CHEST 2025: GLP-1 Agonists Open New Pathways for Treating Obstructive Sleep Apnea

Matthew Biszewski, PharmD, clinical pharmacist at Endeavor Health, discussed how the FDA’s approval of glucagon-like peptide-1 (GLP-1) for obstructive sleep apnea (OSA) expands access to therapy for patients without diabetes.

During his session at CHEST 2025, held October 19-22 in Chicago, Illinois, Biszewski emphasized the importance of careful patient selection, ongoing support, and managing expectations and side effects. He also highlighted the evolving role of pharmacists in coordinating care across conditions like obesity, diabetes, and OSA as these therapies become more widely used.

Pharmacy Times: What does the new FDA approval of GLP-1 agonists for OSA mean for clinical practice?

Matthew Biszewski, PharmD: I primarily work in primary care, so the biggest impact I’ve seen is for Medicare patients who are obese and have sleep apnea. Previously, these medications were a class they didn’t really have access to unless they also had diabetes. With this approval, it opens up this drug class for patients who didn’t previously have it.

Pharmacy Times: What factors should guide patient selection for GLP-1 therapy in OSA?

Biszewski: I think the most important thing is still to follow the label indication—patients with moderate to severe OSA who also are obese. But I also think another important piece is that, when we think about things like bariatric surgery for weight loss, we want to make sure patients have a support system in place, from counseling on physical activity and nutrition. When we think about these medications, that support isn’t always in place, and this is a lifelong commitment for a medication that might cost upwards of $500 a month or more, depending on their insurance status. That really has to be something they’re able to commit to now and for the indefinite future, while also making sure they don’t have any contraindications. Obviously, in any patient who is frail or already has serious GI conditions, we might want to be careful using these.

Pharmacy Times: How might GLP-1 agonists fit into current OSA treatment pathways?

Biszewski: I think weight loss has always been a primary factor for treating OSA through diet, exercise, and lifestyle interventions. Now we have a pretty effective pharmaceutical product that’ll lower patients’ BMI substantially. I don’t think this is going to replace CPAP, but in patients who struggle with adherence or want to minimize their reliance on it, this can really be a great option.

Pharmacy Times: What monitoring and follow-up are key for patients starting these therapies?

Biszewski: I think the most important thing at the start is to really level set with patients about expectations for how much weight they’re expected to lose, but also about side effects. Primarily, when you start, patients may have heard stories from friends or family who took them and had negative side effects. So going through the expected GI side effects with them is important, but also emphasizing that these effects are often transient and get better after the first 48 hours and each week thereafter. I like to follow up with patients three weeks after their first injection to see how they’re doing, and we can talk about whether to increase the dose or wait. Helping them manage any side effects and advising them to keep a food diary to identify triggers that cause side effect exacerbations can really help them avoid problems.

Pharmacy Times: How do you see GLP-1 agonists shaping the future of OSA management and the pharmacist’s role?

Biszewski: I think the pharmacist’s role is going to be interesting. Historically, we really haven’t seen pharmacists involved in OSA, just because there weren’t any medications for it. But I see a lot of parallels with how we think about SGLT2 inhibitors. They’re medications that cross multiple specialties and conditions. With these medications, we have diabetes, obesity, kidney disease, heart disease, and liver disease—all these different pathways—and having someone oversee all of that is important. I think the pharmacist is a common touchpoint for medications. If someone has sleep apnea and diabetes, for example, their diabetes medications might need to be adjusted. Pharmacists are in a really good position to oversee the overlap between conditions and medications that need to be adjusted.