Glucagon-Like Peptide-1 Receptor Agonists for Obstructive Sleep Apnea With and Without Continuous Positive Airway Pressure.

Abstract

To evaluate glucagon-like peptide 1 receptor agonists for obstructive sleep apnea compared with controls. CINAHL, Cochrane Library, PubMed, and Scopus. A PRISMA-compliant search was conducted from database inception through October 2025. Randomized controlled trials evaluating glucagon-like peptide 1 receptor agonist use (liraglutide and tirzepatide) for obstructive sleep apnea were included. The primary outcome was the change in apnea-hypopnea index. Data on apnea-hypopnea index, body weight, waist circumference, blood pressure, inflammatory markers, and adverse events were extracted and stratified by continuous positive airway pressure use. Outcomes were summarized as mean differences (Δ) with 95% confidence intervals (CI). Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Of 3,836 articles screened, five studies met the inclusion criteria, comprising 948 patients (479 GLP-1; 469 control). Glucagon-like peptide 1 receptor agonists reduced apnea-hypopnea index by 12.4 events/hour more than controls (95% CI: -17.2 to -7.7; P < .00001), independent of continuous positive airway pressure use. Glucagon-like peptide 1 receptor agonists produced greater weight loss (Δ: -12.5%; 95% CI: -22.0% to -3.0%; P = .01) and reduced waist circumference (Δ: -3.3 cm; 95% CI: -4.4 to -3.2; P < .00001). Systolic and diastolic blood pressure decreased by 4.5 mmHg (95% CI: -6.4 to -2.7) and 1.30 mmHg (95% CI: -2.59 to -0.01), respectively. Gastrointestinal adverse events were more common with glucagon-like peptide 1 receptor agonists. Glucagon-like peptide 1 receptor agonists produced clinically meaningful improvements in obstructive sleep apnea severity, independent of continuous positive airway pressure use.