FAQ: Anti-Obesity Medications and Obstructive Sleep Apnea

Sleep is a critical pillar of health, alongside exercise, nutrition, and stress management. When an individual has poor sleep, it can make it more challenging for them to live a healthy lifestyle, impacting weight management, energy levels, mood, mental health and increasing their risk of cardiovascular complications.^1,2,3 Sleep is increasingly recognized for its contribution to body weight regulation and better sleep health is associated with greater weight and fat loss.^3,4

Nearly 1 billion adults aged 30–69 years worldwide are estimated to have obstructive sleep apnea (OSA), and the number of people with moderate-to-severe OSA is estimated to be almost 425 million.⁵

Moderate-to-severe OSA has been associated with 33% mortality over a 14-year span, compared to 6.5% and 7.7% mortality in people with mild or no sleep apnea.6

There are many risk factors for obstructive sleep apnea (OSA),⁷ including:

• Asthma
• Chronic nasal congestion
• Diabetes
• Excess weight
• Family history of sleep apnea
• High blood pressure (hypertension)
• Male sex
• Narrowed airway
• Older age
• Smoking

Obesity, or excess weight, is an important risk factor for OSA.⁸ It is estimated that 41-70% of patients (US population) with OSA have obesity.⁹ OSA prevalence is higher in older individuals, males and those with a higher body mass index (BMI).¹⁰ Reduction of weight can, for some people, lower the risk or severity of OSA. ^9,11,12

Currently, only one anti-obesity medication—Zepbound® (tirzepatide)—is FDA-approved to treat moderate-to-severe obstructive sleep apnea in adults with obesity. Positive airway pressure (PAP) therapy—which includes continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) therapies—remains the most used, understood, and successful method for the treatment of obstructive sleep apnea (OSA). It has been shown to reduce a patient’s apnea-hypopnea index (AHI)—the number of apnea and hypopnea events experienced per hour—by an average of 86%.^{13, 14}

Although anti-obesity medications, including GLP-1s, have been shown to be an effective tool for weight management in some individuals, to date, there have been no research studies that compare the effectiveness of CPAP therapy against anti-obesity medications for the treatment of OSA.

Clinical research has demonstrated that in patients with moderate-to-severe obesity-related OSA, the combination of CPAP therapy and weight loss has been shown to be more beneficial than either treatment in isolation.¹⁵ The SURMOUNT-OSA trials support the approach that weight loss and CPAP together is more beneficial than weight loss alone. In the SURMOUNT-OSA trials, adults on tirzepatide lost an average of 45 lbs (18%) of their body weight (compared to 4 lbs (1.6%) adults on placebo), while adults on tirzepatide with PAP therapy lost an average of 50 lbs (20%) of their body weight (compared to 6lbs (2%) adults on placebo).
(https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/217806s013lbl.pdf)
(https://www.nejm.org/doi/full/10.1056/NEJMoa2404881).

Patients consulting with you about options for anti-obesity medications may also be experiencing symptoms such as daytime sleepiness or fatigue, snoring, and breathing pauses during sleep. Prioritizing conversations about sleep health with each of your patients can help identify and treat sleep disorders early. This is especially important for patients with obesity because they are at higher risk for sleep disorders, such as obstructive sleep apnea.

While patients benefitting from anti-obesity medications, such as GLP-1 therapies, may find some relief from sleep-related challenges or symptoms, it’s important to remain aware of potential underlying or persistent sleep issues, especially once patients have stopped using these medications and are tasked with the life-long challenge of weight management.

When you identify an at-risk patient, initiating a sleep screening or referral to a sleep specialist can put them closer to an appropriate diagnosis and treatment that allows them to take charge of their sleep health. Sleep screening tools are widely available and can easily be incorporated into regular checkups. Additionally, your patients can visit our Sleep Assessment page for a free sleep assessment to help them better understand their sleep health. A sleep specialist directory is also available at https://sleepeducation.org/sleep-center/.

Patients with obstructive sleep apnea (OSA) may consult you about options for anti-obesity medications. In patients with moderate-to-severe obesity-related OSA, the combination of continuous positive airway therapy (CPAP) therapy and weight loss has been shown to be more beneficial than either treatment in isolation.¹⁵

Further, weight loss may incentivize patients to adhere to OSA therapy: In a recent analysis of real-world data from IQVIA by Resmed, patients with an OSA diagnosis who were prescribed a GLP-1 were >10% more likely to initiate CPAP therapy and have higher CPAP resupply rates 1 year and 2 years post-setup.¹⁶

While patients benefitting from anti-obesity medications, such as GLP-1 therapies, may find some relief from sleep-related challenges or symptoms, it’s important to remain aware of potential underlying or persistent sleep issues, especially once patients have stopped using these medications and are tasked with the life-long challenge of weight management.

Significant OSA is present in approximately 40% of people affected by obesity.⁸ Resmed believes that the new anti-obesity medications will increase the number of patients interacting with the healthcare system, presenting an opportunity for more people to be screened for sleep disorders and referred for a sleep test.

While weight loss may reduce a patient’s OSA severity, patients who do not achieve remission or have mild, symptomatic OSA may still need treatment. Encouraging patients to have their AHI reassessed by a sleep test will be an important aspect of the management of OSA. It’s important to continue to speak with patients about how obesity is one—but not the only—risk factor for OSA and that proper screening is needed to diagnose the condition, which can often be overlooked.

It’s estimated that as many as 80% of patients with obstructive sleep apnea (OSA) are undiagnosed.¹⁷ Resmed believes that the new anti-obesity medications will increase the number of patients interacting with the healthcare system, presenting an opportunity for more patients to be screened for sleep disorders and initiate treatment if needed.

