Weight loss drugs have gained momentum as treatment for obstructive sleep apnea (OSA) at sleep clinics across the country -- although patients appear more ready for the shift than the clinical team is.
In December, GLP-1 agonist tirzepatide (Zepbound) became the first drug approved to treat moderate-to-severe obstructive sleep apnea (OSA) in adults with obesity after two trials showed it reduced sleep apnea severity regardless of continuous positive airway pressure (CPAP) use. That opened up a new era in treatment of this condition that affects perhaps a billion people worldwide.
"It's an exciting time for the sleep field. Pharmacotherapy is here, it's not just coming," Atul Malhotra, MD, of the University of California San Diego (UCSD), told attendees at the SLEEP meeting hosted jointly by the American Academy of Sleep Medicine (AASM) and the Sleep Research Society.
While CPAP remains first-line treatment for OSA, his group presented data at the meeting showing that patients are more willing to bypass it in favor of medication, he said at an invited lecture.
In a national online survey including responses from 17 UCSD sleep medicine professionals and 365 patients (42% women), patients were more likely than the professionals to prefer tirzepatide over CPAP if equally effective (48% vs 35%). Physicians mostly favored CPAP over tirzepatide (53% vs 26%).
Nearly all the providers endorsed CPAP as "very acceptable," compared with only 60% of patients (P=0.04 for difference in responses).
Co-author Ahmed Khalaf, BS, a sleep technician at UCSD, acknowledged that the patients who opted in represented only about 5% of those approached, which might have provided a biased group. About half had comorbid obesity and obstructive sleep apnea, 73% reported three or more prior attempts at weight loss, 23% reported being current or past users of a GLP-1 drug, and 78% reported being current or past users of CPAP.
Jennifer Martin, PhD, of the University of California Los Angeles and a spokesperson for the AASM, emphasized the importance of allowing patients to choose among sleep treatment options after being fully informed of options.
"CPAP has been the best available treatment for a long time," she told MedPage Today. "It treats sleep apnea in almost everyone, but it doesn't fit into everyone's lifestyle. So I think that oftentimes talking through the risks and benefits of a variety of treatments with a patient is really the best way to start, and being willing to pivot if the treatment you try first doesn't work. So I think GLP-1s will fit into that narrative really nicely."
Peter Gay, MD, of the Mayo Clinic in Rochester, Minnesota, noted the simultaneous challenge and opportunity: "A lot of patients are now coming to the lab who wouldn't come to the lab because all we had was 'C-crap' and they weren't going to even look at you. Now they come and maybe the drug didn't work and now they're talking about CPAP. It's a wonderful time. My problem is and the institution problem is this requires longitudinal care. And how they're going to be able to access the sleep laboratory at Mayo is overwhelming."
Malhotra, noting that he's married to an endocrinologist, agreed that the field is still getting its feet under it with regard to prescription drugs.
"About 80% of the calls that I get are about these agents, but not about medical care -- it's about logistics. It's about prescription authorization, it's about shortages," he said, responding to Gay at the session. "Those things are getting better ... It's going to require resources to achieve this."
"We're trying to transfer this to primary care physicians," Gay noted.
"They're overwhelmed too," Malhotra shot back, noting that at least one in seven Americans have tried to get a GLP-1 receptor agonist.
Indeed, some patients are actually seeing OSA as their ticket to get a GLP-1, said Loretta Colvin, APRN-CNP, of SSM Health Medical Group in Fenton, Missouri. "They're motivated to get a diagnosis, which is weird. You never get people motivated to get a diagnosis."
More patients are coming to the sleep clinic saying they've been started on a GLP-1 drug in primary care, she told MedPage Today.
"So they're taking more of an initiative to treat sleep apnea, where they used to defer more to the sleep clinic," Colvin said. "We're actually talking about the impacts of weight loss in ways that we've never talked about before, because we never saw that many people losing weight successfully other than weight loss surgery -- and then they lost it so fast and they had so many other things going on they just got lost to follow-up in the sleep clinic by and large."
Disclosures
The study was supported by grants from the National Institutes of Health and the AASM Foundation.
Khalaf disclosed no relevant conflicts of interest.
Malhotra disclosed relationships with Eli Lilly, LivaNova, Zoll, and Powell Mansfield as well as ResMed philanthropic funds to his institution.
Colvin disclosed having served on a medical advisory board for Apnimed.
Martin disclosed no relevant relationships with industry.
Primary Source
SLEEP
Source Reference: Khalaf A "The treatment preferences for comorbid obesity and obstructive sleep apnea (PRO-CON OSA) survey" SLEEP 2025; Abstract 0787.
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