Weight-reducing agents for obstructive sleep apnoea
In adults with obesity and moderate to severe obstructive sleep apnoea, what is the effect of a pharmacological weight-reducing agent on the apnoea–hypopnoea index?
§1Abstract
§1.1Review question
In adults with obesity and moderate to severe obstructive sleep apnoea, what is the effect of a pharmacological weight-reducing agent on the apnoea–hypopnoea index?
§1.2PICO frame
Table 1. The registered PICO frame. Any change made after protocol registration is recorded in the amendment log at §5 and is identified there as post hoc.
| Element | As registered |
|---|---|
| Population | Adults with obesity and polysomnographically confirmed moderate to severe obstructive sleep apnoea. |
| Intervention | Tirzepatide or liraglutide 3.0 mg. |
| Comparator | Placebo, with positive airway pressure use recorded and analysed as a stratification factor. |
| Outcomes | Change in the apnoea–hypopnoea index; change in the Epworth Sleepiness Scale; positive airway pressure adherence. |
§1.3Method in brief
A review of the effects of an intervention on pre-specified outcomes, with a quantitative synthesis where the contributing studies are sufficiently similar. The protocol was registered with the Institute's secretariat before the search was executed. The search was run on 11 December 2025 across 8 sources and is reproduced in full at §2. Screening, extraction and certainty assessment were performed independently by two members of the secretariat with disagreement resolved by a third.
§1.4Conclusion
Moderate certainty evidence indicates a clinically meaningful reduction in the apnoea–hypopnoea index. The Institute records that the apnoea–hypopnoea index is itself a surrogate: no contributing trial was powered for cardiovascular events, daytime function measured objectively, or motor-vehicle incidents, and the relationship between index reduction and those outcomes is not established.
The conclusion rests on 3 contributing studies, listed with their extracted data at §3 and summarised outcome by outcome at §4.
§1.5Limitations
§1.6Consultation
This review was released for public comment before ratification. Draft synthesis: Weight-reducing agents for obstructive sleep apnoea received 16 submissions. Amendments arising are recorded in the amendment log and are traceable to a numbered submission.