This narrative review evaluated GLP-1 receptor agonists (GLP-1 RAs) as pharmacotherapy for obesity-related obstructive sleep apnea (OSA) in adults, synthesizing evidence from six meta-analyses and the SURMOUNT-OSA phase 3 trials, with a focus on AHI reduction, mechanisms of action, and positioning within otolaryngologic practice.
Tirzepatide (SURMOUNT-OSA) reduced AHI by 20–24 events/hour vs placebo, with 42–50% of patients achieving disease remission; across six meta-analyses, GLP-1 RAs reduced AHI by −5.7 to −21.9 events/hour — but still fell short of CPAP (≈22 vs ≈31 events/hour reduction).
- This is a review, not a primary trial; no new patient-level data are presented. - Cardiovascular outcome benefits of GLP-1 RAs in OSA remain unproven. - Weight regain after discontinuation is common, raising durability concerns.
Consider GLP-1 RAs (particularly tirzepatide, FDA-approved Dec 2024) as adjunct therapy for patients with OSA and BMI >30 who are CPAP-intolerant or have obesity-related comorbidities — also useful for preoperative optimization before upper airway surgery or to expand hypoglossal nerve stimulator eligibility. GLP-1 RAs are unlikely to benefit OSA patients without obesity or those with primarily anatomical airway obstruction.
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