At a Glance
- Tirzepatide is a highly effective weight-loss tool, and a 20% weight loss in people with obesity and OSA can significantly reduce OSA severity.
- About half of the participants in tirzepatide clinical trials had mild residual OSA after weight loss or normalization of AHI within one year.
- As sleep apnea stems from a variety of factors, some patients will still require CPAP or other treatments, even after weight loss.
- Lifelong obesity management is critical to prevent weight regain and OSA recurrence.
There’s a well-established, two-way relationship between obesity and obstructive sleep apnea (OSA). Excess weight, particularly in the abdominal area and around the upper airway, contributes to airway collapse during sleep, causing respiratory disturbances. And untreated OSA can disrupt metabolism and promote weight gain.
Addressing both conditions simultaneously has long been a challenge, but weight-loss medications like tirzepatide offer new and effective tools for those who qualify for injectable GLP-1 weight loss medication and also have sleep apnea.
What Makes Tirzepatide Different From Other GLP-1s?
Tirzepatide (brand name Zepbound) is both a GLP-1 and GIP receptor that works to decrease appetite, slow food emptying from the stomach, and promote better blood sugar regulation. In clinical studies, this has led to greater weight loss and fewer side effects, compared to GLP-1-only medications like injectable semaglutide (brand name Wegovy for weight loss).
Impact on Sleep Apnea
By reducing upper airway fat and belly fat, tirzepatide helps keep your airway open and makes breathing easier while you sleep. It also has potential anti-inflammatory and fluid-regulating effects that may further benefit people with OSA beyond weight loss.
What the Research Shows
One of the most promising studies investigating the potential of tirzepatide in treating sleep apnea is the SURMOUNT-OSA trial.
Participants in the study were mostly men with a BMI around 39 kg/m2, which falls within the range of obesity, and moderate to severe OSA, meaning they had an average apnea-hypopnea index (AHI) of about 50 partial or total airway obstructions per hour of sleep. Half of the participants were using CPAP (adherence undefined) and half had untreated OSA.
In each group, there were those who received tirzepatide (10 to 15 milligrams) over 52 weeks and others who received placebo. Everyone in the study had lifestyle counseling and followed a diet with a 500-calorie-per-day deficit and were required to log 150 minutes of weekly exercise. Results showed:
- 18 to 20% weight loss (equivalent to about 50 pounds of weight loss from a 250-pound baseline)
- AHI reduction by 50 to 60%
- About half of participants achieved a normal AHI (less than five events per hour) or had residual mild OSA without evidence of daytime sleepiness
- Slightly better outcomes for CPAP users
Those with the highest BMI, most severe OSA, and greatest hypoxic burden tend to benefit the most. And while weight loss alone won’t cure OSA for everyone, it significantly reduces the severity and opens the door to additional treatments as the severity is reduced.
Clinical Considerations
Patients take a once-weekly injection, which has a half-life of about 165 hours (a little less than seven days), ensuring stable hormone levels and sustained effects. Patients can expect 2 to 5% weight loss during the initial ramp-up with tirzepatide, which occurs over four to six weeks. And maximum weight-loss effects are seen around the one-year mark.
Common side effects include nausea, vomiting, and diarrhea, which typically subside with persistent use. More serious risks like acute pancreatitis are possible but uncommon. People who’ve had certain types of cancers (medullary thyroid carcinoma or multiple endocrine neoplasia, for example) are not candidates for tirzepatide, and people with a history of disordered eating should only use GLP-1 weight-loss medications with appropriate medical supervision.
It’s important to note, though, that sleep apnea will return if weight is regained. Long-term weight management plays a big role in keeping symptoms under control. A sustainable approach to weight loss should focus on balanced nutrition, strength training, and quality sleep to maintain muscle and support overall health.
Additional Benefits for Sleep Apnea
While weight loss is the primary driver of OSA improvement, tirzepatide may provide additional sleep-related benefits. Sleep quality improves if eating and sleeping are entirely separate during the day and night, respectively. GLP-1 medications may reduce inflammatory markers and improve glucose sensitivity, which could result in improvements in sleep. Finally, a decrease in fluid retention with tirzepatide may help reduce airway collapse.
A Metabolic Approach to OSA
These findings reinforce the idea that OSA is more than just an airway disorder — it’s a metabolic condition. For providers and patients considering tirzepatide for sleep apnea, the most important thing to remember is this is a long game. There are no quick fixes or magic pills, but the ability to treat OSA through metabolic intervention is an exciting advancement.
Even if tirzepatide isn’t part of the treatment plan, it’s important to promote comprehensive metabolic health strategies (including education on obesity treatment, avoiding weight cycling, and referring to reputable obesity specialists) remains essential.
Insurance and Access Barriers
While the shortage of GLP-1 medications has resolved, insurance coverage remains a challenge. Some insurers are improving their policies, but many patients still face barriers to access. Additionally, compounded tirzepatide isn’t regulated and lacks clinical trial validation, raising concerns about safety and efficacy.
Important questions for future research:
- How does CPAP usage (or other OSA treatments) interact with GLP-1 therapies for optimal outcomes in weight management?
- Does REM-related OSA respond differently to weight loss?
- What role does age play in long-term OSA risk? Should sleep studies be recommended every five to 10 years, like colonoscopies?
- Why do some patients respond dramatically to GLP-1s while others see limited benefit
- What other therapies or medications are in the clinical pipeline for weight loss and OSA?
References
About The Author
Audrey Wells, MD attended University of Michigan Medical School and trained at Washington University School of Medicine in pediatrics and pediatric pulmonary medicine. Following her training, she returned to her home state of New Mexico and completed a sleep medicine fellowship. As Chief Medical Officer, she led the development of OmniSleep Medicine Centers from 2010 to 2018. After relocating to St. Paul, Minnesota, and working for University of Minnesota Physicians, she completed an Obesity Medicine Fellowship at Columbia University and now holds three board certifications in pediatrics, sleep medicine, and obesity medicine. In 2021, she founded Super Sleep MD, an online platform for education, support, and group coaching experiences specifically for people struggling with obstructive sleep apnea treatments. Dr. Wells also has an individual consultation program for physicians who want to optimize their sleep to improve performance, vitality, and well-being.
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