GLP-1 weight-loss medications (like semaglutide or tirzepatide) can help some people lose 12-18% of body weight, which may reduce airway collapse and improve obstructive sleep apnea (OSA) symptoms.1,2
CPAP remains the most effective treatment for OSA.3 GLP-1s aren't a replacement, but they can complement CPAP therapy.4 Benefits take time and vary. Weight loss with GLP-1s can take months;2 some people notice OSA relief sooner with CPAP, while GLP-1 side effects (nausea, GI upset) and other health factors should be monitored with your health care team.1,5,6
Although people of all ages and body types can develop obstructive sleep apnea (OSA), obesity is one of the leading risk factors.7 Obesity is a chronic disease that develops when extra fat builds up in the body.8 If you're living with obesity and OSA, it's natural to wonder if there's a treatment to help manage both conditions.
Glucagon-like peptide-1, known as GLP-1, medications have shown promise in helping people lose excess weight.9 As a result, they may also be helpful for individuals living with OSA. We created this guide to help you better understand how GLP-1 medications and continuous positive airway pressure (CPAP) therapy may work together to help manage weight and sleep conditions like OSA.
Before we explain how GLP-1 medications can affect sleep apnea, let's review what OSA is and what symptoms it can cause.
Obstructive sleep apnea (OSA) is a condition where your upper airway becomes blocked repeatedly during sleep, making it harder for air to flow. These blockages can reduce or completely stop the flow of air, causing your breathing to pause throughout the night.10 People with OSA may experience temporary disruptions in sleep. Even if you don't remember these disruptions, they can reduce sleep quality and cause you to wake up feeling groggy, tired and sluggish.
Common symptoms of OSA include:7
The Apnea-Hypopnea Index (AHI) measures how frequently breathing interruptions occur during sleep. It counts the number of pauses in breathing that last for at least 10 seconds (apneas) as well as partial drops in airflow (hypopneas) that happen, on average, per hour. Doctors use an AHI score to help determine whether sleep apnea is present and how severe it may be, which may help guide diagnosis and treatment decisions. In general, a higher AHI indicates more frequent breathing interruptions and more severe sleep apnea.11
The severity of OSA is classified according to these AHI scores:12
Sleep apnea leads to pauses in breathing that can last from 10 seconds to over a minute.13 These pauses prevent your organs from getting oxygen. Normally, blood oxygen levels while sleeping range from 95% to 100%.
For people with sleep apnea, these levels can drop significantly - sometimes lower than 88%. Your heart, lungs, and brain require oxygen to function properly, and without it, tissue cells begin to die. This lack of oxygen is why sleep apnea is linked to serious health conditions, such as:14, 15
Obesity can also affect your body's ability to breathe normally. Breathing happens automatically - you don't have to think about it - and is controlled by your brainstem.16 Extra weight can interfere with the breathing process and may contribute to OSA.
Obesity contributes to airway collapse in several ways:
Poor sleep and weight gain can become a vicious cycle. The worse a person may sleep, the more weight they may gain. And the more weight they gain, the worse they may sleep.
This cycle can have an impact on your metabolism.17 Metabolic effects of obesity and OSA include:
In medicine, comorbidities are two or more health conditions existing in the same person at the same time. Obesity and OSA have several shared comorbidities:
Some comorbidities are more common than others. For example, up to 80% of people with uncontrolled high blood pressure also have OSA.27 Additionally, up to 56% of people with Type 2 diabetes may have OSA.28
GLP-1 stands for glucagon-like peptide-1 and is a hormone that controls your metabolism by reducing blood sugar levels. GLP-1 medications mimic the effects of a natural GLP-1. When you take a GLP-1 medication, it tells your pancreas to release insulin.9 Remember, insulin helps glucose move from your bloodstream to your cells. This makes it easier to control your blood sugar.
GLP-1 medications also control blood sugar in these ways:9
Glucagon is a hormone that tells the liver to send more glucose into the bloodstream. By telling your pancreas not to produce more glucagon when your blood sugar is already high, GLP-1 medications may help your glucose level stay within a target range.9
Due to their desirable effects on blood sugar, GLP-1 medications have since evolved into medications used for weight management.
Some of the GLP-1 medications are semaglutide-based or tirzepatide-based. Semaglutide works by activating the GLP-1 hormone system in the body. Tirzepatide works by mimicking two natural hormones (GLP-1 and GIP) that help control blood sugar and appetite.9
Both substances support weight management, but research suggests that tirzepatide's dual functions may lead to more significant weight loss.
Because GLP-1 medications can promote weight loss, they may also help people manage obstructive sleep apnea (OSA). Understanding how weight management can improve OSA symptoms is an important step toward achieving better sleep and overall health.
The average amount of weight lost with GLP-1 medications can range from 12% (semaglutide-based)2 to 18% (tirzepatide-based).1 Losing weight may help with OSA symptoms by shrinking soft tissues around the airway.29 This creates more space to breathe, which can help prevent airway collapse.
