Obstructive sleep apnea (OSA) affects almost 1 billion people worldwide. OSA is a disease where the airway repetitively narrows or closes off during sleep, interrupting your breathing. This often causes arousals from sleep, which may result in daytime sleepiness, fatigue, or other related health problems.
The good news is that researchers are looking at ways to improve and hopefully cure OSA. Traditionally, OSA treatments have included continuous positive airway pressure (CPAP), specialized dental sleep devices, or upper-airway surgery.
Recently, doctors have begun using dual glucagon-like peptide-1(GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonists for OSA patients with obesity. GLP-1 medications were originally developed for type 2 diabetes and have more recently been shown to aid in weight loss. In 2024, tirzepatide (a dual GLP-1/GIP agonist) became the first FDA-approved medication specifically for moderate-to-severe obstructive sleep apnea in adults with obesity.
How Weight Affects OSA
Healthier Sleep spoke with Vaishnavi Kundel M.D., M.S., who treats patients with OSA. She explains that being overweight is a common risk factor for OSA. In some people it is the cause while in others a contributing factor. According to an epidemiologic study in the United States, 58% of moderate-to-severe OSA and 40% of mild OSA cases are attributed to overweight or obesity. That is why weight loss is a treatment strategy for OSA.
Reducing body fat may improve OSA by:
- Decreasing fat in the tongue and throat which helps keep the airway open during sleep
- Reducing abdominal fat which improves lung volumes and the traction forces that hold the airway open
- Improving breathing mechanics by relieving pressure on the diaphragm and lungs
- Improving related health conditions including inflammation, blood pressure, diabetes, and cardiac function
Treatments
Dr. Kundel referenced the Surmount OSA study (published in 2024) in which subjects had moderate-to-severe OSA and obesity (BMI ≥ 30 in United States, or ≥ 27 in Japan) and no diabetes. One group received a placebo, and another group received tirzepatide an injectable GLP-1/GIP agonist. After 52 weeks, subjects who received tirzepatide reduced body weight by 18-20% and their apnea-hypopnea index (AHI), or number of times per hour of sleep that their breathing stopped, was reduced by approximately 20-24 events per hour more than patients taking the placebo. Up to half of tirzepatide-treated patients improved to mild or no OSA. They also saw improvement in sleep-related symptoms, oxygen levels, inflammatory markers, and blood pressure.
Tirzepatide is approved for moderate-to-severe OSA in adults with obesity. It works gradually through weight loss and takes months to reach its full effect. Because CPAP and oral appliances provide immediate relief by keeping the airway open during sleep, experts recommend continuing these therapies while tirzepatide takes effect. When significant weight loss is achieved, a sleep specialist may order a follow-up sleep study to reassess OSA severity and determine whether CPAP pressure can be reduced or, if OSA has resolved, whether CPAP is still needed.
Tirzepatide is currently the only FDA-approved medication for the treatment of moderate-to-severe OSA in adults with obesity. Other medications have shown promise in treating OSA, however they have not yet received FDA approval. Each medication varies in expected weight loss, route of delivery (weekly injectable or daily oral pill), and cost.
Side Effects
Because these medications affect the gastrointestinal system, common side effects include nausea, vomiting, diarrhea, and constipation. These are usually mild to moderate, occur most often during dose escalation, and usually diminish over time with continued use. Patients with a family history of endocrine cancers, such as medullary thyroid or pancreatic cancer may be at a higher risk of developing these cancers if taking these medications. They should notify their doctor about these conditions. Because obesity is a chronic condition, these medications are generally intended for long-term use. If treatment is stopped, weight regain is common. Any decision to adjust or discontinue treatment should be made with your healthcare provider.
The GLP-1 and OSA study results are encouraging, and an exciting new direction for the field of OSA. However, many questions remain. Dr. Kundel points out that real-world studies for GLP-1 agonists are needed to understand how these medications perform in everyday use and how they compare and work alongside established OSA therapies such as CPAP.
Vaishnavi Kundel, M.D., M.S. is an Associate Professor of Medicine in the Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine at the Icahn School of Medicine in Mount Sinai, New York. She is also the Program Director of the Sleep Medicine Fellowship.