Tirzepatide may help patients with obstructive sleep apnea and obesity

Obstructive sleep apnea affects more than 900 million people worldwide, with about 40% having moderate-to-severe disease. It is characterized by disordered breathing during sleep and recurrent arousals, and is often accompanied by excessive daytime sleepiness. Obstructive sleep apnea is an independent risk factor for cardiovascular disease. Positive airway pressure (PAP) therapy improves the apnea–hypopnea index (AHI, the number of apneas and hypopneas during an hour of sleep) and reduces symptoms related to obstructive sleep apnea, but its overall effectiveness can be limited by poor adherence to therapy. Obesity is a major risk factor for obstructive sleep apnea and its complications. Tirzepatide has been shown to significantly reduce excess body weight, improve blood pressure, and reduce markers of inflammation and vascular endothelial dysfunction; therefore, it has the potential to be an effective treatment in persons with obesity and obstructive sleep apnea. To examine the efficacy and safety of tirzepatide in obstructive sleep apnea, researchers conducted two double-blind, randomized, controlled trials (SURMOUNT-OSA) involving adults with moderate-to-severe obstructive sleep apnea and obesity. The first trial included 234 participants who were not receiving PAP treatment at baseline and were unable or unwilling to use PAP therapy. The second trial included 235 participants who had been using PAP therapy for at least three months and planned to continue PAP therapy during the trial. Key exclusion criteria were the presence of type 1 or type 2 diabetes, a change in body weight of more than 5 kg in the previous three months, planned surgery for sleep apnea or obesity, and a diagnosis of central or mixed sleep apnea. Participants were assigned in a 1:1 ratio to receive either the maximum tolerated dose of tirzepatide (10 mg or 15 mg subcutaneously once weekly) or placebo for 52 weeks. Tirzepatide was started at a dosage of 2.5 mg once weekly and was increased by 2.5 mg increments every four weeks during the dose-escalation period until the participant reached the maximum tolerated dose of 10 mg or 15 mg in week 20.The primary end point was the change in the AHI from baseline. Key secondary end points included the percent change in AHI and body weight, and changes in hypoxic burden, patient-reported sleep impairment and disturbance, high-sensitivity C-reactive protein (hsCRP) concentration, and systolic blood pressure.Results showed the following:At baseline, the mean AHI was 51.5 events/hour in trial 1 and 49.5 events/hour in trial 2. The mean body-mass index (BMI) was 39.1 in trial 1 and 38.7 in trial 2. In trial 1 (participants not receiving PAP therapy), the mean change in AHI at week 52 was −25.3 events/hour (95% confidence interval [CI], −29.3 to −21.2) with tirzepatide and −5.3 events/hour (95% CI, −9.4 to −1.1) with placebo; the estimated treatment difference was −20.0 events/hour (95% CI, −25.8 to −14.2) (p

Tirzepatide may help patients with obstructive sleep apnea and obesity

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