Tirzepatide Causes Weight Loss and Improves Sleep Apnea Symptoms

Is tirzepatide (Zepbound) effective for the treatment of obstructive sleep apnea?

Tirzepatide induces significant weight loss in adults with obesity (but not in those with diabetes; 95% CI, –16.1% to –17.3%), reduces moderate to severe obstructive sleep apnea with significant reductions in Apnea-Hypopnea Index scores, and improves obstructive sleep apnea symptoms. One study included patients who used positive airway pressure (PAP) therapy and one did not. (Level of Evidence = 1b)

The study reports the results of two similar, phase 3 multi-center trials that randomized patients with obesity (but not diabetes) and moderate to severe obstructive sleep apnea to receive the glucagon-like peptide-1 (GLP-1) receptor agonist tirzepatide (10–15 mg subcutaneously once weekly) or placebo injection. The primary outcome was a change in the Apnea-Hypopnea Index score, which is measured in events per hour. One study included patients who were unable or unwilling to use PAP therapy, and the other included patients who had been using PAP for at least 3 months and planned to continue using it. At baseline, the groups were balanced, with a mean age of 48 years and 52 years in each study, and an average body mass index of 39 kg/m². Analysis was by intention to treat. Table 1 summarizes the changes in Apnea-Hypopnea Index scores and body weight from baseline between treatment groups.

Study design: Randomized controlled trial (double-blinded)

Funding source: Industry

Allocation: Concealed

Setting: Outpatient (any)

Reference: Malhotra A, Grunstein RR, Fietze I, et al.; SURMOUNT-OSA Investigators. Tirzepatide for the treatment of obstructive sleep apnea and obesity. N Engl J Med. 2024;391(13):1193-1205.

Editor’s Note: Dr. Ebell is deputy editor for evidence-based medicine for AFP and cofounder and editor-in-chief of Essential Evidence Plus, published by Wiley-Blackwell.