More pluses for GLP-1s for obstructive sleep apnea | CHEST 2026

Obesity has long been recognized as a major contributing factor in the causation of obstructive sleep apnea, so understandably, patients and their sleeping partners, as well as clinicians, researchers and drug developers, are interested in how the glucagon-like peptide 1 (GLP-1) drugs might be used to treat obstructive sleep apnea. This is not some hazy theoretical issue on some distant horizon. In late 2024, the FDA approved Zepbound (tirzepatide) as a treatment for severe apnea. Still, this is an unsettled area with plenty of unanswered questions. Christopher N. Schmickl, M.D., Ph.D., M.P.H., of the Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology at the University of California San Diego, and his colleagues explored some of them in a review article published earlier this year in the Journal of Clinical Sleep Medicine. One of the most salient is whether Zepbound is unusually effective against obstructive sleep apnea. Although GLP-1s has become something of an umbrella term, Zepbound is a dual-action drug that also contains a glucose-dependent insulinotropic peptide (GIP). Schmickl and his colleagues reference research showing that it is weight loss, not the direct effects of GLP-1 and GIP, that reduces obstructive sleep apnea. They note that the next-generation obesity medications, namely Lilly’s retatrutide, will be a chance to test this proposition.

At the CHEST meeting in Phoenix that starts tomorrow and continues through Oct. 21, researchers are presenting a total of 89 abstracts on sleep disorders, 70 of which are original investigations and 19 are case reports. With the help of artificial intelligence, we identified six that are about GLP-1s or GLP-1/GIP. Here are summaries of three of those abstracts.

Broad boon effects on the cardiopulmonary-metabolic axis — and weight loss explains only part of it

David Savage-Lobeck, M.D., a medical resident in the South Texas Health System, and his colleagues found broad beneficial effects from semaglutide (sold under the brand name Wegovy) and tirzepatide in a systematic review of randomized clinical trials assessing the drugs for obesity in patients with obstructive sleep apnea or high cardiovascular disease risk. The drugs were associated with significant reductions in the apnea-hypopnea index and what the researchers described as a “profound” decrease in hypoxic burden. They also called out that the reduction in cardiovascular events was particularly pronounced in those with high levels of a biomarker for inflammation that is commonly used in the context of cardiovascular disease. Another callout in the abstract is that while weight loss was correlated strongly with improvements in the apnea-hypopnea index, it accounted for only 54% of the reduction in systolic blood pressure and 42% of the improvement in the inflammatory biomarker. “These findings,” wrote Savage-Lobeck and his colleagues “suggest that GLP-1Ras [GLP-1 receptor agonists, which is synonymous with GLP-1s] should be considered primary cardioprotective therapy in the ‘metabolic-OSA’ [obstructive sleep apnea] phenotype, particularly for patients with high hypoxic burden or CPAP [continuous positive airway pressure].”

Will patients give up on CPAP if they take a GLP-1? Apparently not

Understandably, people have a hard time sticking with CPAP as treatment for obstructive sleep apnea. Bibek Timilsina, M.D., a resident at Virtua Our Lady of Lourdes Hospital in Camden, New Jersey, and his colleagues conducted a retrospective cohort study using the TriNetX database to see what GLP-1s might mean for CPAP adherence. If the thought that a GLP-1 prescription would mean even less adherence, Timilsina and his colleagues found the opposite. In a propensity score-matched study, they found that GLP-1 “initiation” was associated with higher adherence (36% vs. 28.9%). This is probing, first-take sort of research that no one believes is the final word. Timilsina and his colleagues note that they used proxies of usage (durable medical equipment claims) rather than more direct measures. Still, they conclude, “clinicians can leverage GLP-1 initiation to reinforce adherence education.”

GLP-1s are associated with lower rates of one of the worst complications of obstructive sleep, acute respiratory failure

One feature of obstructive sleep apnea is excess fat tissue in the upper airway that can cause the airway to collapse. That pathophysiology raises a question: whether GLP-1s and their associated weight loss might reduce one of the rare but real dire consequences of obstructive sleep apnea, acute respiratory failure.

Shubham Gupta, M.D., who, like Timilsina, is a resident at Virtua Our Lady of Lourdes Hospital in Camden, New Jersey (Timilsina is a co-author of this abstract), and his colleagues used the TriNextX Research Network database to identify patients with obesity and obstructive sleep apnea. For their analysis they ended up with approximately 470,000 patients with obesity and obstructive sleep apnea who had been treated with a GLP-1 and nearly 1.5 million with obesity and obstructive sleep apnea who hadn’t been treated with a GLP-1. Then they looked at acute respiratory failure in the two groups. At one year, acute respiratory failure occurred in 1.4% of GLP-1 users compared with 2.3% of nonusers, which translates into a 40% lower risk. At 5 years, the rates were 3.5% in those classified as taking a GLP-1 compared with 5.5% in the nonusers, which works out to a 36% lower risk. Differences in other severe respiratory-related end outcomes suggest that GLP-1s may afford some protection against the most serious respiratory events associated with obstructive sleep apnea. Gupta and his colleagues caution against jumping to cause-and-effect conclusions based on retrospective research like this. Still, they float the notion that GLP-1s may reduce acute respiratory risk by improving “airway mechanics” and ventilatory reserve.