Is GLP-1 (Glucagon-Like Peptide-1) receptor agonist approved for Obstructive Sleep Apnea (OSA) treatment?

GLP-1 Receptor Agonists for Obstructive Sleep Apnea

No GLP-1 receptor agonists are specifically FDA-approved for treating obstructive sleep apnea (OSA) as a primary indication, though they may be used in patients with OSA who have comorbid obesity or type 2 diabetes. 1

FDA Approval Status for GLP-1 RAs in OSA

The FDA has approved certain GLP-1 receptor agonists for weight management in patients with specific BMI criteria and comorbidities, including OSA:

• Liraglutide (3 mg): Approved in 2014 for patients with BMI > 30, or BMI > 27 with comorbidities including OSA 1
• Semaglutide (2.4 mg): Approved in 2021 for patients with BMI > 30, or BMI > 27 with comorbidities including OSA 1

It's important to note that these medications are approved for weight management in patients who have OSA as a comorbidity, not for direct treatment of OSA itself.

Efficacy of GLP-1 RAs in OSA

Recent evidence shows promising results for GLP-1 RAs in improving OSA severity:

• A 2024 meta-analysis found GLP-1 RAs significantly decreased AHI by 9.48 events per hour (95% CI, -12.56 to -6.40) 2
• Different GLP-1 RAs showed varying efficacy:
  • Tirzepatide reduced AHI by 21.86 events per hour (95% CI, -25.93 to -17.79)
  • Liraglutide reduced AHI by 5.10 events per hour (95% CI, -6.95 to -3.26) 2
• In non-diabetic individuals with OSA and elevated BMI, GLP-1 RAs reduced AHI with a weighted mean difference of -16.6 events per hour (95% CI: -27.9 to -5.3) compared to placebo 3

Current Treatment Guidelines for OSA

The established treatment hierarchy for OSA according to guidelines:

1. First-line treatment: CPAP therapy plus weight loss if overweight/obese 4
2. Alternative treatments when CPAP fails or is not tolerated:
   • Mandibular advancement devices (MADs), particularly for mild to moderate OSA 4
   • Surgical options in select cases 1, 4

There are currently no widely effective pharmacotherapies specifically approved for OSA treatment 1. The American Academy of Sleep Medicine does not recommend selective serotonergic uptake inhibitors, protriptyline, methylxanthine derivatives, or estrogen therapy for OSA treatment 1.

Using GLP-1 RAs in OSA Patients

While not approved specifically for OSA treatment, GLP-1 RAs may benefit OSA patients through:

1. Weight reduction: Significant weight loss (6.1-17.4% in non-diabetic patients) can improve OSA severity 1, 2
2. Cardiometabolic benefits: Improvements in blood pressure and metabolic parameters that often accompany OSA 2, 5
3. Reduced polypharmacy: Potential to address multiple comorbidities with a single agent in patients with OSA plus diabetes/obesity 6

Safety Considerations

GLP-1 RAs are associated with a higher frequency of adverse events compared to placebo (OR 1.62,95% CI: 1.16 to 2.24) 3. Common side effects include gastrointestinal symptoms such as nausea, vomiting, and diarrhea.

Conclusion

While GLP-1 receptor agonists show promise in improving OSA severity through weight reduction, they are not FDA-approved specifically for OSA treatment. They may be prescribed for weight management in patients with obesity and OSA as a comorbidity, potentially offering benefits for both conditions simultaneously.