Clinical practice patterns and unmet needs in the use of GLP-1 receptor agonists in sleep medicine: A pan-European survey performed in the European sleep apnoea database network.
GLP-1 receptor agonists are increasingly used in European sleep clinics, but there is considerable variability in how they are managed, indicating a need for better guidelines and coordination in care.
Where it sits
this study against the rest of the liraglutide corpusSummary and findings
This survey evaluated clinical practice patterns regarding GLP-1 receptor agonists in patients with obesity and obstructive sleep apnoea across 24 centres in 14 European countries. It found that 42% of centres allowed sleep physicians to initiate GLP-1RA therapy, with a focus on moderate-to-severe obesity. Variability in practice and a lack of structured pathways were noted.
Abstract
<h4>Background</h4>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual GIP/GLP-1 agonists have demonstrated weight loss benefits and reductions in obstructive sleep apnoea (OSA) severity. Following recent regulatory approval of tirzepatide for OSA with obesity, their integration into sleep medicine is accelerating. However, real-world clinical practice remains undefined.<h4>Methods</h4>The European Sleep Apnoea Database (ESADA) network conducted a multinational online survey across 24 centres in 14 European countries to evaluate current practice patterns regarding GLP-1RA use in patients with obesity and suspected or established OSA.<h4>Results</h4>Forty-two percent of centres reported that GLP-1RA therapy could be initiated by sleep physicians within the sleep clinic. Indications were consistent, primarily targeting moderate-to-severe obesity with metabolic comorbidities. Most clinicians continued to recommend diagnostic sleep studies in symptomatic (92%) and asymptomatic (81%) patients recently started on GLP-1RAs. A weight loss threshold > 10% was considered clinically meaningful for OSA reassessment by 61% of centres. Despite anticipated reductions in OSA severity, proactive positive airway pressure (PAP) re-titration or withdrawal was uncommon (14%). Monitoring focused on weight trajectory, symptoms, and PAP telemonitoring. Structured interdisciplinary pathways were largely absent.<h4>Conclusions</h4>GLP-1RAs are increasingly incorporated into European sleep practice; however, substantial variability exists in diagnostic timing, PAP management, and follow-up strategies. Harmonised guidance and coordinated multidisciplinary care are urgently needed.
Background
This paper addresses the integration of GLP-1 receptor agonists in sleep medicine, particularly for patients with obesity and obstructive sleep apnoea (OSA). Prior knowledge indicates that GLP-1RAs can aid in weight loss and potentially reduce OSA severity. Understanding current clinical practices is essential for identifying gaps and establishing effective treatment protocols.
Methods
The study utilized a multinational online survey conducted by the European Sleep Apnoea Database network across 24 centres in 14 European countries. The survey aimed to evaluate current practice patterns regarding GLP-1RA use in patients with obesity and suspected or established OSA. Specific outcomes measured included initiation of therapy by sleep physicians, recommendations for diagnostic studies, and management strategies.
Results
The survey revealed that 42% of centres permitted sleep physicians to initiate GLP-1RA therapy. Most clinicians (92%) recommended diagnostic sleep studies for symptomatic patients, while 81% did so for asymptomatic patients. A weight loss threshold greater than 10% was deemed clinically meaningful for OSA reassessment by 61% of centres. However, only 14% of centres engaged in proactive PAP re-titration or withdrawal despite expected improvements in OSA severity.
Interpretation
The findings indicate a growing incorporation of GLP-1RAs into sleep medicine, yet highlight significant variability in practice patterns. While some results are statistically significant, the clinical implications of these practices remain uncertain. Limitations include potential biases in survey responses and the lack of standardized protocols, which may affect the generalizability of the findings.
Key findings
- 42% of centres reported that GLP-1RA therapy could be initiated by sleep physicians within the sleep clinic.
- 92% of clinicians recommended diagnostic sleep studies in symptomatic patients recently started on GLP-1RAs.
- 81% of clinicians recommended diagnostic sleep studies in asymptomatic patients recently started on GLP-1RAs.
- 61% of centres considered a weight loss threshold >10% clinically meaningful for OSA reassessment.
- 14% of centres reported proactive PAP re-titration or withdrawal despite anticipated reductions in OSA severity.
Limitations
- Survey-based data may not accurately reflect actual clinical practices.
- Variability in responses indicates a lack of consensus on GLP-1RA use.
- Limited information on the long-term outcomes of GLP-1RA therapy in sleep medicine.