Editorial 1, Issue 13.3

The GLP-1 Era: Why Dental Sleep Medicine Cannot Look Away

http://dx.doi.org/10.15331/jdsm.7450

Jean-François Masse, DMD, MSc, FACD, Diplomate, ABDSM
 
Editor-in-Chief Journal of Dental Sleep Medicine
Universite Laval, Quebec City, Quebec, Canada

Over the past few years, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have moved from endocrinology headlines into everyday conversations in clinics, pharmacies, and even workplaces. In the United States, recent survey data suggest that roughly one in eight adults is currently taking a GLP-1 drug such as semaglutide or tirzepatide, either for weight loss or to treat a chronic condition.1 At the same time, nearly three quarters of American adults live with overweight or obesity, and obesity is implicated as a comorbidity in well over 200 medical conditions, including obstructive sleep apnea (OSA).2

This convergence—widespread obesity, rapid uptake of GLP-1 agents, and the high burden of OSA—creates a new reality that the dental sleep medicine community can no longer treat as a peripheral concern.2 Even if dentists do not prescribe these agents, patients are taking them, and these medications are reshaping the phenotypes of the individuals evaluated and treated with oral appliance therapy.2, 3

From Metabolic Niche to Mass Therapy

GLP-1 RAs were initially viewed as specialized tools for glycemic control in type 2 diabetes, but that perception has shifted dramatically as robust weight-loss data emerged and dedicated obesity indications were pursued or approved.2, 3, 4 Today, GLP-1 agents are increasingly positioned as long-term treatments for chronic weight management, reinforcing the view of obesity as a chronic disease rather than a purely behavioral problem.2

Yet this pharmacologic revolution rests on an economically fragile foundation. Coverage remains inconsistent, costs remain high, and affordability continues to shape uptake and persistence.1, 5, 6 Recent polling found that one in eight adults has used or is using a GLP-1 drug. Cost and insurance coverage remain major barriers, and many patients who discontinue therapy cite financial reasons.1, 5, 6

For dental sleep medicine, these policy dynamics are not abstract. They translate into clinical realities: patients who lose significant weight while coverage is available, then regain weight after reimbursement ends; patients who delay care because medication costs are prohibitive; and patients whose cardiometabolic risk and OSA severity may fluctuate over relatively short time frames.2, 3

The Rise of Oral GLP-1 Pills

Until recently, injectables dominated the GLP-1 landscape. For many individuals, weekly injections are an acceptable trade-off for clinically meaningful weight loss. For others, needle aversion remains a significant barrier, which gives oral therapies obvious strategic importance.4

That is why Eli Lilly’s oral small-molecule GLP-1 receptor agonist, orforglipron, deserves attention. In a phase 3 obesity trial published in 2025, adults with obesity treated for 72 weeks achieved mean weight reductions of 7.5% with 6 mg, 8.4% with 12 mg, and 11.2% with 36 mg, compared with 2.1% with placebo.7 Earlier pharmacology work also showed that orforglipron supports once-daily oral dosing without water or food restrictions, a practical advantage over some earlier oral incretin approaches.4

Even if oral GLP-1 agents prove somewhat less effective than the most potent injectable regimens, they may ultimately have greater population-level reach because they remove the needle barrier and fit more naturally into routine long-term medication use.4, 7 For dental sleep medicine clinicians, this means that a growing portion of the patient population may soon present already taking an oral anti-obesity agent rather than considering one in the future.2
 

GLP-1 Therapy and OSA

Obesity remains one of the strongest and most modifiable risk factors for OSA. Increased neck circumference, central adiposity, and upper-airway soft tissue burden all contribute to pharyngeal collapsibility and higher apnea-hypopnea index (AHI) values.8 Accordingly, weight loss has long been recognized as a path to reducing OSA severity, even if complete resolution is uncommon in moderate-to-severe disease.3, 8

The newer literature suggests that GLP-1 RAs may affect OSA through that weight-loss pathway and possibly through broader cardiometabolic improvement. A 2025 systematic review concluded that GLP-1 RAs were superior to control for reducing AHI in patients with obesity and/or type 2 diabetes, with a mean difference of -5.68 events per hour in the subgroup with type 2 diabetes.3 Another 2025 meta-analysis reported a weighted mean difference of -16.6 events per hour versus placebo in adults with OSA and BMI at least 30 kg/m2 who did not have diabetes, although adverse events were more frequent.9 A separate meta-analysis found an estimated treatment difference of -9.99 events per hour and also reported reductions in body weight and blood pressure.8

These findings should be interpreted with appropriate caution because the evidence base is still relatively young and heterogeneous. Still, the directional signal is consistent: GLP-1 therapies appear capable of improving OSA severity in a meaningful subset of patients while also improving the broader cardiometabolic context in which OSA exists.2, 3, 8
 

