More than 1 in 10 US adults currently take a glucagon-like peptide, or GLP-1, to lose weight or manage a chronic health issue. That’s a large number for a category of drugs that only 3% of U.S. adults reported taking just two years ago, according to a 2026 Gallup poll.
In the few years since the GLP-1 drug semaglutide was approved in the United States, a few other GLP-1s have also been approved for obesity, diabetes and cardiovascular health issues. Now a growing body of knowledge suggests a new group of adults may benefit from these medications: those with moderate to severe obstructive sleep apnea (OSA).
Moderate to severe sleep apnea is defined by the apnea-hypopnea index (AHI), or the number of times breathing is interrupted during an hour of slumber. Those with moderate OSA experience 15-30 pauses and those with severe OSA experience more than 30. Many treatment options exist for OSA, including positive airway pressure therapy, such as a Continuous Positive Airway Pressure, or CPAP machine, that continuously pushes air via a mask to keep an individual’s airway open during sleep.
Jafar Aljazeeri, MD, an assistant professor in Drexel’s College of Medicine, was senior author on a recently published systematic review and meta-analysis in the journal Sleep and Breathing that looked at six randomized controlled trials of 1,069 OSA patients taking the GLP-1 liraglutide or tirzepatide. Tirzepatide was FDA-approved for OSA in December 2024.
The Drexel News Blog asked Aljazeeri about what the findings mean for OSA patients seeking better quality of life in a sea of, let’s say, less than perfect treatment options.
Why did you decide to look at the impact of GLP-1’s on OSA and what did your team find?
OSA and obesity are closely linked (~ 58% of moderate-to-severe OSA is attributable to excess weight). Many patients struggle with existing treatment options and have issues with long-term CPAP adherence. GLP-1’s have emerged as highly effective in weight loss, thus we wanted to understand whether they could also improve OSA outcomes.
Our meta-analysis included 6 randomized controlled trials (1,069 patients with moderate-to-severe OSA). We found that GLP-1’s significantly reduced AHI, lowered body weight, and slightly reduced blood pressure compared with controls. These benefits were achieved without an increase in adverse events.
Were you surprised by any of the findings?
The magnitude of improvement in AHI was encouraging. In our exploratory analysis, we found that greater weight reduction was strongly correlated with larger reductions in AHI. This does not prove causation, thus thought perhaps GLP1’s may offer benefits beyond weight loss alone (we don’t have that confirmed though). Also, the magnitude of improvement we observed in tirzepatide was remarkable, but we still lack direct comparisons between agents (tirzepatide vs others) which require dedicated head-to-head trials.
You note in the paper that there is still much to learn about how GLP-1 drugs lower AHI, but what’s the leading hypothesis from the scientific community?
The leading hypothesis is weight loss. By reducing weight and fat deposition around the upper airway (neck), GLP-1s may decrease airway collapsibility during sleep and reduce apnea events. Other anti-inflammatory and metabolic effects may contribute, but their exact role remains uncertain.
You found that GLP-1 drugs also can aid in treating the high blood pressure often seen in OSA patients. How much of this is due to lifestyle changes that people may start when on these drugs vs. effects strictly from the drug?
Our study cannot precisely separate the effects of lifestyle changes from the direct effects of the medication. However, we observed modest reductions in both systolic and diastolic blood pressure. Weight loss likely plays an important role (as previous research has consistently shown). At the same time, GLP-1s may exert cardiovascular benefits (through improvements in endothelial function, reductions in arterial stiffness and decreased inflammation and oxidative stress). The benefit is likely due to both weight loss and some cardiovascular effects of GLP-1.
How should patients think about these findings when talking with their doctor about whether to use a CPAP and how to maximize quality of life?
Patients should view GLP-1 therapies and CPAP as complementary rather than competing treatments. As of now, CPAP remains the gold-standard therapy for treating the airway obstruction that occurs during sleep (CPAP has a well-established record of improving symptoms and reducing respiratory events). Our findings suggest that GLP-1s may help address one of the major underlying drivers of OSA, excess weight, while also providing additional benefits such as blood pressure reduction. For patients with obesity and OSA, these medications may become an important part of a broader treatment strategy, but they should not be viewed as a replacement for CPAP based on the current evidence.
What’s next in this work? Anything else you would like to add?
The next step is to conduct larger comparative trials that directly evaluate different GLP1s in patients with OSA. Our analysis found differences between agents (tirzepatide and liraglutide), but the available data differed in treatment duration, patient populations and study design, making definitive comparisons difficult. The OSA GLP-1 landscape is also expanding, with growing interest in triple agonists, such as retatrutide. Future research should also address several unanswered questions: Which patients benefit the most? How durable are the benefits over time? Are there meaningful effects beyond weight loss? And how should GLP1s be integrated with established treatments such as CPAP?
One important point is that OSA is increasingly being recognized as a cardiometabolic disease rather than simply a sleep disorder. GLP1s target both excess weight and cardiometabolic health, and this should change how we think about OSA management in the future, but more research is needed before changing current standards of care.
Reporters interested in talking with Aljazeeri should contact Greg Richter, assistant director, News & Media Relations, at gdr33@drexel.edu or 215.895.2614.
