For the millions of people managing both obesity and obstructive sleep apnea (OSA), tirzepatide (Zepbound® and Mounjaro®, Eli Lilly and Co.) may offer a welcome approach to help reduce symptoms and improve overall health and quality of life.
It’s been almost exactly a year since investigators of the SURMOUNT-OSA trial published results showing that tirzepatide could improve or significantly reduce symptoms of OSA in certain patients.1
Based on the data from that trial, the U.S. Food and Drug Administration approved tirzepatide for the treatment of moderate to severe OSA in adults with obesity before the year was out. Zepbound received Fast Track, Priority Review, and Breakthrough Therapy designations from the FDA for this indication.
“These are exciting times for the sleep apnea community,” noted Monica Mallampalli, PhD, president and chief executive officer of the Alliance of Sleep Apnea Partners (ASAP). “But I believe many patients are still not aware of all the innovations that are happening.”
Just before tirzepatide received this approval, Dr. Mallampalli had joined Luca Roberti, president of the Italian Apneic Association, to co-moderate a virtual discussion with Atul Malhotra, MD, principal investigator of the SURMOUNT-OSA trial. Dr. Malhotra is both the lead author of the research paper detailing the trial’s findings and research chief of Pulmonary, Critical Care, and Sleep Medicine at UC San Diego.
During their discussion, the group talked about how tirzepatide works, clinical findings regarding its efficacy and outcomes, and what it means for the future of sleep medicine.
An Expanding Toolkit for OSA
Tirzepatide combines two synthetic hormones, GLP-1 and GIP, that increase insulin sensitivity and decrease appetite. It’s the first drug of this kind to receive FDA approval for managing obstructive sleep apnea in certain patients.
It directly reduces the severity of OSA by addressing one of its primary causes: excess weight. However, Dr. Mallampalli cautioned that patients should not just drop CPAP treatment and try tirzepatide. It’s not a standalone solution—it’s part of an evolving treatment toolkit.
In addition to the gold-standard CPAP, that kit includes such treatments as oral appliances, positional therapy, and surgery, in some cases. Now tirzepatide can join the list.
“It adds to the existing therapies for sleep apnea,” Dr. Malhotra said. “Just giving people CPAP and ignoring their body weight is not a good idea. Diet, exercise, and sleep are the three pillars of health.” He noted that existing research has suggested that weight loss and CPAP combined were more effective than CPAP alone.
“Existing OSA therapies work well,” Dr. Malhotra said. “We didn’t compare CPAP to tirzepatide, and so it’s not that tirzepatide is better or worse than CPAP. It’s an extra therapy, but not a replacement.”
For patients who can’t tolerate CPAP or have struggled with lifestyle-based weight loss alone, tirzepatide could be a new option. But each person and provider should determine “the right treatment for the right patient,” Dr. Mallampalli emphasized.
Clinical Trial Findings
The SURMOUNT-OSA study was a 52-week, randomized, double-blind, placebo-controlled clinical trial. It included two groups of adults with moderate to severe OSA and obesity. One group was using CPAP therapy, and the other wasn’t.
All participants had a body mass index (BMI) over 30, and most had severe sleep apnea with an apnea-hypopnea index (AHI) around 50 at baseline. In the CPAP group, about 72% saw at least a 50% drop in AHI. Roughly 40-50% of patients improved to a level that might no longer require CPAP, depending on other symptoms and severity.
Patients also experienced:
- Average weight loss of 18-20% over one year
- Significant reductions in high-sensitivity C-reactive protein, a marker of cardiovascular risk
- Lower systolic blood pressure
- Better daytime alertness and nighttime sleep quality, according to patient-reported sleep scores
Dr. Malhotra noted that some patients who received tirzepatide in the trial achieved an AHI of less than five or between five and 14 without daytime sleepiness.
Tirzepatide’s most commonly reported side effects include nausea, vomiting, and diarrhea. Findings from the SURMOUNT-OSA trial revealed two cases of mild pancreatitis in the tirzepatide group. “There may be something called ascertainment bias,” Dr. Malhotra said, where symptoms like nausea prompt more frequent testing. Dr. Malhotra said after careful review of these, he didn’t find them overly worrying.
Overall, “the safety and tolerability profile of tirzepatide in people with moderate to severe sleep apnea and obesity was generally consistent with the safety profile in people with obesity,” Dr. Malhotra said.
“What I believe clinically is that treating both sleep apnea and obesity is a good idea,” he said. “If diet and exercise don’t work, then we have tirzepatide as an option for improving weight loss.”
By Glenye Cain Oakford is a communications consultant and multimedia content producer.
Source: SleepWorld Magazine Sept/Oct 2025
Glenye Cain Oakford is a communications consultant and multimedia content producer.
Reference
- Malhotra A, Grunstein RR, Fietze I, et al, on behalf of the SURMOUNT-OSA Investigators. Tirzepatide for the treatment of obstructive sleep apnea and obesity. N Engl J Med. 2024;391(13):1193-1205. doi: 10.1056/NEJMoa2404881.
Caption
Tirzepatide activates the GLP-1 receptor, which helps to regulate glucose balance, gastric motility, and food intake—making it a powerful tool in managing type 2 diabetes and obesity.
