GLP-1 medications, originally developed to treat type 2 diabetes, are now being prescribed to address obstructive sleep apnea (OSA), a serious breathing disorder that affects millions of people with obesity. Zepbound, a GLP-1 drug, recently became the first and only prescription medication FDA-approved specifically for moderate to severe OSA in adults living with obesity, marking a significant shift in how doctors treat this condition beyond traditional CPAP machines.

What Is Obstructive Sleep Apnea and Why Does Weight Matter?

Obstructive sleep apnea is a condition in which the airway in the throat repeatedly collapses or becomes blocked during sleep, causing people to briefly stop breathing multiple times per hour. This leads to drops in oxygen levels, disrupted sleep, loud snoring, and daytime tiredness. Over time, untreated OSA can increase the risk of high blood pressure, heart disease, and other serious health problems.

Excess weight, especially around the neck, plays a major role in OSA. The extra tissue can narrow the airway and increase the risk of collapse during sleep. Research shows that losing just 10% to 15% of body weight can reduce OSA severity by as much as 50% in people with moderate obesity.

How Are GLP-1 Drugs Helping People With Sleep Apnea?

GLP-1 medications work by reducing appetite and slowing digestion, leading to weight loss. By helping people shed pounds, these drugs address the underlying cause of many OSA cases. NBA legend Shaquille O'Neal recently shared his experience using Zepbound, noting that since starting the medication, he has experienced improvements in his OSA symptoms, including fewer breathing interruptions during sleep.

O'Neal was initially diagnosed with moderate OSA in 2011 after an overnight sleep study at Harvard Medical School. He tried using a CPAP machine, which involves wearing a mask to help keep the airway open while sleeping, but found it difficult to use consistently. His snoring worsened over time, and he experienced significant daytime tiredness. After consulting with his doctor, he decided to try Zepbound as an alternative approach.

"Excess weight, especially around the neck, can narrow the airway and increase the risk of collapse during sleep. Clinical evidence suggests that weight loss is highly effective in reducing disease severity," said Alex Dimitriu, MD, founder of Menlo Park Psychiatry and Sleep Medicine.

Alex Dimitriu, MD, Founder of Menlo Park Psychiatry and Sleep Medicine

What Makes GLP-1 Drugs Different From Other Weight Loss Options?

While CPAP remains the gold standard for treating OSA because it effectively uses pressurized air to keep the airway open, many people struggle with consistent use. Roughly 30% to 60% of people using CPAP use it consistently, making adherence a significant challenge. GLP-1 medications offer a different approach by addressing the root cause of weight-related OSA: excess body weight itself.

However, experts emphasize that GLP-1 medications are not a replacement for CPAP in all cases. Many patients with OSA may still require CPAP to manage their symptoms effectively, especially while weight loss is in progress or if they have anatomical factors like a small jaw that contribute to airway obstruction.

Steps to Maximize GLP-1 Effectiveness for Weight Loss and Sleep Apnea

• Adopt a high-protein, reduced-calorie diet: O'Neal prioritized eating a lot of protein, including chicken, fish, and steak, while cutting out high-calorie foods like his previous habit of eating four or five McDonald's items daily. He also eliminated bread and club sandwiches, his favorite foods, because they interfered with his weight loss goals.
• Engage in regular exercise, especially strength training: O'Neal adjusted his exercise routine to include regular use of an elliptical machine and biking. Strength training is particularly important while taking GLP-1 medications to maintain muscle mass during weight loss.
• Work with a healthcare provider for ongoing support: Guidance from a healthcare professional is essential while being treated for OSA and obesity, as well as after stopping medication. Obesity is a chronically progressive disease, and most people regain substantial weight if they stop therapy without proper support and monitoring.

O'Neal emphasized the importance of personalized medical care, saying, "If you're experiencing snoring, daytime tiredness, fatigue, get with your doctor and let him prescribe what's best for you".

What About Newer GLP-1 Medications and Weight Loss?

The GLP-1 medication landscape is expanding rapidly. AstraZeneca's new oral GLP-1 pill, called elecoglipron, showed promising results in a phase 2b clinical trial, helping people with type 2 diabetes reduce blood glucose levels and lose 10.5% of their body weight at 26 weeks. The trial involved 406 adults with type 2 diabetes from nine countries.

Nearly 90% of participants who took elecoglipron achieved an HbA1c level of 7%, the standard target for average blood glucose levels, compared with about 25% of participants who received a placebo. Additionally, 72% of participants in the treatment groups achieved at least a 5% weight reduction, with an average of 10.5% at 26 weeks.

"It's exciting to see another new oral medication that reinforces the positive effects of non-injectable GLP-1 medications," said Pouya Shafipour, MD, a family and obesity medicine physician at Providence Saint John's Health Center in California.

Pouya Shafipour, MD, Family and Obesity Medicine Physician at Providence Saint John's Health Center

The advantage of oral GLP-1 medications is that they appeal to patients who are uncomfortable using needles. Injectable medications require refrigeration and are less portable than pills. However, oral tablets must be taken daily, whereas injectable drugs are administered once weekly and tend to be more effective because they are absorbed directly into the bloodstream.

Are There Even More Powerful Weight Loss Drugs on the Horizon?

An experimental drug called retatrutide, a "triple agonist" medication, has generated significant buzz in the obesity treatment field. Unlike semaglutide (Wegovy, Ozempic), which targets one hormone receptor, or tirzepatide (Zepbound, Mounjaro), which targets two, retatrutide targets three hormone receptors: GLP-1, gastric inhibitory polypeptide (GIP), and glucagon.

In late-stage clinical trials, retatrutide produced dramatic weight loss results. Participants taking the highest 12-milligram dose lost an average of 70.3 pounds, or about 28% of their starting body weight, over 80 weeks. In an extended trial period, people on the maximum dose lost an average of 85 pounds, or slightly more than 30% of their starting body weight, after 104 weeks. More than 65% of those participants reached a BMI below 30, which no longer classifies them as having obesity.

However, doctors caution that such dramatic weight loss raises important questions. Some participants in the retatrutide trials dropped out because they worried they were losing too much weight. Researchers have also voiced concern that a 25% to 30% reduction in body weight could compromise some patients' health, potentially leading to nutritional deficiencies or loss of muscle mass.

"Is bigger always better? Is bigger always needed? Is bigger always right? And the answers are no, no, and no. Not every person requires, wants, needs, or should have weight loss at these high numbers," said Alice Yuk-Yan Cheng, MD, an associate professor of medicine at University of Toronto.

Alice Yuk-Yan Cheng, MD, Associate Professor of Medicine at University of Toronto

Retatrutide is not yet FDA-approved, though phase 3 clinical trials are continuing through 2026, and many doctors anticipate approval sometime in 2027. The most common side effects in trials included nausea (29% to 42% of participants), diarrhea (25% to 34%), constipation (24% to 26%), and vomiting (11% to 25%). Some unusual side effects also emerged, including nerve sensitivity and urinary tract infections.

What Should You Know Before Starting a GLP-1 Medication?

Experts stress that GLP-1 medications are part of a long-term strategy that requires adopting a healthy lifestyle. They are not quick fixes. People should discuss the appropriateness of any weight loss medication with their healthcare provider, as every medication has risks and contraindications that require educated, shared decision-making.

For those considering GLP-1 medications for weight loss or OSA treatment, the key takeaway is that these drugs work best when combined with lifestyle changes, ongoing medical support, and realistic expectations about weight loss goals. The goal is not just weight loss for its own sake, but improved health outcomes and quality of life.