GLP-1 receptor agonists for obstructive sleep apnea: a meta-analysis of randomized controlled trials

Purpose: Weight reduction is recommended in all overweight and obese patients with obstructive sleep apnea (OSA). Glucagon-like peptide-1 (GLP-1) receptor agonists-based therapies have demonstrated clinical benefits in reducing weight and could potentially improve OSA outcomes. We aim to analyze the efficacy and safety of GLP-1 receptor agonists-based therapies in patients with moderate-to-severe OSA. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared GLP-1 receptor agonists-based therapies versus control in adults with moderate-to-severe OSA. We systematically searched electronic databases and registries up to February 10, 2025. Outcomes assessed included apnea–hypopnea index (AHI), body weight, oxygen desaturation index (ODI), minimum oxygen saturation, systolic blood pressure (SBP), diastolic blood pressure (DBP), and adverse events. Results: A total of 6 RCTs involving 1,069 participants were included, four evaluating liraglutide and two tirzepatide. Compared with control, GLP-1 receptor agonist-based therapies reduced AHI by − 9.99 events/hour (95% CI, − 16.47 to − 3.50; p < 0.01; I2 = 87%) and body weight by − 9.68 kg (95% CI, − 15.84 to − 3.51; p < 0.01; I2 = 98%). These therapies also reduced SBP by -4.77 mmHg (95% CI, -7.04 to -2.51; p < 0.01), and DBP by -1.41 mmHg (95% CI, -2.71 to -0.11; p = 0.03). No significant differences were observed in ODI or minimum oxygen saturation. GLP-1 receptor agonists-based therapies did not increase the risk of adverse events. Conclusion: GLP-1 receptor agonist-based therapies reduced AHI and body weight in the populations studied. Substantial heterogeneity limits interpretation of the pooled effect magnitude. These findings support their potential role within comprehensive OSA management but do not establish them as substitutes for CPAP. Registry: International Prospective Register of Systematic Reviews; No.: CRD42024564018; URL: https://www.crd.york.ac.uk/prospero/. © The Author(s), under exclusive licence to Springer Nature Switzerland AG 2026.