Counseling Patients With OSA on Side Effects of GLP-1s: Matthew Biszewski, PharmD

Effective patient counseling is paramount for adherence as patients with obstructive sleep apnea (OSA) start looking to take glucagon-like peptide-1 (GLP-1) receptor agonists, explained Matthew Biszewski, PharmD, clinical pharmacist at Endeavor Health.

The FDA first approved tirzepatide (Zepbound; Eli Lilly) for moderate to severe OSA in patients with obesity in December 2024. During his session at CHEST 2025, held October 19-22 in Chicago, Illinois, Biszewski focused on the pharmacology of GLP-1s, contraindications, and the practicalities of prescribing these medications.

This transcript has been edited for clarity; captions were auto-generated.

Transcript

How should patients with obstructive sleep apnea be counseled on common side effects of GLP-1s to ensure long-term adherence and continued use of other treatments, such as CPAP?

I think when a patient started, really counseling them on what to expect [is crucial]. Initially, they might have nausea, vomiting, diarrhea, [and] constipation, and I think it's important to let them know these are usually transient and get better within the first 48 hours to a couple of weeks of using it. I think telling them that [is important] so when and if they do experience these side effects, they're more likely to continue on with it. Also, I think [recommendations like] eating smaller meals, stop eating when they're…full, and avoiding triggers and things like that can really make a big difference when you start [a GLP-1].

What barriers to access are there for patients seeking GLP-1s for OSA?

They're still very expensive, and insurance coverage can vary pretty widely from plan to plan. If a patient's plan covers these drugs at all is one question, and then finding it out on the patient side can be very difficult. Then, even if they do get it covered now, it's not to say that if the patient switches insurance in a few months or their insurance decides to make a formulary change, it's a medication they might be able to afford today, and then next year [or] 5 years from now, it might become unaffordable, and that can be very difficult for patients to manage.