Tirzapetide: The New Medication Treating Sleep Apnoea

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28 Aug Tirzapetide: The New Medication Treating Sleep Apnoea

Posted at 17:49h in Blog by admin

 

The Australian Therapeutic Goods Association and American Association of Sleep Medicine have recently approved tirzepatide (Zepbound/Mounjaro) as the first medication specifically for obese adults with moderate-to-severe obstructive sleep apnea (OSA).
Unlike Positive Airway Pressure (PAP) therapy, the current gold standard for OSA treatment which props the airway open at night, tirzepatide tackles the underlying problem: the body fat (especially around the neck and throat) that makes the airway collapse.
Why this matters
Think of OSA like a door that keeps slamming shut at night because heavy furniture is leaning against it. While CPAP is a wedge that holds the door open when you sleep, tirzepatide helps move the furniture, producing large, sustained weight loss in the order of approximately 18% over 1 year in clinical trials. When the fat around the airway shrinks, breathing interruptions fall dramatically: studies reported patients with severe OSA had their apnea/hypopnea index halved following year-long tirzepatide treatment, with roughly 25-30 fewer respiratory disturbances per hour regardless of whether they were on previous CPAP therapy.
Treating the source

 

While the traditional mechanical support provided by PAP therapy has made an enormously positive impact on patient’s symptoms of OSA, its overall effectiveness can be significantly reduced without consistent adherence to therapy. Studies have found patients diagnosed with obesity are more likely to be intolerant to PAP therapy due to excessive neck obstruction that requires higher pressures which further increase overall discomfort and non-compliance. Moreover, various trials have failed to show CPAP’s efficacy in reducing adverse secondary cardiovascular outcomes. Tirzapetide offers a non-invasive pharmaceutical intervention that targets a major underlying cause of the obstructive events and the secondary cardiovascular complications.
What can go wrong?
While tirzapetide has shown to be an effective treatment so far, the initial trial came with some adverse effects. An average of 80% of participants reported adverse events which generally pertained to mild to moderate gastrointestinal pain, especially when the dose was increased. While no deaths were reported in the trial, approximately 7.5% of participants experienced severe effects ranging from sporadic depressive disorders to acute cases of pancreatitis. These side effects exacerbate the importance for interested patients to seek careful guidance from their sleep physician on possible treatment opportunities.
References
  1. Malhotra A, Grunstein RR, Fietze I, Weaver TE, Redline S, Azarbarzin A, Sands SA, Schwab RJ, Dunn JP, Chakladar S, Bunck MC, Bednarik J. Tirzepatide for the treatment of obstructive sleep apnea and obesity. N Engl J Med 2024;391:1193-1205.
  2. McEvoy, R. D. et al. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N. Engl. J. Med. 375, 919–931 (2016).
  3. Peker, Y. et al. Effect of positive airway pressure on cardiovascular outcomes in coronary artery disease patients with nonsleepy obstructive sleep apnea: the RICCADSA randomized controlled trial. Am. J. Respir. Crit. Care Med. 194, 613–620 (2016).
  4. Borsini, E., Blanco, M. & Nigro, C. A. Formulas to predict continuous positive airway pressure level using a home auto-adjusting device for obstructive sleep apnea treatment. Sleep Breath. 28, 2071–2079 (2024).
  5. Hudgel, D. W. et al. The role of weight management in the treatment of adult obstructive sleep apnea: an official American Thoracic Society clinical practice guideline. Am. J. Respir. Crit. Care Med. 198, e70–e87 (2018).