Written by Sophie Vergnaud, MD | Reviewed by Alyssa Billingsley, PharmD
Published on May 3, 2024
Key takeaways:
Tirzepatide (Zepbound) isn’t currently approved for the treatment of obstructive sleep apnea (OSA), but it could be as early as the end of 2024.
People who could potentially benefit from the medication for OSA may already be eligible for it.
In clinical trials, people with moderate to severe OSA who took tirzepatide had much better sleep, with far fewer episodes of holding their breath.
It’s likely that weight loss, rather than taking tirzepatide, leads to improvements in OSA for people with a larger body size.
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Tirzepatide (Mounjaro) was approved by the FDA in May 2022 to lower blood glucose (sugar) levels in people with Type 2 diabetes. In November 2023, tirzepatide was also approved for weight loss in people with and without diabetes, under the brand name Zepbound.
Now, the multitasking medication is making waves as a potential game-changer in the treatment of moderate to severe obstructive sleep apnea (OSA). With this common sleep disorder, a person experiences episodes of apnea — pauses in breathing — during sleep. It’s more common in people with higher body mass index (BMI), because of fat deposits and excess weight in the tongue, airway, and neck.
OSA has a significant impact on health beyond extreme daytime sleepiness. It can cause a range of problems, from headaches and high blood pressure to heart disease, stroke, and diabetes — even dementia.
Until now, treatments for OSA have centered on mouthguards and continuous positive airway pressure (CPAP) breathing machines — along with the usual recommendations for weight loss. But weight loss can be hard to achieve — especially weight loss significant enough to decrease excess fat in the neck, tongue, and airways. This is why tirzepatide and other similar medications could be such a breakthrough, if they are approved by the FDA for OSA.
So, how does tirzepatide work? Are its effects on OSA symptoms determined by weight loss alone, or are there other factors at work? And how soon could it be prescribed as a treatment for OSA?
How does tirzepatide work?
Tirzepatide belongs to a new class of weekly injectable weight-loss medications. Other similar injectable medications include semaglutide, sold under the brand names Ozempic (for diabetes) and Wegovy (for weight loss).
These medications work by mimicking incretin hormones, hormones that are naturally released after eating. This causes the following effects:
Signals to your brain you are full
Reduces your appetite
Makes you feel fuller for longer
Lowers blood glucose levels by increasing insulin and lowering glucagon hormones
Could tirzepatide help with OSA?
New research shows that tirzepatide significantly improves OSA. The research was published in June 2024 in the New England Journal of Medicine (and funded by the drug manufacturer Eli Lilly). The focus is a pair of year-long studies, which looked at people with high BMI and moderate-to-severe OSA. The studies compared sleep quality in two groups:
One group took the maximum tolerated dose of tirzepatide (10 mg or 15 mg).
The other group took a placebo (a fake injection).
None of the included participants had diabetes.
One study (SURMOUNT-OSA Study 1) looked at people with OSA who wouldn’t or couldn’t use a CPAP breathing machine to treat OSA.
In the other study (SURMOUNT-OSA Study 2), participants did use a CPAP machine as treatment for OSA. And they were encouraged to continue using it throughout the year-long trial.
Tirzepatide helps ‘resolve’ OSA
Both studies showed that people with OSA who received 10 mg or 15 mg tirzepatide had improved sleep quality. This was measured using overnight sleep studies to count the number of apnea (breath-holding) episodes during sleep — the apnea-hypopnea index (AHI). The AHI is used to grade the severity of OSA. It’s also used to assess how well treatment works.
The researchers were looking at two things:
The number of breath-holding episodes per hour
And the level of daytime sleepiness, measured using the Epworth Sleepiness Scale
They considered a person had met the “criteria for disease resolution” if the number of breath-holding episodes fell below 5 per hour. Or, if the number of breath-holding episodes was between 5 and 14, and their level of daytime sleepiness was within a normal range. In other words, the person’s symptoms had improved so much that OSA had “resolved.”
The results were as follows for people receiving tirzepatide:
First study (no CPAP): 40% of people had disease resolution
Second study (using CPAP): 50% of people had disease resolution
In contrast, only about 14% of people receiving a placebo met “criteria for disease resolution.”
Tirzepatide reduces severity of OSA
Some people didn’t have “disease resolution.” But, still, many people receiving tirzepatide had a 50% (or more) improvement in the number of nightly breath-holding episodes (AHI). These improvements were as follows:
A little over 60% in the first study
About 75% in the second study
This compares to about 20% of people in the placebo group.
