GLP-1s for Sleep Apnea

Though GLP-1s have primarily been prescribed to treat people with type 2 diabetes and/or obesity Trusted Source StatPearls View Source , they’ve also garnered interest as a potential treatment for obstructive sleep apnea (OSA), a common sleep disorder where the upper airway is obstructed, leading to lapses in breathing.

Though research is still emerging, GLP-1 medications appear to improve the severity of OSA. As such, they may provide a promising addition to traditional therapies for OSA. Below, we’ll take a closer look at GLP-1 medications for sleep apnea: how they may help, possible risks, and who may be an ideal candidate for treatment.

What Are GLP-1s?

The body naturally produces a hormone called glucagon-like peptide-1 (GLP-1). Made in the intestines, GLP-1 serves several functions: 

• It triggers the release of insulin, which helps regulate blood sugar levels.
• It affects the areas of the brain that control hunger, decreasing appetite.
• It reduces the rate of gastric emptying (food leaving the stomach), increasing satiety.

“The injectable form of GLP-1 mimics the naturally occurring hormone to medically influence blood glucose levels, satiety, and weight loss,” says Thomas Kilkenny, DO, director of the Institute of Sleep Medicine at Northwell’s Staten Island University Hospital. In other words, GLP-1 agonists help people eat less, feel fuller on less food, and, ultimately, lose weight.

Since GLP-1 agonists can help manage blood sugar levels and promote weight loss, they’re primarily used to treat people with type 2 diabetes, as well as adults with obesity. Some of the common GLP-1 agonists include:

• Semaglutide (Ozempic, Rybelsus, Wegovy)
• Dulaglutide (Trulicity)
• Exenatide (Byetta, Bydureon BCise)
• Liraglutide (Victoza)
• Lixisenatide (Adlyxin)

Tirzepatide (Mounjaro, Zepbound) is another popular injectable drug that impacts hormone receptors to reduce appetite. It belongs to a related class of medications called dual agonists that activate two hormone pathways: GLP-1 receptors and other hormone receptors called glucose-dependent insulinotropic polypeptide (GIP) receptors Trusted Source U.S. Food and Drug Administration (FDA) The FDA is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and by ensuring the safety of our nation's food supply, cosmetics, and products that emit radiation. View Source .

Though all the injectable GLP-1 agonist medications work similarly, some research appears to show that the dual-agonist drugs may lead to more weight loss Trusted Source American Academy of Sleep Medicine (AASM) AASM sets standards and promotes excellence in sleep medicine health care, education, and research. View Source .

How Do GLP-1s Work for Sleep Apnea?

In general, the higher a person’s BMI (body mass index, a ratio of height and weight) is, the higher their risk of obstructive sleep apnea is, says Andrew Namen, MD, FCCP, FAASM, spokesperson for the American Academy of Sleep Medicine. That’s because excess weight can affect the airway in several ways. 

“Weight gain causes fatty deposits around the neck and in the tissues of the throat,” Dr. Kilkenny says. “This, in turn, narrows the area within the airway, worsening obstructive sleep apnea. Increased weight in the abdominal area also compresses the lungs and decreases the airflow in the airways.”

OSA can also lead to weight gain and a greater risk for developing diabetes Trusted Source Journal of Translational Medicine View Source . By disrupting deep sleep and the sleep-wake cycle, OSA can dysregulate metabolism and impact hunger and satiety hormones, increasing a person’s appetite for high-calorie foods and decreasing feelings of fullness.

However, in many cases, weight loss can help decrease the severity of OSA. “Less body weight, especially around the neck, throat, and chest, can reduce the likelihood of airway collapsibility, as well as improve breathing function,” Dr. Namen says.

With weight being a major factor in OSA severity, scientists are exploring how GLP-1 agonists may help people with OSA and obesity. One systematic review and meta-analysis concluded that GLP-1 agonists can support weight loss, improve insulin sensitivity, and have anti-inflammatory and neuroprotective effects for people with OSA and obesity. 

Most significantly, researchers noted that GLP-1 agonists helped lower the apnea hypopnea index (AHI), the number of breathing interruptions per hour that indicates the severity of sleep apnea. Essentially, the lower the AHI, the lower the severity.

Other studies have similarly concluded that GLP-1 agonists could significantly improve OSA by aiding in weight loss while reducing blood pressure Trusted Source Sleep View Source and AHI Trusted Source Sleep Medicine View Source . However, all the studies’ authors have observed the need for more research to confirm the long-term benefits and safety of GLP-1 medications in OSA treatment.