Further, weight loss may encourage patients to adhere to OSA therapy. In a recent analysis of real-world data from IQVIA by Resmed, patients with an OSA diagnosis who filled a GLP-1 prescription were 10.8 percentage points more likely to initiate continuous positive airway therapy (CPAP) therapy than those without a GLP-1 prescription.¹⁶

CPAP therapy—either standalone or in combination with anti-obesity medications such as GLP-1s for weight loss—can be more effective for patients with comorbid obesity if they can lose weight in any healthy, sustainable way.

On December 20th, the FDA approved Eli Lilly’s Zepbound® (tirzepatide) for the treatment of moderate-to-severe OSA in adults with obesity (https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-obstructive-sleep-apnea). The SURMOUNT-OSA clinical trial assessed the efficacy of tirzepatide independently from CPAP therapy among a small subset of the total OSA population and does not compare the efficacy of tirzepatide to CPAP therapy in treating OSA. To date, there have been no significant studies that compare the effectiveness of CPAP therapy against anti-obesity medications, including GLP-1s.

CPAP therapy remains the first-line treatment–either alone or in combination with weight loss, which may include anti-obesity medications such as GLP-1s–for all patients with moderate-to-severe OSA. A recent real-world data analysis conducted by Resmed showed that patients with an OSA diagnosis and prescribed a GLP-1 had higher CPAP resupply rates 1 year and 2 years post-setup.¹⁶

As patients lose significant weight, their OSA symptoms may improve. Offering closer follow-up to patients on CPAP therapy can improve long-term adherence.

If you’re concerned about your sleep quality or consistently feel excessively tired during the day, it’s a good idea to talk to your doctor about your symptoms. Your doctor can help determine if a sleep disorder, such as obstructive sleep apnea (OSA), might be preventing you from getting the quality sleep that you need. If necessary, your doctor may refer you to a sleep specialist who can assess your nighttime sleep patterns and symptoms, such as snoring, gasping for air during sleep, and/or excessive daytime sleepiness.

Positive airway pressure (PAP) therapy—which includes continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) therapies—gently flows air into your lungs while you sleep. It helps people improve their breathing while they sleep and experience fewer nighttime disruptions. CPAP therapy is the most used, most understood and most successful method of treating obstructive sleep apnea.

The term ‘apnea’ means that you stop breathing for at least 10 seconds. ‘Hypopnea’ is when you have a partial blockage of your airway, so your breath is more shallow than normal. An at-home or in-lab sleep test will provide your apnea-hypopnea index (AHI), which tells you how many apneas and hypopneas you have per hour while you sleep and gives you an average.¹⁸ The apnea–hypopnea index is an index used to indicate the severity of sleep apnea, and, if you go on CPAP therapy, one of the likely goals will be to reduce your apnea–hypopnea index score to a healthy level. 19 CPAP therapy has been shown to reduce AHI by an average of 86%.¹³

When people with sleep apnea use their CPAP as prescribed by their doctor, they may notice improvements in their mood, focus, memory, productivity and daytime energy levels. 20 Left untreated, obstructive sleep apnea has been linked to the development of type 2 diabetes, cardiovascular disease and depression.^{21, 22}

CPAP therapy may be more effective for people with obesity if they are able to lose weight in any healthy, sustainable way. In some cases, people with sleep apnea may benefit from a combination of weight loss medications, like GLP-1s, and CPAP therapy. An earlier study has shown that the combination of weight loss interventions and CPAP therapy is more beneficial in improving health benefits than either treatment alone.¹⁷

If you’re concerned about your sleep quality or consistently feel excessively tired, it’s a good idea to talk to your doctor. Your doctor can help determine if a sleep disorder, such as obstructive sleep apnea (OSA), is preventing you from getting the quality sleep that you need.

Learn more about PAP therapy and how it works here.

On December 20, 2024, the U.S. Food and Drug Administration (FDA) approved Eli Lilly and Company’s Zepbound® (tirzepatide), an obesity medication, for the treatment of moderate-to-severe obstructive sleep apnea in adults with obesity. (https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-obstructive-sleep-apnea)

Reduction of weight can, for some people, lower the risk or severity of obstructive sleep apnea (OSA).^{9, 11, 12} However, while losing weight can be helpful for managing obstructive sleep apnea (OSA), CPAP therapy is the most used, most understood and most successful method of treating OSA. It is also the recommended OSA therapy per treatment guidelines established by sleep specialists.¹³

In many cases, a combination of weight loss medications, including medications like GLP-1s, and CPAP therapy may provide the greatest benefit.^{15, 24} Your doctor will be able to determine the best treatment plan for you, so it’s important to include sleep-related concerns in any weight management conversations with your doctor.

Among the risk factors for sleep apnea, obesity is one of the most important.⁸ It is estimated that 40% of patients with obstructive sleep apnea (OSA) have obesity.⁹ OSA prevalence is higher in older people, men, and people with a higher body mass index (BMI).¹⁰

Reduction of weight can, for some people, lower the risk or severity of obstructive sleep apnea. Weight management is always recommended as complementary treatment for obesity-related sleep apnea. But obesity is far from the only risk factor that matters. OSA can and does occur in people who are considered to be at a healthy weight and is also linked to major comorbidities, including hypertension and cardiovascular disease.⁴

CPAP therapy may be more effective for people with obesity if they are able to lose weight in any healthy, sustainable way. In some cases, people with sleep apnea may benefit from a combination of weight loss medications, like GLP-1s, and CPAP therapy. An earlier study has shown that the combination of weight loss interventions and CPAP therapy is more beneficial in improving health benefits than either treatment alone.¹⁷