Why This Matters for Oral Appliance Therapy

The relationship between obesity, upper-airway anatomy, and oral appliance therapy is well established. Earlier work by Remmers and colleagues showed that remotely controlled mandibular protrusion during sleep can help predict therapeutic success with oral appliances, and favorable responders tended to have characteristics such as lower BMI, smaller neck circumference, and more favorable disease phenotypes.10

Additional work has reinforced the importance of body habitus. A 2013 study found that patients with moderate OSA who were obese and had marked oropharyngeal crowding were unlikely to respond to oral appliance treatment, and the combination of elevated BMI and a Mallampati class 4 airway had a high negative predictive value for success.11 Earlier physiologic and cephalometric work also found better oral appliance responses among younger patients with lower BMI.12 Later reviews and phenotyping studies have generally supported the same pattern: less obesity, more favorable anatomy, and specific phenotype features tend to predict better results with mandibular advancement.13, 14

That observation is where GLP-1 therapy becomes clinically relevant to dental sleep medicine. A patient who loses 10% to 15% of body weight under GLP-1 therapy may move from a borderline or poor oral appliance candidate into a more favorable phenotypic zone for success.3, 7, 8 In practical terms, the same patient who once seemed destined for CPAP-only management may, after substantial weight reduction, become a reasonable or even strong candidate for mandibular advancement therapy.10, 11


A Time-Sensitive Practice Opportunity

The time course of GLP-1-induced weight loss suggests that dental sleep medicine should adopt a more explicitly dynamic approach to patient reassessment. Weight reduction often unfolds over months and may plateau with continued therapy, while discontinuation may be followed by partial rebound if lifestyle change is not durable.2, 3, 8
This has several practical implications:

  1. Baseline Documentation: When a patient with OSA starts a GLP-1 medication, baseline documentation should include weight, BMI, neck circumference, disease phenotype, and current treatment status.2
  2. Strategic Reassessment: The 6- to 12-month period after treatment initiation may be an ideal window to reassess candidacy for oral appliance therapy through updated clinical examination and repeat sleep testing where appropriate.3, 7
  3. Monitoring for Rebound: Because financial pressures frequently drive discontinuation, clinicians should anticipate possible rebound, monitor symptoms, and revisit titration or treatment modality if weight returns.1, 5, 6
  4. Interdisciplinary Communication: This dynamic environment necessitates robust interdisciplinary communication. Dental sleep medicine clinicians must actively establish channels with the prescribing physicians, whether primary care providers or endocrinologists, managing the patient's obesity. Coordinating repeat sleep testing and oral appliance reassessment to coincide with the plateau phase of pharmacologic weight loss requires a cohesive, team-based approach. This ensures that objective changes in the patient's airway collapsibility are accurately captured, allowing the dental clinician to optimize the device just as the patient achieves their new baseline phenotype.

This model reframes oral appliance therapy as part of a longitudinal strategy rather than a static intervention. The device, the titration target, and the chance of success may all evolve as the patient’s metabolic phenotype changes.14

Equity, Ethics, and Scope

Any discussion of GLP-1 therapy must also confront issues of access and equity. Insurance coverage, socioeconomic status, and geography may all influence whether patients can obtain and sustain therapy, meaning that two otherwise similar OSA patients may follow very different trajectories simply because one can afford pharmacologic weight reduction and the other cannot.14

That raises legitimate ethical questions for dental sleep medicine. How should clinicians discuss GLP-1 therapy without reinforcing a two-tiered model of care? How should the field acknowledge the impact of these medications without over-medicalizing obesity or stepping outside appropriate professional boundaries?2 The appropriate role is neither to prescribe outside scope nor to ignore what is happening. It is to understand the consequences of GLP-1 therapy for OSA phenotype, treatment selection, titration, and follow-up.3

CONCLUSION

The GLP-1 era does not replace the fundamentals of dental sleep medicine. Upper-airway anatomy still matters, patient-centered decision-making still matters, and CPAP and oral appliance therapy remain complementary rather than competing modalities. What has changed is the substrate on which these therapies are applied. The phenotypes encountered in practice are increasingly being shaped by potent anti-obesity medications that clinicians in dental sleep medicine may not prescribe, but must understand.2, 3

In that sense, dental sleep medicine is entering an era in which clinicians must become better interpreters of phenotype. Weight loss achieved through GLP-1 therapy may alter candidacy for oral appliances, reduce disease severity, and open new treatment windows that did not previously exist.3, 7, 8 The profession should not view this as someone else’s revolution. It is already entering sleep clinics, changing case selection, and reshaping expectations for what oral appliance therapy can achieve.2

CITATION

Masse, JF. The GLP-1 Era: Why Dental Sleep Medicine Cannot Look Away. J Dent Sleep Med. 2026;13(3).

