GLP-1-based drugs lowered the apnoea-hypopnoea index by about 10 events an hour

Design

Systematic review and meta-analysis of randomised trials

Population

6 trials, 1,069 adults with moderate to severe obstructive sleep apnoea

Primary outcome

Apnoea-hypopnoea index

Effect

−9.99 events/hour (95% CI −16.47 to −3.50), I² 87%

A meta-analysis of six randomised trials pooled 1,069 adults with moderate to severe obstructive sleep apnoea; four trials tested liraglutide and two tirzepatide.

Against control, these drugs lowered the apnoea-hypopnoea index by about 10 events per hour (95% CI −16.5 to −3.5) and weight by about 9.7 kg, with systolic blood pressure about 4.8 mmHg lower. Oxygen desaturation index and nadir oxygen saturation did not change significantly. Adverse events were not increased.

Heterogeneity was very high (I² 87% for the apnoea index, 98% for weight), largely reflecting the difference between liraglutide and tirzepatide. For the multimorbid patient with obesity, diabetes and sleep apnoea, this supports a GLP-1-based drug as part of treatment. It does not support stopping CPAP.

• Ask about snoring and daytime sleepiness in patients with obesity starting a GLP-1-based drug.
• Consider a GLP-1-based drug in a patient with obesity and sleep apnoea who also has another indication, such as diabetes.
• Keep CPAP in place; these drugs were not shown to replace it.
• Repeat a sleep study after substantial weight loss before changing CPAP settings.

Why it matters

Many patients now on these drugs for diabetes or weight also have untreated sleep apnoea.

Don't overread it

Pooled across very different drugs; the size of the effect is uncertain and CPAP remains standard care.

The statistics, in plain English

I² of 87% means most of the variation between trials reflects real differences, likely drug and dose, rather than chance; a single pooled figure therefore hides a range. The lack of change in oxygen desaturation is a reminder that a lower event count does not always mean better oxygenation.

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