A class of weight-loss medications is garnering attention as a potential pharmacological treatment option for obstructive sleep apnea (OSA) in patients with obesity. Several glucagon-like peptide-1 (GLP-1) agonists, already FDA-approved for obesity or type 2 diabetes, are now being investigated for their efficacy in treating OSA.
GLP-1s and OSA: A Growing Body of Evidence
While no GLP-1 agonist currently holds FDA marketing clearance for OSA treatment, this could soon change. Eli Lilly submitted a supplemental new drug application to the FDA in June, seeking approval for tirzepatide for OSA, based on the results of the SURMOUNT-OSA trial. The FDA had previously granted Fast Track designation to tirzepatide for moderate-to-severe OSA in patients with obesity in 2022.
"We are hopeful about the potential to bring a first-of-its-kind treatment option to people living with moderate-to-severe OSA and obesity, who currently have no pharmaceutical treatments for the underlying disease," said a spokesperson for Eli Lilly.
Clinical Evidence Supporting GLP-1s for OSA
Earlier studies have hinted at the potential of GLP-1s in treating OSA. A 2015 clinical trial linked a GLP-1 to significant improvements in OSA severity, while a 2016 trial found that weight loss resulting from liraglutide was significantly associated with a reduction in the apnea-hypopnea index (AHI).
The SURMOUNT-OSA trial, funded by Eli Lilly, provided further evidence. Two phase 3, double-blind, randomized controlled trials evaluated tirzepatide in moderate-to-severe OSA patients with obesity, both with and without CPAP therapy. Participants received either 10 or 15 mg of tirzepatide or a placebo for 52 weeks. The results showed that AHI decreased by an average of 25.3 events per hour (a 50.7% reduction) in the non-CPAP group and 29.3 events per hour (a 58.7% reduction) in the CPAP group.
Expert Perspectives on GLP-1s for OSA
Katherine H. Saunders, MD, DABOM, an obesity physician at Weill Cornell Medicine, described GLP-1s as "nothing short of a miracle for patients with obesity and sleep apnea." She noted that GLP-1s are "complete game-changers" for these patients, enabling more individuals to improve or resolve their sleep apnea.
Anthony Izzo, DO, FAAN, FAASM, sleep center medical director at Community Neuroscience Services, prescribes GLP-1s to patients who cannot tolerate CPAP. Raj Dasgupta, MD, FACP, FCCP, FAASM, chief medical advisor for Sleepopolis, refers OSA patients to endocrinologists for GLP-1 consideration if he believes they might benefit.
The Role of GLP-1s in the Broader OSA Treatment Landscape
Experts emphasize that GLP-1s are unlikely to replace existing OSA therapies. Brandon Peters, MD, FAASM, a sleep physician at Virginia Mason Medical Center, believes GLP-1s are not a first-line treatment, as it can take months or years to achieve sufficient weight loss to improve OSA. He suggests that GLP-1s may be used alongside treatments like CPAP, potentially allowing for reduced CPAP pressure settings as patients lose weight.
Challenges and Considerations
Despite the promising benefits, significant barriers remain, including supply shortages, cost, and insurance coverage. Novo Nordisk’s Ozempic and Wegovy have faced supply issues, and while Eli Lilly’s Zepbound and Mounjaro were recently removed from the FDA's drug shortage list, intermittent disruptions may still occur.
A Kaiser Family Foundation (KFF) analysis revealed that Affordable Care Act Marketplace plans rarely cover GLP-1s approved for obesity treatment, and a KFF poll found that only about 1 in 4 patients using GLP-1s reported full insurance coverage. These challenges raise health equity concerns, potentially limiting access for patients from diverse backgrounds.
Experts also caution that GLP-1s are not a universal solution for weight loss and should be prescribed with comprehensive evaluation, lifestyle management, and ongoing support. Careful patient selection is crucial to minimize side effects and adverse events.
Future Directions
Further research is needed to understand why some OSA patients do not fully respond to GLP-1 treatments and to conduct comparative effectiveness studies between CPAP and tirzepatide. As GLP-1 medications are developed and implemented, ongoing research will help identify appropriate candidates and optimize treatment strategies.
