Although drugs like Ozempic have been around for a while now, the hype has only recently reached fever pitch thanks to celebrity endorsements and a whole lot of social media buzz.
Originally, GLP-1 receptor agonists like this were used mainly for glucose control in adults with type 2 diabetes (a condition, by the way, that raises your risk of gum disease – even as gum disease raises your risk of diabetes). Eventually, they began to be repurposed to help with weight loss.
And now one of them – Zepbound – has been approved by the FDA for the treatment of obstructive sleep apnea (OSA). As the agency noted in a news release just before Christmas,
OSA occurs when a person’s upper airway becomes blocked, causing pauses in breathing during sleep. While OSA can affect anyone, it is more common in people who have overweight or obesity. Zepbound works by activating receptors of hormones secreted from the intestine (glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP)) to reduce appetite and food intake. By reducing body weight, studies show that Zepbound also improves OSA.
The approval was based on two year-long studies. Both documented “significant” weight loss and a reduction in OSA symptoms among those who received the drugs. In the news release, the description of these studies was followed by four paragraphs about the drug’s potential side effects and health risks.
And that, of course, is one common reason why some people refuse drugs and opt for safer alternatives.
More importantly, while it’s true that being overweight or obese does raise a person’s risk of sleep apnea – and losing weight can improve apnea symptoms – it’s hardly the only cause.
Often, the root cause of OSA is actually a dental one. Narrow or misaligned jaws, for instance, can result in the lower jaw or tongue falling backward during sleep, blocking the airway. In fact, we see that a lot these days, as people’s jaws tend to be smaller now thanks to the soft modern diet. (The forces of chewing are an important stimulant of jaw growth.) Smaller jaws mean smaller airways, jaws that are more retruded, and a greater likelihood of developing sleep apnea or other disordered breathing.
Other changes in the mouth’s structure can also affect the airway space. One study on the impact of tooth loss on apnea risk in adults from 25 to 65 years old, each missing tooth meant a 2% jump in the prevalence of high-risk OSA. Once they adjusted for variables, the risk was up 25% in those missing 5 to 8 teeth, 36% in those missing 9 to 31 teeth, and 61% in those who had lost all of their teeth.
Losing weight – either with or without the use of a drug – isn’t apt to help here. It doesn’t address the root cause.
What can help in such cases is oral appliance therapy. These custom-fit devices are designed to address the structural causes of OSA. They let us optimize conditions in the mouth to help keep the airway open and clear through the night.
And, yes, oral appliance therapy is also an option for those who do have weight issues but would rather not take drugs or be tethered to a machine every night (CPAP) to help them breathe.
Once considered something kind of out-there, oral appliance therapy for sleep apnea is now considered as much of a first-line treatment as CPAP, even in cases of severe sleep apnea.
And it’s certainly cheaper than Zepbound or any other weight loss drug out there.