GLP-1 Therapy and Sleep Apnea: What the SURMOUNT-OSA Trial Showed

Obstructive sleep apnea (OSA) affects approximately 30% of adults in the United States and is strongly associated with obesity. The SURMOUNT-OSA trial, published in The New England Journal of Medicine in 2024, demonstrated that tirzepatide significantly reduces sleep apnea severity — a finding with important implications for prescribers.

SURMOUNT-OSA enrolled 469 adults with moderate-to-severe OSA and obesity (BMI ≥30). Participants were randomized to tirzepatide (up to 15 mg weekly) or placebo for 52 weeks.

The trial had two cohorts:

• Cohort 1: Patients not using positive airway pressure (PAP) therapy
• Cohort 2: Patients using PAP therapy who agreed to discontinue it for the trial

The primary endpoint was change in the apnea-hypopnea index (AHI) — the number of breathing interruptions per hour of sleep. A higher AHI indicates more severe sleep apnea.

Cohort 1 (no PAP therapy):

• Tirzepatide: AHI reduced by 25.3 events/hour (55% reduction)
• Placebo: AHI reduced by 5.3 events/hour (5% reduction)
• Difference: 20.1 events/hour (p<0.001)

Cohort 2 (PAP therapy discontinued):

• Tirzepatide: AHI reduced by 29.3 events/hour (63% reduction)
• Placebo: AHI reduced by 5.5 events/hour (6% reduction)
• Difference: 23.8 events/hour (p<0.001)

Secondary outcomes:

• 42% of tirzepatide patients in Cohort 1 achieved OSA resolution (AHI <5)
• Significant improvements in hypoxia, sleep quality, and patient-reported outcomes
• Average weight loss: 18.1% in tirzepatide group vs. 1.0% in placebo group

Based on the SURMOUNT-OSA data, the FDA approved tirzepatide (Zepbound) for the treatment of moderate-to-severe OSA in adults with obesity in 2024 — the first pharmacological treatment approved specifically for OSA.

The OSA indication expands the clinical rationale for GLP-1 prescribing. Patients with obesity and OSA now have a strong evidence-based reason to consider GLP-1 therapy beyond weight loss alone.

Prescribers offering GLP-1 programs should screen patients for OSA:

• Ask about snoring, witnessed apneas, daytime sleepiness
• Use validated screening tools (STOP-BANG questionnaire)
• Refer for sleep study if OSA is suspected

Identifying OSA in GLP-1 patients strengthens the clinical rationale for therapy and may support insurance coverage.

Patients with OSA should be counseled about the potential for GLP-1 therapy to improve their sleep apnea:

• "Weight loss is one of the most effective treatments for sleep apnea, and GLP-1 therapy produces significant weight loss."
• "The SURMOUNT-OSA trial showed that tirzepatide reduced sleep apnea severity by more than 50% on average."
• "Some patients may be able to reduce or discontinue CPAP therapy as their sleep apnea improves."

For patients with OSA on GLP-1 therapy:

• Repeat sleep study after significant weight loss (20%+ of body weight)
• Assess CPAP pressure requirements — may need adjustment as OSA improves
• Monitor for OSA resolution

The SURMOUNT-OSA trial used tirzepatide. What about semaglutide?

The SELECT trial (semaglutide for cardiovascular risk reduction) included patients with OSA and showed improvements in OSA-related outcomes as a secondary endpoint. A dedicated OSA trial for semaglutide is ongoing.

Given the strong relationship between weight loss and OSA improvement, it is likely that semaglutide also improves OSA — but the tirzepatide data is more robust.

For patients with OSA who cannot access branded tirzepatide (Zepbound), compounded tirzepatide offers an access pathway. The clinical rationale for compounded tirzepatide in OSA patients is strong given the SURMOUNT-OSA data.

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This content is for informational and educational purposes only. It does not constitute medical advice. Prescribers should review current prescribing information and use clinical judgment.