What is the role of Glucagon-like peptide-1 (GLP-1) medications in the treatment of Obstructive Sleep Apnea (OSA)?

From the Guidelines

GLP-1 receptor agonists like semaglutide (Wegovy, Ozempic) and tirzepatide (Mounjaro) may help some patients with obstructive sleep apnea (OSA) through weight loss, but they are not currently FDA-approved specifically for OSA treatment. These medications can lead to significant weight reduction, which often improves OSA severity since excess weight is a major risk factor. Typical starting doses are 0.25mg weekly for semaglutide, gradually increasing to 2.4mg weekly for Wegovy (or 1mg for Ozempic), or 2.5mg weekly for tirzepatide, increasing to 15mg weekly. Treatment is typically long-term as weight regain often occurs when medication is stopped. While using these medications, patients should continue their primary OSA treatment (usually CPAP) and have their OSA reassessed after significant weight loss. The mechanism involves how excess fat deposits around the upper airway contribute to airway collapse during sleep; reducing this tissue through weight loss can improve airway patency. Some early research suggests GLP-1 medications may also have direct effects on respiratory control beyond weight loss, but more studies are needed before these can be recommended as primary OSA treatments 1.

Key Considerations

• Weight loss is a key factor in improving OSA severity, and GLP-1 receptor agonists can help achieve this goal.
• Patients should continue their primary OSA treatment while using GLP-1 medications and have their OSA reassessed after significant weight loss.
• The potential benefits and risks of GLP-1 medications for OSA treatment should be carefully considered, and more research is needed to fully understand their effects.

Treatment Approach

• Typical starting doses for GLP-1 receptor agonists are 0.25mg weekly for semaglutide, gradually increasing to 2.4mg weekly for Wegovy (or 1mg for Ozempic), or 2.5mg weekly for tirzepatide, increasing to 15mg weekly.
• Treatment is typically long-term, and patients should be monitored for weight regain and OSA symptoms.
• Patients should be encouraged to lose weight and maintain a healthy lifestyle to improve OSA symptoms and overall health 1.

From the Research

GLP-1 Meds for OSA

• The use of GLP-1 receptor agonists (GLP-1 RAs) has been explored as a potential therapeutic option for managing obstructive sleep apnea (OSA) [ 2 ].
• GLP-1 RAs are known for their ability to reduce body weight and improve metabolic health, which can help address obesity, a major modifiable risk factor for OSA [ 2 ].
• Emerging evidence suggests that GLP-1 RAs may offer therapeutic benefits in managing OSA, particularly by reducing OSA severity [ 2 ].

Mechanism and Benefits

• GLP-1 RAs can provide a "one-stop shop" for OSA patients by addressing multiple comorbidities, such as hypertension, diabetes, obesity, metabolic syndrome, and atherosclerotic cardiovascular diseases [ 3 ].
• The use of GLP-1 RAs can help reduce polypharmacy, cost, and adverse drug events, and improve quality of life for patients living with OSA and diabetes [ 3 ].
• Weight reduction, which can be achieved through the use of GLP-1 RAs, is a cornerstone for the prevention and treatment of metabolic syndrome and can correct or improve the symptoms of OSA [ 4 ].

Clinical Significance

• Obesity is a major health burden and the most important risk factor for OSA, with at least 70% of patients being obese [ 4 ].
• Weight loss has been shown to have a notable ameliorative impact on the occurrence of OSA, and modest weight reduction may alleviate the need for long-term nCPAP therapy or upper-airway surgery [ 5 ].
• The concomitant use of nCPAP and behavioral weight loss therapy in obese patients with OSA may result in enhanced weight loss [ 5 ].