Obstructive Sleep Apnoea and Weight Loss
Treating the Underlying Cause
Obstructive sleep apnoea affects up to 1 billion people worldwide.
Approximately 70% of patients with obstructive sleep apnoea are overweight or obese.
When someone has obstructive sleep apnoea, their airway becomes repeatedly partially or completely blocked during the night, causing their breathing to stop and start.
They then have poor sleep, daytime sleepiness and other symptoms including brain fog, headaches, mood change and decreased sex drive.
Weight reduction addresses an underlying cause rather than only the symptoms. Excess adiposity (fat) is a key driver of upper airway collapse.
CPAP remains first-line therapy, but adherence is often poor.
How GLP-1s (weight loss drugs Ozempic, Wegovy, Mounjaro) help obstructive sleep apnoea
- Reduce body weight by decreasing appetite and energy intake.
- Improve upper airway anatomy through fat loss.
- Reduce apnoea/hypopnoea index (AHI). This is the number of times that people stop/start breathing during an hour (< 5 X / is normal, >30 x/ hour severe sleep apnoea)
- Improve daytime sleepiness and quality of life as measured by Epworth Sleepiness Scale. (see chart)
Additional Benefits:
Improvement in blood pressure control, blood glucose control, cardiovascular risk and inflammation.
Evidence Base – Key Clinical Findings:
Significant reductions in body weight (10-20%, depending on which GLP1 is used, and how well adhered to).
Improvements in obstructive sleep apnoea severity correlate with weight loss (even 5-10% of weight loss can make a difference).
Improved cardiovascular risk in high-risk populations.
Current evidence supports GLP-1 receptor agonists as an additional treatment, not a replacement for CPAP in appropriate patients.
Dr Catrin Bevan, GP
General Practitioner, Safeguarding Lead
MBBS, DRCOG
Available GLP-1 Therapies:
Semaglutide (Wegovy) (Ozempic), tirzepatide (Mounjaro) can be given as a weekly injection or as a daily oral tablet.
Tirzepatide (Mounjaro) is the first FDA-approved medication specifically for moderate to severe obstructive sleep apnoea in adults with obesity.
Oral Wegovy (semaglutide) is the first oral GLP-1 to be approved in the UK for weight management. It is a daily tablet that offers an alternative to patients reluctant to use injections. It is approved for adults with obesity or overweight with a weight-related comorbidity including obstructive sleep apnoea or high blood pressure, high cholesterol, diabetes or cardiovascular issues.
It has been approved by the MHRA (Medicines and Healthcare products Regulatory Agency), but availability at this time is only on private prescription.
Practical Considerations:
Patients:
- BMI over 30 kg/m2.
- BMI over 27 kg/m2 with obstructive sleep apnoea or high blood pressure, high cholesterol, type 2 diabetes or cardiovascular disease.
- Poor CPAP tolerance.
Counselling:
Patients need to apply lifestyle modification, which is essential i.e. healthy high protein diet and exercise.
Low dose initially improves tolerability. (go low, go slow) sty on lowest dose that achieves weight loss.
Gastrointestinal side effects are common early in treatment.
Conclusion
Obesity is a major driver of obstructive sleep apnoea.
GLP-1 receptor agonists treat the underlying disease process rather than the symptoms alone (which can be treated by CPAP).
Weight loss improves obstructive sleep apnoea severity and cardiometabolic outcomes.
Oral Wegovy represents a significant advance by offering a non-injectable GLP-1 option for eligible patients.
At LGP we use the Epworth Sleepiness Scale (ESS) and also the STOP-Bang questionnaire to help patients assess whether they may have obstructive sleep apnoea.