The Emerging Role of GLP-1s in Treating Obstructive Sleep Apnea and Obesity in Sleep Medicine

October 22, 2025

New Hope for Sleep Apnea Sufferers: Weight Loss Drugs Show Promise

Millions worldwide grapple with obstructive sleep apnea (OSA), a condition impacting breathing during sleep. Now, a novel approach utilizing medications designed for weight management is generating excitement among medical professionals. Recent findings, presented at the CHEST 2025 Annual Meeting, suggest that Glucagon-like peptide-1 (GLP-1) inhibitors could significantly alleviate OSA symptoms.

The Link Between Weight and Sleep Apnea

Obesity is a major risk factor for obstructive sleep apnea, with approximately one billion individuals globally affected. These medications, initially lauded for their efficacy in managing obesity and related cardiovascular issues, are now being investigated as a potential therapeutic intervention for OSA. Studies led by Atul Malhotra, MD, of the University of California, San Diego, have begun to unravel this connection.

SURMOUNT Trials Reveal Important Improvements

the SURMOUNT trials involved adults with moderate to severe OSA and obesity. Participants received either 10mg or 15mg of tirzepatide, or a placebo. The trials included groups both with and without continuous positive airway pressure (CPAP) therapy. Researchers observed considerable reductions in the apnea-hypopnea index (AHI) – a key measure of OSA severity – among those treated with tirzepatide.

Specifically, individuals receiving tirzepatide experienced AHI reductions of approximately 25 to 29 events per hour, compared to just 5 to 6 events in the placebo groups. These improvements were coupled with enhanced patient-reported outcomes related to sleep quality and overall well-being.

Here’s a summary of the key findings:

Trial group	Mean AHI Reduction
Tirzepatide (10mg/15mg) – Trial 1	-25.3 events/hour
Tirzepatide (10mg/15mg) – Trial 2	-29.3 events/hour
Placebo – Trial 1	-5.3 events/hour
Placebo – Trial 2	-5.5 events/hour

*AHI = Apnea-Hypopnea Index*

Expert Perspectives and Implementation Challenges

Following the presentation of trial data, a panel of experts discussed the practical implications of using GLP-1 inhibitors for sleep apnea. Dennis Auckley, MD, a pulmonologist at MetroHealth Medical Center, highlighted the current challenges in accessing obesity management programs, with wait times frequently exceeding eight to nine months.

“One in four Americans is now utilizing GLP-1 receptor agonists,” noted Dr. Malhotra, emphasizing the growing prevalence of these medications. Experts also discuss the need for standardized protocols within sleep medicine practices.

Nancy Callop, MD, director of the Emory Sleep Center, explained that prescribing practices vary, with younger physicians often more comfortable utilizing these medications due to recent training. Babak Mokhlesi, MD, chief of pulmonary, critical care, and sleep medicine at Rush University, shared his personal experience with the medications.

Implementing these therapies effectively also requires a holistic approach. Allison Rhodes, MD, assistant professor of clinical medicine at The Ohio State University Medical Center, emphasized the importance of integrating GLP-1 inhibitors with lifestyle modifications, including nutrition, exercise, sleep hygiene, and stress management. Patients are frequently enough required to demonstrate adherence to these lifestyle changes to continue receiving medication refills.

Did you know that GLP-1 medications can influence “food noise,” or the urge to eat for pleasure rather than hunger, potentially improving dietary control?

The Future of OSA Treatment

While GLP-1 inhibitors show promise, experts caution that they are not a universal solution. CPAP remains a cornerstone of OSA treatment, and weight loss achieved through medication may not eliminate the need for CPAP in all cases. However, these medications can potentially reduce the severity of OSA, allowing some patients to transition to less intensive therapies.

What role do you believe lifestyle changes should play alongside pharmaceutical interventions for OSA?

Do you think wider access to GLP-1 medications could reshape the landscape of sleep apnea treatment?

Understanding Obstructive Sleep Apnea

Obstructive Sleep Apnea (OSA) occurs when muscles in the throat relax during sleep, causing a blockage of the airway. This leads to pauses in breathing, resulting in reduced oxygen levels and disrupted sleep. Common symptoms include loud snoring, daytime sleepiness, and difficulty concentrating.left untreated, OSA can increase the risk of heart disease, stroke, and other serious health problems. The condition impacts an estimated 30 million Americans according to the National Sleep Foundation,and often goes undiagnosed.

Frequently Asked Questions about GLP-1s and Sleep Apnea

• What are GLP-1 inhibitors? These medications were originally developed to treat type 2 diabetes but have gained popularity for their weight loss effects.
• How do GLP-1s help with sleep apnea? They can reduce the severity of OSA by promoting weight loss, which in turn reduces fat deposits in the airway.
• Are GLP-1s a replacement for CPAP? Not necessarily. While they can improve OSA symptoms, CPAP may still be necessary for some patients.
• What are the potential side effects of GLP-1s? Common side effects include nausea, vomiting, and diarrhea.
• Is this treatment suitable for everyone with sleep apnea? GLP-1s are most effective for individuals with OSA related to obesity.
• How long does it take to see results? Improvements in AHI can be observed within several months of starting treatment.
• What lifestyle changes should I make while using GLP-1s? A healthy diet,regular exercise,and adequate sleep are essential for maximizing the benefits of these medications.

