Researchers looked at 34 different studies involving nearly 4,000 people to compare two main treatments for obstructive sleep apnea (OSA), a condition where breathing stops and starts during sleep. They studied CPAP machines, which help keep airways open, and GLP-1 medications, which are often used for weight loss and diabetes. The study found that CPAP machines are best at fixing breathing problems and reducing daytime sleepiness, while GLP-1 medications are better at helping people lose weight and control blood sugar. Interestingly, using both treatments together appeared to work even better for weight loss than either treatment alone.

The Quick Take

  • What they studied: Which treatment works best for obstructive sleep apnea: CPAP machines, GLP-1 medications (like semaglutide), both together, or no treatment at all?
  • Who participated: Nearly 4,000 adults across 34 different research studies who had obstructive sleep apnea. The researchers combined results from all these studies to see the big picture.
  • Key finding: CPAP machines were the clear winner for stopping breathing interruptions during sleep and reducing daytime sleepiness. GLP-1 medications were better at helping people lose weight and manage blood sugar. Using both treatments together gave the best weight loss results.
  • What it means for you: If you have sleep apnea, CPAP is still the gold standard for treating the breathing problem itself. If you also need to lose weight or manage diabetes, adding a GLP-1 medication may help more than CPAP alone. Talk to your doctor about whether combining treatments makes sense for your situation.

The Research Details

This is a network meta-analysis, which means researchers looked at 34 different randomized controlled trials (the gold standard type of study) and combined all their results together. They searched medical databases through August 2025 for studies testing CPAP machines, three different GLP-1 medications (exenatide, liraglutide, and tirzepatide), or combinations of these treatments. By combining all these studies, they could see patterns that might not be obvious in any single study.

The researchers measured several important outcomes: how many breathing interruptions people had per hour (called the apnea-hypopnea index), how sleepy people felt during the day, weight, blood pressure, and blood sugar control. They used special statistical methods to fairly compare treatments even though the original studies weren’t all identical.

Network meta-analysis is powerful because it lets researchers compare treatments that were never directly tested against each other in a single study. Instead of just looking at CPAP versus nothing, or GLP-1 versus nothing, they could figure out how CPAP compares to GLP-1, and how the combination compares to both. This gives doctors and patients much better information for making treatment decisions.

The researchers used GRADE, a standard method for judging how confident we should be in research findings. They found moderate confidence in the results about CPAP’s effects on breathing and sleepiness, and moderate confidence in GLP-1’s effects on weight and blood sugar. However, confidence was lower for effects on blood pressure and fasting glucose, meaning we should be more cautious about those findings. The fact that they included nearly 4,000 people across many studies makes the results more reliable than any single small study.

What the Results Show

CPAP machines were the most effective treatment for the main problem in sleep apnea: reducing breathing interruptions. Compared to no treatment, CPAP reduced breathing interruptions by about 22 events per hour—a substantial improvement. CPAP also significantly reduced daytime sleepiness, with people reporting feeling noticeably less tired during the day.

GLP-1 medications, particularly liraglutide, showed their strength in different areas. They helped people lose weight (about 1.6 kg/m² reduction in BMI) and improved blood sugar control (HbA1c dropped by 0.19%). However, GLP-1 medications did not significantly reduce breathing interruptions or daytime sleepiness.

When researchers looked at combining CPAP with liraglutide, they found the best weight loss results—about 2 kg/m² reduction, which is better than either treatment alone. This suggests the two treatments work on different problems and complement each other well.

Interestingly, neither CPAP nor GLP-1 medications significantly changed blood pressure or fasting glucose levels in this analysis. This was somewhat surprising, as doctors often expect these treatments to affect blood pressure. The researchers noted that the evidence for these outcomes was weaker, meaning we should be cautious about drawing firm conclusions. The ranking of treatments (called SUCRA scores) consistently showed CPAP as best for breathing and sleepiness, while GLP-1 medications ranked highest for weight and blood sugar control.

These findings align with what doctors have long observed: CPAP is the established, proven treatment for the breathing problems of sleep apnea, while GLP-1 medications are newer tools that address the weight and metabolic issues often accompanying sleep apnea. This study is one of the first to systematically compare these approaches and suggest they target different aspects of the disease. The results support an ‘integrated’ approach where both treatments might be used together for patients who have both sleep apnea and weight/metabolic concerns.

This study combined results from different trials that weren’t all designed the same way, which can introduce some uncertainty. The researchers only looked at randomized controlled trials, which is good for quality but means some real-world experiences might not be captured. Some treatments (like the combination of CPAP plus GLP-1) had fewer studies, making those conclusions less certain. The studies varied in how long people used the treatments and how they measured outcomes. Additionally, most participants were likely from developed countries, so results might not apply equally to all populations worldwide.

The Bottom Line

If you have obstructive sleep apnea, CPAP therapy remains the first-line treatment for controlling breathing interruptions and daytime sleepiness (high confidence). If you also struggle with weight or blood sugar control, ask your doctor about adding a GLP-1 medication like liraglutide, as the combination appears more effective for weight loss than CPAP alone (moderate confidence). Do not stop CPAP treatment in favor of GLP-1 alone, as GLP-1 medications don’t adequately treat the breathing problem. Blood pressure and fasting glucose changes are less certain, so don’t expect major improvements in these areas from either treatment (low confidence).

This research is most relevant for people with obstructive sleep apnea who also have weight concerns or type 2 diabetes. If you have sleep apnea but normal weight and good blood sugar control, CPAP alone is likely your best option. If you’re considering GLP-1 medications for weight loss or diabetes, and you have sleep apnea, this research suggests combining it with CPAP might be beneficial. People without sleep apnea should not use these findings to justify GLP-1 use for weight loss alone.

CPAP typically improves breathing and daytime sleepiness within days to weeks of consistent use. GLP-1 medications usually take 2-4 weeks to show effects on weight and blood sugar, with more noticeable changes over 3-6 months. If combining treatments, expect to see the full benefit of the combination over several months as your body adjusts to both therapies.

Want to Apply This Research?

  • Track daily CPAP usage (hours per night) and weekly weight measurements. If using GLP-1 medication, also log energy levels and daytime sleepiness using a simple 1-10 scale each morning. This helps you and your doctor see whether the combination is working for you personally.
  • Set a specific goal like ‘Use CPAP every night for at least 6 hours’ and ‘Take GLP-1 medication on schedule.’ Use app reminders for medication timing and CPAP setup. Log how you feel each morning to connect treatment adherence with real improvements in how you feel.
  • Check in monthly with your doctor about CPAP compliance and medication tolerance. Track trends in weight, sleepiness, and energy over 3-month periods rather than daily fluctuations. If combining treatments, monitor for any side effects from the GLP-1 medication and ensure CPAP settings remain comfortable as your weight changes.

This research summary is for educational purposes only and should not replace professional medical advice. Sleep apnea is a serious medical condition requiring diagnosis and treatment by a qualified healthcare provider. Do not start, stop, or change any sleep apnea treatment or medication without consulting your doctor. The findings presented here represent research trends but may not apply to your individual situation. If you have sleep apnea symptoms (loud snoring, gasping for air during sleep, daytime sleepiness), consult a sleep specialist for proper evaluation and personalized treatment recommendations.