REFERENCES

  1. KFF. Poll: 1 in 8 Adults Say They Are Currently Taking a GLP-1 Drug for Weight Loss, Diabetes, or Another Chronic Condition. Published November 13, 2025.
  2. Sutherland K, Cistulli PA, Dalci O. Current perspectives on the use of GLP-1 receptor agonists in obesity-related obstructive sleep apnea: a narrative review. Expert Opin Pharmacother. 2025;26(1):57–68. doi:10.1080/14656566.2024.2437525.
  3. Li M, Lin H, Yang Q, Zhang X, Zhou Q, Shi J, Ge F. Glucagon-like peptide-1 receptor agonists for the treatment of obstructive sleep apnea: a meta-analysis. Sleep. 2025;48(4):zsae280. doi:10.1093/sleep/zsae280. PMID: 39626095.
  4. Pratt E, Ma X, Liu R, Robins D, Haupt A, Coskun T, Sloop KW, Benson C. Orforglipron (LY3502970), a novel, oral non-peptide glucagon-like peptide-1 receptor agonist: a Phase 1a, blinded, placebo-controlled, randomized, single- and multiple-ascending-dose study in healthy participants. Diabetes Obes Metab. 2023;25(9):2634–2641. doi:10.1111/dom.15184.
  5. KFF. Poll: 1 in 8 Adults Say They’ve Taken a GLP-1 Drug, Including 4 in 10 of Those With Diabetes and 1 in 5 of Those Who Are Overweight or Obese. Published May 9, 2024.
  6. JAMA. Roughly 12% of US Adults Have Used a GLP-1 Drug, Even If Unaffordable. Published July 1, 2024.
  7. Wharton S, Aronne LJ, Stefanski A, et al. Orforglipron, an oral small-molecule GLP-1 receptor agonist, in adults with obesity. N Engl J Med. 2025;393:1796–1806. doi:10.1056/NEJMoa2511774.
  8. Aljazeeri J, Carvalhal De Almeida Cordeiro G, Peralta-Jiménez GA, Roca Mora MM, Ayasa L, Barrera V, Advani K. GLP-1 receptor agonists for obstructive sleep apnea: a meta-analysis of randomized controlled trials. Am J Respir Crit Care Med. 2025;211(Suppl 1):A2901. doi:10.1164/ajrccm.2025.211.Abstracts.A2901.
  9. Kow CS, Ramachandram DS, Hasan SS, Thiruchelvam K. Efficacy and safety of GLP-1 receptor agonists in the management of obstructive sleep apnea in individuals without diabetes: a systematic review and meta-analysis of randomized, placebo-controlled trials. Sleep Med. 2025;129:40–44. doi:10.1016/j.sleep.2025.02.010. PMID: 39978242.
  10. Remmers JE, Charkhandeh S, Grosse J, Topor Z, Brant R, Santosham P, Bruehlmann S. Remotely controlled mandibular protrusion during sleep predicts therapeutic success with oral appliances in patients with obstructive sleep apnea. Sleep. 2013;36(10):1517–1525. doi:10.5665/sleep.3048. PMID: 24082311.
  11. Tsuiki S, Ito E, Isono S, Ryan CF, Komada Y, Matsuura M, Inoue Y. Oropharyngeal crowding and obesity as predictors of oral appliance treatment response to moderate obstructive sleep apnea. Chest. 2013;144(2):558–563. PMID: 23493981.
  12. Liu Y, Lowe AA, Fleetham JA, Park YC. Cephalometric and physiologic predictors of the efficacy of an adjustable oral appliance for treating obstructive sleep apnea. Am J Orthod Dentofacial Orthop. 2001;120(6):639–647. doi:10.1067/mod.2001.118782. PMID: 11742309.
  13. Remmers JE, Topor Z, Grosse J, Vranjes N, Mosca EV, Brant R, Bruehlmann S, Charkhandeh S, Zareian Jahromi SA. A feedback-controlled mandibular positioner identifies individuals with sleep apnea who will respond to oral appliance therapy. J Clin Sleep Med. 2017;13(7):871–880. doi:10.5664/jcsm.6656. PMID: 28502280.
  14. Sutherland K, Chan ASL, Ngiam J, Dalci O, Darendeliler MA, Cistulli PA. Awake multimodal phenotyping for prediction of oral appliance treatment outcome. J Clin Sleep Med. 2018;14(11):1879–1887. doi:10.5664/jcsm.7484. PMID: 30373687.
 

SUBMISSION AND CORRESPONDENCE INFORMATION

Submitted in final revised form June 14, 2026
 
Address correspondence to: Jean-François Masse, DDS, MSc, FACD, D.ABDSM, Professor, Universite Laval, 2780 Masson #200, Quebec City, QC, G1P 1J6, Canada; Tel: 418871-1447; Fax: 418-871-4983; Email: jean-francois.masse@fmd.ulaval.ca

PDF