What are the key mechanisms by which GLP-1 receptor agonists contribute too weight loss, and how do thes mechanisms differ from traditional weight loss approaches?

Understanding the Interplay of Obesity and Obstructive Sleep Apnea (OSA)

Obesity and obstructive sleep apnea (OSA) are frequently co-occurring conditions, creating a complex cycle of metabolic and respiratory dysfunction. Excess weight, particularly around the neck, increases the risk of airway collapse during sleep, leading to OSA.Conversely, OSA exacerbates metabolic issues, contributing to weight gain and hindering weight loss efforts. Traditional treatments for OSA, like CPAP therapy, address the symptoms but don’t tackle the underlying obesity. This is where GLP-1 receptor agonists are showing notable promise.

What are GLP-1 Receptor agonists?

GLP-1s (Glucagon-Like Peptide-1 receptor agonists) are a class of medications originally developed for type 2 diabetes. They work by mimicking the effects of the naturally occurring GLP-1 hormone, which:

* Stimulates insulin release when blood sugar is high.

* Suppresses glucagon secretion (reducing glucose production).

* Slows gastric emptying, promoting a feeling of fullness.

* Appears to have direct effects on appetite regulation in the brain.

Commonly prescribed GLP-1s include semaglutide (Ozempic, Wegovy), liraglutide (Saxenda), and dulaglutide (Trulicity). While initially focused on glycemic control, their substantial weight management benefits have broadened their submission.

GLP-1s and Weight Loss: A Powerful Combination

The impact of GLP-1s on obesity treatment is substantial. Clinical trials, such as the STEP-1 trial with semaglutide, have demonstrated significant weight reduction – often exceeding 15% of initial body weight – in individuals with obesity, even without diabetes. This weight loss isn’t merely cosmetic; it directly impacts OSA severity.

How Weight Loss from GLP-1s Improves OSA

* Reduced Pharyngeal Fat: Weight loss, particularly in the neck region, decreases the amount of fat surrounding the upper airway, reducing the likelihood of collapse.

* Improved Lung volume: Lower body weight can improve lung capacity and reduce the effort required for breathing during sleep.

* Decreased Inflammation: Obesity is associated with chronic inflammation, which can worsen OSA. GLP-1s may have anti-inflammatory effects, further contributing to improvement.

* Enhanced CPAP Tolerance: For patients already using CPAP machines, weight loss can make therapy more cozy and improve adherence.

Emerging Evidence: GLP-1s Directly Impacting OSA Severity

recent research suggests GLP-1s may have a direct effect on OSA, autonomous of weight loss.Studies are investigating the impact on:

* upper Airway Muscle Activity: Some evidence suggests GLP-1s may enhance the activity of muscles that keep the airway open during sleep.

* Chemoreceptor Sensitivity: GLP-1s might modulate the sensitivity of chemoreceptors,which regulate breathing drive.

* Ventilatory Control: Preliminary findings indicate potential improvements in overall ventilatory control during sleep.

A 2023 study published in the American Journal of Respiratory and Critical Care Medicine showed a significant reduction in apnea-Hypopnea Index (AHI) – a measure of OSA severity – in patients treated with semaglutide, even before substantial weight loss occured. This suggests a neurophysiological effect beyond simply reducing tissue mass.

GLP-1s in Sleep Medicine: Current Protocols & Considerations

Currently, GLP-1s are not a first-line treatment for OSA. polysomnography (sleep study) remains the gold standard for diagnosis. However, GLP-1s are increasingly being considered as an adjunct therapy, particularly for:

* Obese patients with moderate to severe OSA: Those who struggle with CPAP adherence or are not candidates for surgery.

* Patients with comorbid conditions: Such as type 2 diabetes and cardiovascular disease.

* Individuals seeking comprehensive metabolic and respiratory health improvement.

Practical Considerations for Clinicians

* Patient Selection: Careful assessment of patient suitability is crucial, considering medical history, potential side effects, and contraindications.

* Monitoring: regular monitoring of AHI, weight, and metabolic parameters is essential.

* Multidisciplinary Approach: Optimal care involves collaboration between sleep specialists, endocrinologists, and dietitians.

* Lifestyle Modifications: GLP-1s are most effective when combined with a healthy diet and regular exercise. Behavioral therapy can also support long-term weight management.

Potential Side Effects and Risks

While generally well-tolerated, GLP-1s can cause side effects, including:

* Nausea and vomiting

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