21.9 events per hour across six meta-analyses, with tirzepatide achieving disease remission in 42% to 50% of adults with moderate to severe obstructive sleep apnoea (OSA) and obesity in the SURMOUNT-OSA trials.
- The benefits appear to be driven primarily by weight loss, including reductions in tongue fat and parapharyngeal adipose tissue, although emerging preclinical evidence points to possible weight-independent mechanisms.
- Continuous positive airway pressure (CPAP) still delivers greater AHI reductions, and the review authors position GLP-1 RAs as a complementary therapy rather than a replacement, best suited to people with a BMI above 30 who cannot tolerate CPAP and have obesity-related comorbidities.
A new treatment avenue for obesity-related sleep apnoea
GLP-1 RAs significantly improve outcomes for people living with both OSA and obesity, according to the findings of a review published in JAMA Otolaryngology–Head & Neck Surgery.
Obesity is common among people with OSA, yet until recently there were no medicines specifically aimed at treating excess body weight in this population. That changed towards the end of 2024, when the US Food and Drug Administration (FDA) approved tirzepatide for the treatment of moderate to severe OSA in adults with obesity. The approval was based on positive results from the phase 3 SURMOUNT-OSA trials.
In the recent review, researchers examined the effects of several medicines acting on the GLP-1 receptor in OSA, including tirzepatide, semaglutide, liraglutide, exenatide and retatrutide.
What the evidence shows
Data drawn from six previous meta-analyses showed that GLP-1 RA use reduced AHI by between 5.7 and 21.9 events per hour.
The SURMOUNT-OSA trials, which enrolled adults living with moderate to severe OSA and obesity, found that tirzepatide reduced AHI by approximately 20 to 24 events per hour compared with placebo. Participants also achieved an average weight loss of 18% to 20%.
Disease remission was achieved in 42% to 50% of these participants. In the trials, remission was defined as an AHI of fewer than 5 events per hour, or fewer than 15 events per hour in the absence of symptoms.
Weight loss as the main driver
According to the study authors, the benefits of GLP-1 RAs were primarily driven by weight loss. Studies have shown that these medicines reduce both tongue fat and parapharyngeal adipose tissue, each of which contributes to upper airway collapse.
The link between body weight and OSA severity is well established. Findings from the Wisconsin Sleep Cohort Study showed that a 10% increase in body weight was associated with a 32% increase in AHI, while the same degree of weight loss was associated with a 26% reduction in AHI.
Possible weight-independent effects
The authors also highlighted early research suggesting that GLP-1 RAs may influence OSA through mechanisms beyond weight loss.
“Emerging preclinical evidence has suggested potential weight-independent effects through carotid body [GLP-1] receptor modulation of chemosensitivity (affecting loop gain), leptin pathway interactions that are associated with upper airway neuromuscular control, and NLRP3 inflammasome suppression,” the study authors noted.
For healthcare professionals seeking to deepen their understanding of how these therapies work and where they fit within wider obesity care, The College of Contemporary Health’s GLP-1RA Therapy: The Complete Programme course explores this rapidly evolving class of medicines.
How GLP-1 RAs compare with CPAP
While medicines acting on the GLP-1 receptor are effective in treating OSA, their effects are more limited than those of CPAP, the established standard treatment. According to a previous umbrella review comparing OSA interventions, CPAP delivers greater AHI reductions, of approximately 31 events per hour compared with 22 events per hour for tirzepatide.
The review also identified further limitations of GLP-1 RAs, including:
- uncertainty about their impact on cardiovascular outcomes
- weight regain when treatment is stopped
- data suggesting that tirzepatide may not be cost-effective for treating OSA under commonly used thresholds
Positioning GLP-1 RAs in clinical practice
Rather than replacing existing treatments, the authors see GLP-1 RAs as one part of a broader management strategy.
“This review suggests that GLP-1 RAs offer otolaryngologists a disease-modifying adjunct for obesity-related OSA that is best positioned as complementary therapy alongside CPAP, preoperative optimization before upper airway surgery, or potentially to expand hypoglossal nerve stimulator candidacy,” the review authors said.
Who may benefit most
The authors advised that GLP-1 RAs are appropriate options for people with a body mass index (BMI) above 30 who have inadequate tolerance to CPAP and who are living with obesity-related comorbidities.
However, they noted that these medicines are not suitable for people without obesity, or for people whose OSA is primarily caused by anatomical obstruction or who have central sleep apnoea.
Disclosure: One author declared affiliations with biotech, pharmaceutical and/or device companies. Please see the original reference for a full list of the authors’ disclosures.
CCH insight
As GLP-1 RAs extend into new indications such as obstructive sleep apnoea, healthcare professionals need a clear understanding of the evidence, appropriate patient selection and the limitations of these therapies. GLP-1RA Therapy: The Complete Programme from The College of Contemporary Health helps clinicians stay up to date with this fast-moving area of practice.
Explore GLP-1RA Therapy: The Complete Programme →
Source: JAMA Otolaryngology–Head & Neck Surgery
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