Sleep Apnea and GLP-1 Weight Loss Drugs: A Comprehensive Overview

Quick Takeaways:

• GLP-1 weight-loss medications (like semaglutide or tirzepatide)
  can help some people with obesity 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 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 with obesity 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.

Understanding the connection between sleep apnea and GLP-1 medications

Before we explain how GLP-1 medications can affect sleep apnea, let’s
review what OSA is and what symptoms it can cause.

What is obstructive sleep apnea?

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

• Excessive daytime sleepiness
• Morning headaches
• Feeling irritable or moody
• Difficulty concentrating
• Struggling to feel present during the day
• Snoring or gasping for air while you sleep

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

• Mild sleep apnea: AHI of 5-14 per hour
• Moderate sleep apnea: AHI between 15-29 per
  hour
• Severe sleep apnea: AHI greater than 30 per
  hour

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

• Heart disease
• High blood pressure
• Diabetes
• Obesity
• Depression
• Stroke
• Kidney disease

The obesity-sleep apnea connection

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:

• Fat deposits. When fat builds up around your
  neck, it can narrow the space inside your throat. If you have a narrow
  airway, it’s harder for air to move from your throat to your
  lungs.¹⁴
• Reduced pull on the upper airway. When you
  breathe, your lungs gently pull on the structures in your upper airway.
  This helps keep the airway open. If your lung volume is lower, that
  supportive pull isn’t as strong, which can make the airway more likely
  to narrow or close.
• Weakened muscles. As you sleep, your muscles
  work to keep your airways open. If these muscles are affected by fatty
  buildup, they may not work as well. For some people, this can increase
  the risk of airway collapse.

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:

• Insulin resistance. Your pancreas produces
  insulin, which is a hormone that helps glucose (sugar) move from your
  bloodstream into your cells. If you have insulin resistance, your body
  doesn’t respond to insulin as well as it should. This can cause high
  blood sugar and increase your risk for Type 2 diabetes.
• High cholesterol and triglycerides. Your body
  needs cholesterol to produce hormones and help build healthy cells.
  However, too much cholesterol in your blood can raise your risk of
  serious health concerns, including stroke and heart attack.¹⁸
  Triglycerides are a common type of fat in the body. Your body uses them
  as a source of energy. High triglyceride levels in your blood may
  increase your risk of heart disease.¹⁸

Hormonal imbalances. Insulin isn’t the only hormone
affected by obesity and sleep apnea. Obstructive sleep apnea (OSA) and
obesity also seem to have an effect on leptin levels. Leptin is a
hormone that helps control your appetite. Some people may also have
ghrelin imbalances. Ghrelin stimulates hunger and plays a role in energy
balance.¹⁹

• Inflammation. Obesity promotes inflammation,
  which can damage the tissues in your airway. What you may not know is
  that obstructive sleep apnea can also trigger
  inflammation.²⁰
• Nonalcoholic fatty liver disease (NAFLD). NAFLD
  occurs when extra fat builds up in the liver cells. The condition tends
  to develop in people with obesity.²¹ Research suggests that
  sleep apnea may be associated with worsening NAFLD due to factors like
  inflammation and insulin resistance.²²

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:

• High blood pressure²³
• Type 2 diabetes²³
• Atrial fibrillation (an abnormal heart
  rhythm)²⁴
• Heart failure²⁵
• Stroke²³
• Depression Systemic inflammation (inflammation throughout the
  body)²⁶

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

Introduction to GLP-1 medications

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

• Causing the muscles to absorb more glucose
• Reducing glucose production in the liver
• Telling the pancreas not to produce glucagon if your blood sugar
  is high

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 were
originally used to treat Type 2 diabetes.⁹ However, they’ve
since evolved into medications used for weight
management.⁹

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.

GLP-1 medications’ impact on sleep apnea

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.

Weight loss effects and sleep apnea improvement

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 (1.3years) 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

GLP-1 and sleep apnea research findings

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 highly 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 and a 55% lower risk of
dying from heart-related causes in people with OSA.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.

Considerations for people with sleep apnea

If you’re living with obstructive sleep apnea (OSA), GLP-1
medications may complement your CPAP therapy. However, there are some
important considerations.

GLP-1 medications and CPAP therapy

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.

Side effects and safety considerations

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

• Nausea
• Vomiting
• Diarrhea
• Constipation
• Loss of appetite⁹

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.
The risk is especially high in people living with diabetes. In contrast
to GLP-1 medications, CPAP is a drug-free sleep apnea treatment with
zero medication-related side effects.

Insurance coverage and access

If you’re considering sleep apnea medication, it’s important to
understand how it’s covered by your insurance.⁴⁰ Currently,
coverage varies widely based on what insurance carrier you have and why
you have been prescribed a GLP-1 medication.

Some plans cover GLP-1s for people with Type 2 diabetes, but they
don’t cover them for weight loss. For instance, Medicare covers certain
GLP-1 medications for people living with Type 2 diabetes, but it doesn’t
cover any drugs used specifically for weight loss or weight gain. If you
have a commercial insurance plan, check your benefits guide to determine
what type of coverage you have for GLP-1s and other medications.

The out-of-pocket cost of GLP-1 medications can be around $1,000 per
month, so many insurance companies require prior authorizations. If your
plan doesn’t provide coverage, check with the manufacturer to find out
if there’s an assistance program available.

Comprehensive treatment approach

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.

Curious about current advancements in sleep health? Check out our emerging therapies resource page.

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 obstructive sleep apnea patients
worldwide.

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