Beyond Diabetes: Tirzepatide Now Approved to Treat Obstructive Sleep Apnea (OSA)

Tirzepatide has been making lots of headlines. Under the brand name Mounjaro, it was approved by the FDA in May 2022 to lower blood glucose (sugar) levels in people with Type 2 diabetes. Then, in November 2023, another version of this medication, Zepbound, was approved for weight loss in people with and without diabetes.

Now, the multitasking medication has been FDA approved as a treatment for 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 Zepbound and other similar medications could be such a breakthrough 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? 

How does tirzepatide work?

Tirzepatide belongs to a newer 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). 

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Tirzepatide and other similar medications work by mimicking hormones naturally released after eating (called incretin hormones). This causes the following effects: 

• Signals to your brain you’re 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?

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.

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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

• 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. 

So, the fact that tirzepatide is now approved for OSA is a big deal. 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?

If you have a high BMI and OSA, you may have already been 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).

Now that tirzepatide is approved for the treatment of OSA, it may also be available for people who meet certain criteria, including:

• A diagnosis of moderate-to-severe OSA, confirmed through sleep studies and clinical assessments

• Lack of improvement with other treatments, like CPAP ventilation or mouth devices 

It’s possible that this FDA approval may also help more people access the medication. Until now, insurance coverage for medications like tirzepatide for weight loss alone has been limited to nonexistent. But as an FDA-approved treatment for OSA, insurance coverage may need to expand to cover this indication. 

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.

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Written by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

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