Obstructive sleep apnea (OSA) is a common sleep disorder characterized by repeated episodes of upper airway collapse during sleep, leading to breathing pauses and reduced blood oxygen levels. The prevalence of OSA has increased over time, with recent studies indicating that it affects a significant portion of the adult population. According to a systematic review, the prevalence of OSA, defined as ≥5 apnea or hypopnea events per hour, ranges from 9% to 38% in the general adult population, with higher rates in men, older adults, and individuals with obesity. In some elderly groups, the prevalence can be as high as 90% in men and 78% in women. Because OSA negatively impacts long-term health and increases the risk of complications during anesthesia, refining treatment is an important focus of some medical research. The recent approval of Zepbound for treating obstructive sleep apnea represents a major step forward.
Traditionally, the primary treatment for moderate to severe OSA has been continuous positive airway pressure (CPAP) therapy. CPAP involves wearing a mask during sleep that delivers pressurized air to keep the airway open. While effective, CPAP adherence can be challenging for many patients. Other treatments include oral appliances, positional therapy, and in some cases, surgical interventions. However, the landscape of OSA treatment is evolving.
On December 20, 2024, the U.S. Food and Drug Administration (FDA) approved Zepbound® (tirzepatide) as the first medication for the treatment of moderate to severe obstructive sleep apnea in adults with obesity. Zepbound is a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist. It works by activating receptors of hormones secreted from the intestine, which reduces appetite and food intake. By promoting weight loss in patients with obesity, Zepbound can indirectly improve OSA symptoms.
The efficacy of Zepbound for OSA was demonstrated in the SURMOUNT-OSA phase 3 clinical trials. These studies evaluated Zepbound (10 mg or 15 mg) in adults with obesity and moderate to severe OSA, both with and without positive airway pressure (PAP) therapy. In patients not using PAP therapy, Zepbound reduced breathing disruptions by an average of 25 events per hour, compared to 5 events per hour with placebo. For those on PAP therapy, Zepbound led to 29 fewer breathing disruptions per hour, versus 6 with placebo. After one year of treatment, 42% of adults on Zepbound without PAP therapy and 50% of those on Zepbound with PAP therapy experienced remission or mild, non-symptomatic OSA, compared to 16% and 14% on placebo, respectively.
While Zepbound shows promising results for the treatment of obstructive sleep apnea, it is important to consider its potential risks and complications. Common side effects include nausea, diarrhea, vomiting, constipation, abdominal pain, and injection site reactions. More serious side effects, though less common, can include severe gastrointestinal issues, pancreatitis, gallbladder problems, hypoglycemia (especially when combined with insulin or sulfonylureas), and kidney damage. Additionally, Zepbound carries a boxed warning for the potential risk of thyroid C-cell tumors, based on animal studies.
In conclusion, the approval of Zepbound represents a significant advancement in the treatment of obstructive sleep apnea, particularly for patients with obesity. Its dual mechanism of promoting weight loss and directly improving OSA symptoms offers a novel approach to managing this prevalent sleep disorder. However, as with any medication, the benefits of Zepbound must be weighed against its potential risks. Patients considering Zepbound for OSA should consult with their healthcare providers to determine if it is an appropriate treatment option based on their individual health profile and medical history.
References
- Senaratna CV, Perret JL, Lodge CJ, et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev. 2017;34:70-81. doi:10.1016/j.smrv.2016.07.002
- Food and Drug Administration. FDA Approves First Medication for Obstructive Sleep Apnea. Published December 20, 2024. Accessed January 11, 2025. https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-obstructive-sleep-apnea
- Eli Lilly and Company. FDA approves Zepbound® (tirzepatide) as the first and only prescription medicine for moderate-to-severe obstructive sleep apnea in adults with obesity. Published December 20, 2024. Accessed January 11, 2025. https://investor.lilly.com/news-releases/news-release-details/fda-approves-zepboundr-tirzepatide-first-and-only-prescription
- Baptist Health. Zepbound Side Effects: What You Need to Know. Published August 30, 2024. Accessed January 11, 2025. https://www.baptisthealth.com/blog/weight-management/zepbound-side-effects
- Drugs.com. Zepbound Side Effects: Common, Severe, Long Term. Updated December 30, 2024. Accessed January 11, 2025. https://www.drugs.com/sfx/zepbound-side-effects.html
