SLEEP 2026 | Reflecting on the SURMOUNT-OSA trial and the integration of GLP-1 agonists into OSA treatment

The SURMOUNT-OSA study was published in the New England Journal of Medicine in 2024. And in fact, it was two studies. Study one where patients who couldn’t or wouldn’t use CPAP were randomized to tirzepatide or placebo. And study two, patients who were using CPAP were randomized to tirzepatide or placebo. The primary outcome was the apnea hypopnea index, which did improve both clinically and statistically significantly, about 25 or 30 events per hour improvement in the two studies. In addition, there were secondary outcomes that were both pre-specified and controlled for multiple comparisons. That included systolic blood pressure, which markedly improved. High sensitivity C-reactive protein, which we know is a strong cardiovascular risk marker, improved. The sleep apnea-specific hypoxic burden, which is also a cardiovascular risk factor that improved. The patient-reported outcomes were also improved markedly. You have to be careful of patient-reported outcomes in studies that are hard to blind, but concomitant improvements in objective and subjective outcomes were quite compelling. And then body weight improved considerably, about 18 to 20%. So to put that in context, if you start at 200 pounds, 20% would be 40 pounds. That would take you from 200 pounds to 160 pounds. So quite a marked improvement and a game changer for those patients. And on the basis of that study, FDA approved tirzepatide for the treatment of moderate to severe sleep apnea in people with obesity in December of 2024. Yeah, so these GLP-1 receptor agonists are really taking things by storm. So I was told about one in four Americans has tried a GLP-1 receptor agonist, so it’s certainly out there whether you realize it or not. Many of the patients I see now are already getting GLP-1 receptor agonist from their primary care or from their referring physicians, and many patients now come to the sleep clinic seeking a sleep apnea diagnosis to help get insurance coverage for tirzepatide since the FDA approval. And so it has become quite an important advance. And many patients are looking for weight loss as a potential treatment. It is important to emphasize, though, that the SURMOUNT-OSA study didn’t compare tirzepatide to CPAP, and so the first-line treatment remains CPAP. That hasn’t changed. People are talking about doing comparative effectiveness studies where you compare CPAP to tirzepatide, but for now, first-line treatment remains CPAP. Adjunctive therapy includes tirzepatide to help manage cardiovascular risk markers. If people can’t tolerate CPAP, then tirzepatide is a reasonable alternative as well in people with moderate to severe sleep apnea and obesity.

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