Weight loss also leads to other improvements that may help with OSA. For example, losing excess weight may help improve lung capacity and reduce inflammation.30,31
Clinical research shows that losing weight can reduce a person's apnea-hypopnea index (AHI). In one study, a 20% reduction in body mass index resulted in a 57% reduction in AHI scores.22
It takes time to lose weight with GLP-1 medications. Weight loss is personal, so how long it takes depends on diet, activity level and other factors. However, it may take up to 72 weeks (1.3 years) to lose 12% to 18% of your body weight with a GLP-1 medication.1,2 In contrast, some people report improvements in their OSA symptoms quickly after starting treatments for sleep apnea. For example, when used as directed, continuous positive airway pressure (CPAP) therapy can help alleviate OSA symptoms after the first night of use.6,29
In the SURMOUNT-OSA trial, researchers wanted to determine if tirzepatide improves sleep apnea in people with obesity.32 They enrolled 469 people with moderate or severe obstructive sleep apnea (OSA). Participants received either tirzepatide or a placebo for 1 year.
Researchers observed that the people taking tirzepatide experienced significant reductions in their AHI scores. They also lost up to 20% of their body weight and had lower blood pressure than those on placebo.33
Continuous positive airway pressure (CPAP) is effective, and it's the most used and understood method for treating sleep apnea. In fact, CPAP therapy may reduce a person's apnea-hypopnea score by as much as 86%.34 As a drug-free treatment with no medication-related side effects, CPAP remains the leading method of treatment for sleep apnea symptoms. Plus, CPAP therapy may help people with OSA live longer, healthier lives.35 Research shows that CPAP therapy has been linked to a 37% lower overall risk of dying.35 That noted, CPAP therapy combined with GLP-1 medications may offer additional benefits.
Research into GLP-1 medications and sleep apnea is relatively new. One of the biggest gaps is in determining if OSA improvements continue after a person stops taking weight loss drugs. There's also little research on the effects GLP-1 medications may have on people with OSA who aren't living with obesity.
If you're living with obstructive sleep apnea (OSA), GLP-1 medications may complement your CPAP therapy. However, there are some important considerations.
CPAP therapy is an effective treatment for OSA.3 When used as prescribed, some people report improvements in their symptoms and sleep quality soon after starting therapy.5, 6 By comparison, GLP-1 medications may take several months to show results.1 Therefore, weight loss drugs should not be considered a replacement for CPAP therapy.
Rather, CPAP therapy and GLP-1 medications may be better together.36 Once your GLP-1 starts working, you may notice that you don't need as much CPAP pressure to lower your AHI score.37 If you're using both CPAP and a GLP-1 medication, a sleep specialist can monitor your AHI and determine whether any CPAP setting adjustments are needed over time.
After losing 10% of your body weight, consider reassessing the severity of your OSA with a sleep test. A sleep test collects information about your health - including oxygen levels, heart rate, brain waves and breathing patterns - as you sleep. It can help you and your doctor determine if the severity of your sleep apnea has changed since losing weight.38 Losing around 10% of body weight is associated with meaningful reductions in OSA severity for many people.
With continuous positive airway pressure (CPAP) therapy, all you need is water and air. Most GLP-1 treatments require you to give yourself injections.9 These medications also have some common side effects, such as:1
Some side effects may interfere with the quality of your sleep.39 For example, if you feel nauseous, you may have trouble falling asleep at bedtime. You might even wake up from a deep sleep because you feel sick. There's also a risk that your blood sugar will drop too low (hypoglycemia) while you're taking GLP-1 medications. In contrast to GLP-1 medications, CPAP is a drug-free sleep apnea treatment with zero medication-related side effects.
Your doctor may recommend combining GLP-1 medications, continuous positive airway pressure (CPAP) therapy and lifestyle changes, creating a well-rounded treatment plan. With this type of approach, your doctor may have to adjust your CPAP settings as your weight changes.
Your doctor can help you manage conditions like diabetes and obesity, but they may recommend that you see an endocrinologist, a specialist in care related to hormone and metabolism. A sleep medicine specialist can help optimize your CPAP settings and monitor the severity of your OSA.
At Resmed, we welcome any medical advances that address sleep quality and sleep disorders. We also value the opportunity to increase awareness of the importance of sleep, as well as to continue to address the significant number of undiagnosed people with obstructive sleep apnea worldwide.
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*Resmed Sleep Coaches are customer service representatives who have received training in products to manage sleep apnea. They can give general information about products that may assist to manage sleep apnea, but they are not qualified healthcare professionals and cannot provide medical advice. Please continue to consult your medical practitioner.
The information shared here is for educational purposes and not a substitute for medical advice. Consult your healthcare provider for medical guidance.