GLP-1 Drugs Show Sleep Apnea Benefits

For millions of people struggling with Obstructive Sleep Apnea (OSA), the standard treatment has long been a bulky, noisy CPAP machine. However, recent developments in medical science suggest a pharmaceutical solution may finally be on the horizon. New clinical trials concerning tirzepatide, the active ingredient in the weight-loss drug Zepbound, indicate that GLP-1 medications could drastically reduce sleep apnea severity in patients with obesity.

The SURMOUNT-OSA Trial Results

The excitement surrounds the results of the SURMOUNT-OSA phase 3 clinical trials conducted by Eli Lilly. These studies were designed specifically to see how tirzepatide affects moderate-to-severe obstructive sleep apnea in adults who are also obese. The findings were published in the New England Journal of Medicine in mid-2024 and presented at the American Diabetes Association Scientific Sessions.

The results were statistically significant. Researchers measured the Apnea-Hypopnea Index (AHI), which tracks how many times a person’s breathing stops or becomes shallow per hour of sleep. Before the trial, participants experienced significant disruptions to their sleep.

After 52 weeks of treatment, the study found the following:

• Significant Reduction in Events: Patients taking tirzepatide experienced a mean reduction of approximately 27.4 to 30.4 events per hour. In comparison, the placebo group saw a reduction of only about 5 to 6 events per hour.
• Disease Resolution: Perhaps most notably, between 43% and 51% of participants taking the highest dose reached a point of “disease resolution.” This is defined as having an AHI of fewer than 5 events per hour, or between 5 and 14 events per hour with no daytime sleepiness. Effectively, the drug cleared the clinical diagnosis of sleep apnea for nearly half the patients.
• Weight Loss Correlation: Participants lost nearly 20% of their body weight on average. This supports the long-standing medical advice that weight management is a primary treatment for OSA.

How Zepbound Impacts Sleep Apnea

To understand why this drug works for sleep disorders, you must look at the mechanics of Obstructive Sleep Apnea. In patients with obesity, excess fat deposits can accumulate in the neck and tongue. When the muscles relax during sleep, this excess soft tissue collapses the airway, preventing oxygen from reaching the lungs.

Zepbound (tirzepatide) functions as a dual agonist. It mimics two hormones, GLP-1 and GIP, to signal fullness to the brain and slow gastric emptying. The resulting weight loss is systemic, meaning fat is reduced throughout the body, including the neck and tongue.

When the volume of tissue surrounding the upper airway decreases, the mechanical obstruction is removed or significantly lessened. This prevents the airway from collapsing during sleep. While CPAP machines use air pressure to physically hold the airway open, GLP-1 drugs appear to address the root anatomical cause in patients with obesity-related apnea.

A Potential Shift Away from CPAP

The current gold standard for treating OSA is continuous positive airway pressure (CPAP). While highly effective when used correctly, adherence is a major issue. Studies typically show that 30% to 50% of patients eventually abandon CPAP therapy because they find the masks uncomfortable, claustrophobic, or disruptive to their partners.

The introduction of a pharmaceutical option like Zepbound could revolutionize treatment protocols. In the SURMOUNT-OSA trials, Eli Lilly tested two distinct groups:

1. Study 1: Patients who were not using CPAP therapy.
2. Study 2: Patients who were using CPAP therapy but planned to continue it.

The drug proved effective in both groups. For those unable or unwilling to use a machine, this provides a critical lifeline. Untreated sleep apnea is not just a snoring issue; it significantly increases the risk of hypertension, coronary artery disease, stroke, and heart failure. By treating the apnea pharmacologically, doctors may be able to lower these cardiovascular risks without relying on patient compliance with a mechanical device.

FDA Status and Future Outlook

Following the success of these trials, Eli Lilly submitted an application to the U.S. Food and Drug Administration (FDA) to expand the label for Zepbound to include the treatment of moderate-to-severe obstructive sleep apnea in adults with obesity.

The FDA granted this application Priority Review. If approved, Zepbound would become the first pharmaceutical treatment specifically indicated for the underlying cause of sleep apnea in this demographic.

This move also has significant implications for insurance coverage. Currently, many Medicare plans and private insurers restrict coverage for weight-loss drugs, categorizing them as “lifestyle” medications. However, if Zepbound receives FDA approval specifically for treating sleep apnea (a serious medical condition), it could force a change in coverage policies. Medicare is prohibited from covering weight-loss drugs, but it does cover treatments for diagnosed illnesses like OSA. This label expansion could open access to millions of seniors currently paying out-of-pocket prices that exceed $1,000 per month.

Side Effects and Considerations

While the sleep data is promising, potential patients must consider the side effects associated with GLP-1 and GIP medications. The SURMOUNT-OSA trial reported adverse events consistent with other tirzepatide studies.

Common issues include:

• Gastrointestinal Distress: Nausea, vomiting, diarrhea, and constipation are the most frequently reported side effects. These usually occur when starting the medication or increasing the dosage.
• Muscle Mass: Rapid weight loss can lead to a reduction in lean muscle mass alongside fat loss. Patients are generally advised to maintain a high-protein diet and engage in resistance training.
• Cost and Availability: As of late 2024, shortages of tirzepatide remain a challenge due to high demand. Additionally, without insurance coverage, the cost remains prohibitive for many.

It is also important to note that this treatment targets obesity-related sleep apnea. Patients who have OSA due to other anatomical issues (such as jaw structure or enlarged tonsils) may not see the same benefits if weight is not the primary driver of their condition.

Frequently Asked Questions

Does Zepbound replace the need for a CPAP machine? For some patients, it might. In the clinical trials, nearly half of the participants reached “disease resolution,” meaning their sleep apnea was effectively cured or reduced to a level that may not require mechanical intervention. However, you should never stop using your CPAP machine without consulting your doctor and undergoing a follow-up sleep study.

Is Zepbound FDA-approved for sleep apnea yet? As of the most recent updates, Eli Lilly has applied for FDA approval for this specific use, and it is under Priority Review. While doctors can prescribe it “off-label” for this purpose currently, official marketing approval is pending.

How much weight do you need to lose to cure sleep apnea? There is no single number that applies to everyone. However, clinical data suggests that a weight loss of 10% to 15% can significantly improve apnea severity. In the SURMOUNT-OSA trial, participants lost nearly 20% of their body weight, which correlated with the drastic reduction in apnea events.

Will insurance cover Zepbound for sleep apnea? This is the expected outcome of the label expansion. If the FDA approves the drug for OSA, it becomes a treatment for a chronic respiratory condition rather than just a weight-loss drug. This distinction is critical for Medicare and private insurance formularies, potentially improving access for millions of Americans.

Can Wegovy or Ozempic also treat sleep apnea? Wegovy (semaglutide) is a similar GLP-1 drug. While likely effective due to the weight loss mechanism, Eli Lilly’s tirzepatide (Zepbound) is currently further ahead in the specific clinical trial process for a dedicated sleep apnea indication. However, weight loss achieved through any method generally benefits OSA patients.