Hi. I’m Dr Alison Kole, a triple-boarded pulmonary, critical care, and sleep medicine physician and the creator and host of the Sleep Is My Waking Passion podcast. Today I want to speak to you about a critical intersection in medicine, which is obesity and obstructive sleep apnea (aka OSA) and why this topic is especially relevant for those of us in the primary care community.
So, let’s start with a mindset shift. Obesity is a chronic inflammatory disease. It’s not just a matter of “eat less and move more.” We now understand that obesity involves complex genetic, hormonal, and neurobiological regulation. This chronic disease promotes low-grade inflammation throughout the body and significantly raises the risk for cardiovascular disease, metabolic syndrome, and even cancer — regardless of other risk factors.
Moving on to obstructive sleep apnea: Obesity and OSA are tightly linked and create a vicious cycle when you have them both together. Obesity is the single strongest modifiable risk factor for OSA, and even a 10% gain in weight can increase the risk for OSA by six times. And the relationship goes both ways: Untreated OSA can worsen metabolic dysfunction, fueling further weight gain and increasing the risk of serious disease, including insulin resistance, hypertension, and a myriad of other cardiac disease, including cardiac arrhythmias such as atrial fibrillation.
So, where do these new weight loss medications fit in? GLP-1 medications work by reducing appetite and caloric intake, slowing gastric emptying, and regulating hormones involved in hunger mechanisms that contribute to clinically meaningful weight loss. Studies have shown these medications are most effective for weight loss when combined with a reduced-calorie diet and increased physical activity.
Tirzepatide is the newest agent in this class, unique in its targeting of both the GIP-1 and GLP-1 receptors, so thereby it creates a greater weight loss. Notably, it is the only GLP-1-based medication currently approved for both weight loss and the treatment of moderate-to-severe OSA in patients who are obese.
While many patients may experience improvements in OSA severity as they lose weight, these medications are considered adjunctive and are not a replacement for established OSA therapies such as CPAP or oral appliances. Ongoing OSA management remains essential, even with substantial weight loss, until objective resolution of OSA is confirmed.
We also need to keep in mind that safety is top priority. Many of us are familiar with the most common side effects involving GLP-1s, which typically tend to be GI side effects, including nausea, vomiting, diarrhea, and constipation. Other things to keep in mind: Tirzepatide should be avoided in patients with a history of medullary thyroid carcinoma (or MTC), as well as MEN2 [multiple endocrine neoplasia type 2], severe gastroparesis, or those who are pregnant.
You may also want to ensure that your patients are staying adequately hydrated, as this could increase the risk for acute kidney injury. While routine labs are not strictly required (unless otherwise indicated), you may want to consider very close monitoring — especially in patients with diabetes or those who are on antihypertensives, as rapid weight loss can lead to episodes of hypoglycemia or hypotension.
Collaboration remains at the heart of quality OSA and obesity care. Primary care providers are often the very first to prescribe GLP-1s for obesity, but OSA still remains underdiagnosed and sometimes undertreated in our patient panels. So, partnering with sleep specialists ensures that patients receive proper diagnosis, ongoing management, and timely reassessment — especially after significant weight loss — to confirm any improvement or resolution of their obstructive sleep apnea. You can’t declare OSA cured without objective testing, and even mild OSA, if untreated, may increase the risk for some long-term issues.
One more point is worth considering, which is that you should be setting expectations with your patients early. GLP-1 medications are often a long-term or even lifelong therapy, and if stopped too soon, over half of patients may regain weight. So, you want to be thinking of these medications as you would statins or beta-blockers — a tool for ongoing risk reduction and not necessarily a quick fix.
Lastly, please do not let a lack of in-house nutrition or counseling services stop you from initiating meaningful obesity treatment. Many of our patients have already tried and struggled with lifestyle interventions, so we owe it to them to offer up-to-date, evidence-based solutions and to treat the whole patient — not just a number on the scale or a sleep study result. Let’s continue empowering our patients with compassion, evidence-based care, and teamwork. And I can’t forget to thank you for your commitment to advancing obesity and obstructive sleep apnea care.
Please remember to subscribe to my YouTube channel, @AskTheSleepMD, so you can catch all the latest episodes of the Sleep is My Waking Passion podcast — particularly my episode with Dr Ruchir Patel on GLP-1s. Thank you.
