A recent review of published studies found that drugs used to treat diabetes and obesity may reduce the severity of obstructive sleep apnea, particularly in patients whose condition is associated with excess weight. However, the researchers stressed that these drugs are not a definitive solution for all cases and are not an absolute substitute for established treatments.
Review examines tirzepatide’s effect on sleep apnea
The review, published by JAMA Otolaryngology–Head & Neck Surgery in September, focused on glucagon-like peptide-1 receptor agonists, known as GLP-1. Its findings indicated that tirzepatide reduced the sleep apnea index, which measures the number of times breathing stops or decreases during sleep.
How airway obstruction disrupts sleep
Obstructive sleep apnea occurs when the upper airway repeatedly narrows or becomes blocked during sleep, reducing airflow or temporarily stopping breathing. An episode may last more than 10 seconds. Episodes can occur more than five times per hour, causing low oxygen levels, fragmented sleep and strain on the body.
Common symptoms include loud or irregular snoring, gasping or choking at night, frequent awakenings, morning headaches, excessive daytime sleepiness and not feeling rested despite getting enough hours of sleep.
Obesity is one of the main factors associated with the disorder, as fat accumulation around the neck, tongue and abdomen can narrow the airway and reduce breathing efficiency. This is why weight-loss drugs appear to offer greater benefit to patients whose condition is driven by obesity, while their effect may be smaller in those whose condition is linked to anatomical problems involving the jaw, throat or tongue.
The researchers noted that the condition may return if weight increases after treatment is stopped. The effectiveness, cost and safety of long-term use also remain issues to consider. Accordingly, GLP-1 drugs may be viewed as a potential supplementary treatment for some patients, alongside traditional approaches.
CPAP remains the most reliable treatment
Continuous positive airway pressure, known as CPAP, remains the most common and reliable treatment, particularly for moderate and severe cases. The device delivers a steady flow of air through a mask worn during sleep, helping keep the airways open and preventing breathing interruptions or reducing their frequency.
The data indicate that the device can reduce apnea episodes by about 31 per hour, compared with about 22 per hour with tirzepatide. Some patients may find the mask uncomfortable at first, but adjusting the straps and choosing the right size can help them adapt to it.
Oral devices and surgery for persistent obstruction
Some oral devices may also be used to reduce apnea and snoring. Surgery may become an option when drugs or assistive devices do not provide an adequate response, usually after other options have been tried for at least three months. If the anatomical abnormality is clear, doctors may consider surgery a first option in limited cases.
Possible interventions include removing excess tissue in the throat, pharynx, tonsils or adenoids; reducing tissue at the back of the throat using radiofrequency; or moving the jaw forward to widen the space behind the tongue and throat. A device may be implanted in the chest to stimulate the hypoglossal nerve when nonsurgical treatments fail.
The effects of the disorder extend beyond poor sleep and daytime fatigue. Epidemiological studies have linked it to higher risks of coronary artery disease, congestive heart failure and stroke. Studies also indicate possible links to disrupted clotting factors, damage to the lining of blood vessels, increased inflammation and platelet activation.
By contrast, CPAP use has been associated with lower systolic blood pressure, improved left ventricular function and reduced platelet activation.
Determining the most appropriate treatment depends on diagnosing the cause and severity of the obstruction. One patient may benefit from weight loss, while another may need the device or an intervention to address an anatomical problem in the airway.
