Design: Two phase 3, double-blind, randomised, placebo-controlled trials nested in larger basket trials
Population: 691 adults with moderate-to-severe OSA and BMI of at least 27, without (243) or with (448) type 2 diabetes
Primary outcome: Change in apnoea-hypopnoea index at 80 weeks with 9 mg and 12 mg
Effect: 9 mg vs placebo: −24.4 events/h (95% CI −34.1 to −14.7) without diabetes; −14.4 (−21.6 to −7.2) with diabetes

TRIUMPH-1-OSA and TRIUMPH-2-OSA were double-blind placebo-controlled trials nested inside larger retatrutide programmes. They enrolled 243 adults without diabetes and 448 with type 2 diabetes, all with moderate-to-severe obstructive sleep apnoea (OSA) and a BMI of at least 27. Baseline apnoea-hypopnoea index (AHI) was high, at 56 to 59 events per hour, and mean weight was about 116 to 120 kg. Results appeared in NEJM on 21 October.

At 80 weeks, the 9 mg dose lowered AHI by 24 events per hour more than placebo in people without diabetes, and by 14 more in people with diabetes. Weight fell by 12 to 22% without diabetes and 12 to 19% with it, against about 5% on placebo. Gastrointestinal effects were the commonest adverse events.

This extends the pattern seen with tirzepatide: incretin-based weight loss treats OSA through the weight, and the effect is smaller in people with diabetes, who lose less. Even after treatment, many participants would still have had AHI values in the moderate range.

Retatrutide is investigational and not approved by the FDA, EMA or CDSCO. For now, the practical message is to screen for OSA in people with diabetes and obesity and to treat it with what is available, while keeping CPAP in the plan.

Ask about snoring, witnessed apnoeas and daytime sleepiness in adults with type 2 diabetes and a BMI above 27.
Refer for a sleep study when symptoms or a high-risk score suggest OSA; weight loss does not replace diagnosis.
Expect a smaller fall in apnoea severity with incretin therapy in people with diabetes than in those without.
Do not stop CPAP during weight-loss treatment unless repeat testing shows it is no longer needed.
Retatrutide is not available outside trials, in India or elsewhere.

Why it matters

Sleep apnoea is becoming a disease that weight-loss pharmacotherapy treats, which makes looking for it in diabetes clinic more worthwhile.

The statistics, in plain English

The AHI counts breathing pauses per hour of sleep. A difference of −24.4 (95% CI −34.1 to −14.7) with 9 mg in people without diabetes means the true extra benefit over placebo is probably between 15 and 34 fewer events per hour. In people with diabetes the same dose gave −14.4 (−21.6 to −7.2): still clearly better than placebo, but about half the size. Placebo groups also improved by about 10 events per hour, which is why the comparison with placebo, not the raw fall, is the honest number.