Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual GIP/GLP-1 agonists have demonstrated benefits for weight reduction and have been associated with reductions in obstructive sleep apnoea (OSA) severity. Recent regulatory approval of tirzepatide for OSA with obesity has accelerated interest in integrating these agents into sleep medicine. Despite increasing clinical adoption, real-world practice patterns for when and how to use GLP-1RAs in patients with obesity and suspected or established OSA have not been well defined.
The European Sleep Apnoea Database (ESADA) network conducted a multinational online survey to assess current clinical practice. The survey encompassed 24 centres across 14 European countries and targeted clinicians involved in management of patients with obesity and suspected or established OSA. The instrument queried who may initiate GLP-1RA therapy in the sleep clinic, typical indications, approaches to diagnostic sleep testing after GLP-1RA initiation, thresholds for reassessment, PAP management strategies, monitoring priorities, and the presence of structured interdisciplinary care pathways.
Survey responses revealed heterogeneous practice across centres but several consistent themes.
Initiation of therapy: Forty-two percent of centres reported that GLP-1RA therapy may be initiated by sleep physicians within the sleep clinic.
Indications: Indications for prescribing GLP-1RAs were consistent across respondents, focusing primarily on patients with moderate-to-severe obesity accompanied by metabolic comorbidities.
Diagnostic sleep testing after initiation: Most clinicians continued to recommend diagnostic sleep studies after patients had recently started GLP-1RA therapy. Specifically, 92% of centres recommended diagnostic testing for symptomatic patients and 81% for asymptomatic patients who had recently begun GLP-1RA treatment.
Threshold for OSA reassessment: A weight loss threshold greater than 10% was considered a clinically meaningful point for reassessment of OSA by 61% of centres.
PAP management: Although reductions in OSA severity might be anticipated with GLP-1RA–associated weight loss, proactive re-titration or withdrawal of positive airway pressure (PAP) therapy was uncommon; only 14% of centres reported routinely performing proactive PAP re-titration or withdrawal following GLP-1RA initiation.
Monitoring priorities: Monitoring efforts focused on weight trajectory, patient-reported symptoms, and PAP telemonitoring data.
Multidisciplinary pathways: Structured interdisciplinary care pathways to coordinate GLP-1RA use and OSA management were largely absent across surveyed centres.
The survey documents increasing incorporation of GLP-1RAs into European sleep practice for patients with obesity and suspected or established OSA, but it also highlights substantial variability in how these therapies are operationalized. Key areas of variation include which clinicians initiate therapy, timing and indications for diagnostic sleep testing after GLP-1RA initiation, criteria for re-evaluating OSA in the context of weight loss, and strategies for PAP re-titration or discontinuation.
This variability has practical implications for patient care: differing approaches to diagnostics and PAP management could lead to inconsistent reassessment of OSA severity, variable decisions about continued PAP therapy, and heterogeneous follow-up intensity. The absence of structured interdisciplinary pathways suggests limited integration between sleep medicine, obesity management, and metabolic care in many centres.
Across centres, the main elements of monitoring after GLP-1RA initiation were:
Tracking weight trajectory to assess magnitude and timing of weight loss.
Monitoring symptoms attributable to OSA to detect clinical improvement or persistence.
Using PAP telemonitoring where available to review adherence and objective respiratory parameters.
Despite routine monitoring of these domains, relatively few centres reported proactive PAP re-titration or withdrawal, indicating a cautious approach to altering PAP prescriptions even when weight loss and symptomatic improvement are observed.
The ESADA survey identifies several unmet needs in integrating GLP-1RAs into sleep medicine practice:
Harmonised guidance is needed to standardize indications, timing of diagnostic sleep testing after GLP-1RA initiation, objective thresholds for OSA reassessment, and criteria for PAP re-titration or withdrawal.
Coordinated multidisciplinary care pathways are largely lacking; development of structured collaboration between sleep specialists, metabolic/obesity services, and primary care would support consistent management.
Clear operational protocols for monitoring—defining which clinical and objective measures should prompt repeat sleep testing or PAP adjustments—would reduce practice variability.
The survey authors conclude that these gaps justify urgent efforts to develop consensus guidance and multidisciplinary models to optimize care for patients with obesity and OSA receiving GLP-1RAs.
GLP-1RAs are being increasingly used in European sleep clinics for patients with obesity and suspected or established OSA. The ESADA multinational survey of 24 centres across 14 countries found consistent indications focused on moderate-to-severe obesity with metabolic comorbidities, high rates of continued diagnostic testing after GLP-1RA initiation, and a common view that >10% weight loss is a meaningful threshold for reassessment. However, proactive PAP re-titration or withdrawal was uncommon, and structured interdisciplinary pathways were largely absent. Overall, the findings point to substantial variation in clinical practice and underscore the need for harmonised guidance and coordinated multidisciplinary care.
Note: The source article abstract provided the data and conclusions summarized here. Additional methodological details, quantitative breakdowns beyond those reported in the abstract, and limitations were not reported in the provided source text.