Episode # 3 • 17 Jan 2025
Integrating GLP-1s in Obesity & OSA Management
Which patients with obstructive sleep apnea are candidates for a GLP-1, and how do you start, escalate, and monitor one safely? On this episode of BackTable ENT & Allergy, host Dr. Gopi Shah is joined by obesity medicine specialist Dr. Shanail Berry and sleep specialist Dr. John Carter to discuss the practical questions that arise when adding GLP-1 and GLP/GIP therapies in OSA management. They discuss drug mechanisms and formulations, patient selection, screening and referral, management of side effects and contraindications, adherence strategies, perioperative considerations, and nutritional issues.
Timestamps
00:00 - Introduction
02:18 - The Overlap Between Obesity and Sleep Apnea
04:02 - GLP-1 Medications: Basics and History
05:52 - Dual and Triple Agonists in Development
08:56 - Clinic Evaluation and Team-Based Referrals
14:18 - Navigating Insurance Coverage
17:28 - Key GLP-1 Trials in OSA
18:25 - Results from SURMOUNT-OSA
26:31 - Integrating CPAP and GLP-1 Therapy
37:35 - Moving Beyond AHI: New Assessment Metrics
40:40 - Safety, Perioperative Risks, and Sarcopenia
50:16 - Wrap-Up
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More about this episode
The discussion also addresses the challenges of long-term GLP-1 therapy, including insurance barriers, prior authorizations, dose escalation, and common side effects. The doctors review when to reassess OSA after starting treatment, the growing importance of hypoxic burden beyond AHI, and strategies to prevent sarcopenia during weight loss. Throughout, they emphasize a multidisciplinary approach and the evolving landscape of OSA care in the era of GLP-1 therapies.
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