November 13, 2026

@michaelokun

A pill for sleep apnea? New JAMA trials suggest we may be entering a new era of treatment. Obstructive sleep apnea (OSA) occurs when the upper airway repeatedly collapses during sleep, interrupting breathing and reducing oxygen levels. The apnea-hypopnea index (AHI) measures how many times breathing stops or becomes significantly reduced per hour of sleep. Atul Malhotra and colleagues describe in a new paper in JAMA the results of two phase 3 randomized clinical trials testing orforglipron, a once-daily oral GLP-1 medication, for moderate to severe OSA in adults who were overweight or had obesity. An accompanying editorial by Diego Mazzotti and Damien Stevens asks an important question: Could a pill become part of a more personalized approach to treating sleep apnea? Key points: - The ATTAIN-OSA trials enrolled 712 adults across two studies, one involving folks not using positive airway pressure (PAP) therapy and another involving folks already receiving PAP. After 52 weeks, orforglipron reduced breathing interruptions by approximately 12 to 13 additional events per hour compared to placebo. - Participants receiving orforglipron lost approximately 10.5% of their body weight and experienced improvements in oxygen-related breathing burden and several cardiometabolic risk markers. However, many participants continued to have moderate to severe sleep apnea despite treatment. - Gastrointestinal side effects were common, affecting approximately 68% to 71% of participants receiving orforglipron. The editorial emphasized that oral treatment may improve convenience, however we still need better evidence on long-term cardiovascular outcomes, patient-reported benefits and how these medications should be combined w/ existing treatments. My take: This is an exciting development because sleep apnea is not simply about snoring or a poor night's sleep. Repeated breathing interruptions can affect daytime alertness, cognition, blood pressure and cardiovascular health. As a neurologist, I am particularly interested in how improving sleep and nighttime oxygenation may influence brain health, especially in folks living w/ Parkinson's disease, Alzheimer's disease and others.