Overall, people taking tirzepatide had on average 30 fewer breath-holding episodes per hour. That’s compared to 5 or 6 fewer in the placebo group.
Tirzepatide resulted in significant weight loss
In both studies, people who received tirzepatide lost about 20% of their starting body weight. That’s compared to between 1% and 2% weight loss for those taking the placebo.
How does tirzepatide help with sleep apnea?
The main way that tirzepatide improves OSA is through weight reduction.
Weight loss has long been a “lifestyle change” recommended for people with OSA. But losing large amounts of weight is hard to achieve through lifestyle alone. And it’s even harder to maintain the weight loss.
Weight isn’t the only factor, though, in OSA. The studies mentioned above didn’t include people with Type 2 diabetes. But in reality, excess body weight, Type 2 diabetes, and sleep apnea are deeply interlinked.
Each is a risk factor for the other, and the risks go in both directions. So, if you have excess body weight, you’re more likely to have both Type 2 diabetes and OSA. But OSA can increase your risk for Type 2 diabetes. And both Type 2 diabetes and sleep disturbances can increase your risk of excess weight.
Tirzepatide hasn’t been approved for OSA — but it would be a big deal if it happens. It’s likely that losing significant amounts of weight with medications like tirzepatide kicks off a chain of events that results in improvements in OSA. These improvements are:
Reduced amounts of fat deposits in the neck and airway
Reduced waist size
Improved blood glucose levels
Improved metabolic function
Lower levels of inflammation
Losing weight can help with more than OSA, though. Other, more long-term benefits of weight management are lower risk of:
High blood pressure, heart disease, heart attacks, strokes, and death
Dementia
Depression
Who can use tirzepatide for sleep apnea?
Tirzepatide isn’t currently approved as treatment for OSA just yet. But it may be soon, possibly by the end of 2024.
If you have a high BMI and OSA, you may already be eligible for tirzepatide (as Zepbound) to help you lose weight.
What’s more, many people with OSA also have a high BMI and diabetes. In this case, you could also already be eligible for tirzepatide (as Zepbound or Mounjaro).
If tirzepatide is approved for the treatment of OSA, it may be for people who meet certain criteria, including:
A diagnosis of OSA, confirmed through sleep studies and clinical assessments
Lack of improvement with other treatments, like CPAP ventilation or mouth devices
What are the side effects of tirzepatide?
Tirzepatide can cause some typical side effects, though not everyone experiences them.
Common side effects include:
Nausea
Vomiting
Bowel disturbance, like diarrhea or constipation
Abdominal pain
Headache
Side effects tend to be worse when starting out on this medication, although most are mild and ease with time. Still, these medications may not be a good fit for everyone. Like with all medications, it’s important to balance risks with benefits and make a decision that’s right for you and your health.
Other treatments for sleep apnea
Tirzepatide shows potential as a standalone treatment for sleep apnea. But combining weight-loss medications with other therapies may further improve OSA symptoms.
Here are the current recommended treatment options for OSA:
CPAP therapy: CPAP remains the “gold standard” for treating moderate-to-severe OSA. Using a CPAP machine during sleep helps keep the airway open by delivering a continuous flow of air through a mask.
Weight-management strategies: In addition to tirzepatide’s weight-reducing effects, exercising and eating a nutritious diet can also help with weight management to improve OSA symptoms.
Positional therapy: In some people, certain sleeping positions can help reduce OSA. Positional therapy techniques include using special pillows or devices to encourage side sleeping.
Mouth devices: Mouth guards can help to keep the airway propped open during deep sleep.
Surgical options: Upper-airway surgery may be an option for people with moderate or severe OSA, or specific anatomical issues causing airway obstruction.
The bottom line
Diet, exercise, and sleep are considered the three pillars of health. Disrupted sleep can cause and worsen metabolic problems like weight gain and Type 2 diabetes. And, because of how linked these conditions are, they can be hard to pick apart and treat.
Newer weight-loss medications, such as tirzepatide (Zepbound), will likely be a huge step forward in treating OSA and other related health problems.
Tirzepatide isn’t approved yet for the treatment of OSA, but it may be soon. In addition to helping with significant weight loss, tirzepatide has shown impressive results for people dealing with OSA.
References
American Academy of Sleep Medicine. (2008). Obstructive sleep apnea.
Eli Lilly and Company. (2024). Lilly’s tirzepatide reduced obstructive sleep apnea (OSA) severity, with up to 51.5% of participants meeting the criteria for disease resolution.
View All References (4)
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