Which GLP-1 Is Approved for Sleep Apnea?

“The FDA has approved Zepbound (tirzepatide) as the first and only [so far] prescription medication for adults with moderate to severe OSA and obesity,” Dr. Namen says.

As a dual agonist, Zepbound activates GLP-1 and GIP hormone receptors, helping to lessen appetite and food intake. While the drug can promote weight loss and improve OSA, it’s most effective when combined with exercise and a reduced-calorie diet.

The FDA’s approval of Zepbound for OSA “is a positive development for patients and clinicians, who now have another treatment option for this pervasive and under-diagnosed sleep disorder,” Dr. Namen says.

Can GLP-1s Replace CPAP?

Though GLP-1 agonists show great potential as part of an OSA treatment plan, research on the role of GLP-1 drugs and sleep apnea is still underway. More research is needed to inform the use of GLP-1 agonists as a potential standalone therapy for OSA.

For now, continuous positive airway pressure (CPAP) therapy, which works by delivering pressurized air through a mask to keep the airways open, remains the gold standard for the treatment of sleep apnea. That’s because it prevents airway collapse no matter the underlying cause of someone’s sleep apnea. 

Excess weight is only one factor when it comes to OSA risk. “Many cases of sleep apnea are related to other factors such as the structure of the jaw and upper airway,” Dr. Namen says. Similarly, enlarged tongue or tonsils that significantly block the airway can lead to OSA as well.

In these cases, weight loss alone (and use of GLP-1 agonists) may not cure the person of sleep apnea, Dr. Kilkenny says. In fact, some data show that even in patients with significant weight loss (through bariatric surgery), approximately half still require CPAP therapy to manage OSA, he says.

However, in certain cases, GLP-1 medications may provide an alternative for those who struggle with CPAP. Some people find sleeping with a mask clunky and uncomfortable, which can be a deterrent for consistent use.

But like any other OSA treatments, GLP-1 agonists are most effective when used in conjunction with healthy lifestyle habits like increased physical activity and proper sleep hygiene to support sleep healthy and weight management.  

Who Might Be a Candidate for GLP-1s?

The ideal candidate for GLP-1 agonists is a person with moderate to severe obstructive sleep apnea and obesity (BMI greater than 30). Additionally, a care provider will take other health factors into consideration before prescribing a GLP-1 agonist. A person might also be a candidate if they have:

• Diabetes (GLP-1 agonists can improve blood sugar control)
• Cardiovascular disease (Some GLP-1 agonists like Wegovy may lower the risk of cardiovascular death, heart attack, and stroke in people with cardiovascular disease and either obesity or overweight) Trusted Source U.S. Food and Drug Administration (FDA) The FDA is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and by ensuring the safety of our nation's food supply, cosmetics, and products that emit radiation. View Source

What Are the Risks and Side Effects of GLP-1s?

Though GLP-1 agonists show great promise for treatment of OSA in adults with obesity, they’re not without risks. Some GLP-1 drugs have been shown to trigger gastrointestinal side effects including:

• Nausea
• Vomiting
• Diarrhea
• Bloating
• Constipation
• Pancreatitis (inflammation of the pancreas)
• Gastroparesis (a disorder that delays or stops the movement of food from the stomach to the small intestine)
• Bowel obstruction (a partial or complete blockage of the bowel)

These side effects are more common when a person first starts taking GLP-1 agonists, and severe complications are typically rare.

Other potential issues to consider when taking GLP-1 medications:

• Sagging skin due to rapid weight loss
• Rapid weight gain if the medication is discontinued

In addition, GLP-1 agonists are not safe for everyone. People with the following medical conditions should avoid taking GLP-1 drugs:

• A history of pancreatitis
• Gastrointestinal disorders, such as Crohn’s disease, ulcerative colitis, or gastroparesis  
• Certain kidney diseases
• A personal or family history of thyroid cancer
• Allergic reactions to GLP-1 agonists or any active ingredients

GLP-1 agonists are also not recommended for pregnant people, as some preliminary research in animals shows they may cause developmental abnormalities or birth defects Trusted Source World Journal of Diabetes View Source .

For safety, it’s important to talk to your doctor and thoroughly review your current health conditions and past medical history to decide whether GLP-1 therapy is an appropriate treatment option.