Effect of GLP-1 Receptor Agonists and Tirzepatide on Obstructive Sleep Apnea Severity: A Systematic Literature Review
This systematic review and meta-analysis, conducted following PRISMA 2020 guidelines, examined the effects of GLP-1 receptor agonists (semaglutide, liraglutide) and the dual GIP/GLP-1 receptor agonist tirzepatide on obstructive sleep apnea (OSA) severity, as measured by apnea-hypopnea index (AHI). The authors searched PubMed, Google Scholar, and SciSpace through May 2026 and included 40 studies involving adults with OSA receiving GLP-1–based therapies with quantitative AHI outcomes. The review found that tirzepatide was associated with greater AHI reductions (−25.3 to −29.3 events/h; approximately 50.7%–58.7%) compared with liraglutide (−12.2 events/h; ~25%), and a pooled meta-analytic estimate showed an overall AHI reduction of −16.57 events/h across therapies. The authors attributed these effects primarily to weight loss, while noting emerging evidence for potential weight-independent mechanisms. Limitations include the heterogeneity of included studies, reliance on a preprint-stage document, and the inability to fully disentangle weight-mediated versus direct effects. The authors conclude that GLP-1–based therapies, particularly tirzepatide, may represent meaningful treatment options for obesity-related OSA, especially among patients with poor CPAP adherence.
Why this grade: Although the review synthesizes human data across 40 studies and applies PRISMA methodology, its preprint status, likely heterogeneity across included trials, and inability to isolate weight-independent mechanisms limit confidence in the pooled estimates.
Obstructive sleep apnea (OSA) is a highly prevalent sleep-related breathing disorder characterized by recurrent upper airway collapse, intermittent hypoxemia, and increased cardiovascular risk. Obesity is the principal modifiable risk factor, and weight loss has been shown to improve OSA severity. Recently, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and the dual glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonist tirzepatide have emerged as promising pharmacotherapies for obesity-related OSA. We conducted a systematic review in accordance with PRISMA 2020 guidelines to evaluate the impact of GLP-1 RAs (semaglutide, liraglutide) and tirzepatide on apnea-hypopnea index (AHI). Databases including PubMed, Google Scholar, and SciSpace were searched up to May 2026. Eligible studies involved adults with OSA receiving GLP-1–based therapies with quantitative AHI outcomes. A total of 40 studies were included. Tirzepatide demonstrated greater reductions in AHI (−25.3 to −29.3 events/h; 50.7%–58.7%) compared with liraglutide (−12.2 events/h; ~25%). Meta-analyses showed an overall AHI reduction of −16.57 events/h. These effects were largely mediated by weight loss, with additional evidence suggesting weight-independent mechanisms.GLP-1–based therapies, particularly tirzepatide, represent effective treatment options for obesity-related OSA, especially in patients with poor adherence to continuous positive airway pressure therapy.
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