The weight-loss drug Zepbound is the first FDA-approved prescription medicine to help treat obstructive sleep apnea (OSA). Zepbound, or tirzepatide, originally received approval in November 2023 to treat obesity. It’s now a new rival to Novo Nordisk’s popular drug, Wegovy.
The FDA has now given the green light for tirzepatide to treat obstructive sleep apnea in adults who are obese and have moderate to severe OSA. OSA is a condition that makes breathing hard during sleep and is characterized by loud snoring, interrupted breathing (gasping), and daytime tiredness. Sleep apnea happens when the upper airway gets blocked during sleep. It can affect anyone, but it’s more common in people who are overweight.
The FDA recommends using tirzepatide along with a controlled diet and exercising more to treat obstructive sleep apnea.
What the research says
The FDA said research shows that tirzepatide can help with weight loss, which may improve sleep apnea symptoms for some people.
In two studies lasting 52 weeks, adults with obesity and moderate to severe sleep apnea saw major improvements while using tirzepatide. According to the FDA, people taking this medication had fewer episodes of shallow breathing or breathing pauses during sleep than those taking a placebo. This was true for people using a CPAP machine and those who didn’t. A CPAP machine delivers a stream of air through a mask to keep the airway open during sleep to treat obstructive sleep apnea, which then helps to prevent interruptions in breathing.
The American Academy of Sleep Medicine (AASM) backs the FDA’s approval of tirzepatide to treat obstructive sleep apnea but stresses that it isn’t suitable for everyone. The group said on Saturday that while being overweight is the main cause of sleep apnea, many cases are also linked to other things like the shape of the jaw and structure of the upper airway. However, the AASM did say obese or overweight people with OSA would benefit from losing weight over time.
What is the difference between the popular weight loss medications?
Glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are hormones made in the small intestine after eating. They tell the body to release more insulin and make less glucose. These hormones also slow down how quickly food moves through the digestive system and signal the brain to reduce hunger and appetite.
Medications called GLP-1 receptor agonists or dual GLP-1/GIP receptor agonists were first created to treat type 2 diabetes. Over time, doctors and patients noticed these medications also led to weight loss. Because of this, new versions were made to focus on treating obesity and weight issues. All the medications being compared can lead to weight loss, but the FDA approves some for treating type 2 diabetes, while others are approved for managing obesity and now for treating sleep apnea.
Wegovy, Ozempic, and Rybelsus contain semaglutide, a GLP-1 agonist. Wegovy is FDA-approved for weight loss, and the other two for patients with type 2 diabetes.Â
Mounjaro and Zepbound contain tirzepatide as their main ingredient. It delivers both GLP-1 agonist and GIP, which works alongside GLP-1 to help the body use insulin more effectively and can signal feelings of fullness. Zepbound has recently been FDA-approved for weight loss, while Mounjaro is prescribed for adult patients with type 2 diabetes.
Tirzepatide vs Semaglutide
Tirzepatide (found in Mounjaro and Zepbound) and semaglutide (found in Ozempic, Wegovy, and Rybelsus) are both GLP-1 receptor agonists. This means they copy the actions of the natural hormone GLP-1. The only difference is that tirzepatide also has GIP, making it a dual GLP-1/GIP receptor agonist. These hormones help the body make more insulin, lower blood sugar and make a person feel full for longer. GIP may also boost how well GLP-1 works.
Mounjaro vs Ozempic
Mounjaro and Ozempic are both injectable medications. Mounjaro contains tirzepatide, which works on both GLP-1 and GIP receptors. Ozempic contains semaglutide, which only works on GLP-1 receptors. Both medications have been proven effective in managing type 2 diabetes.
Wegovy vs Zepbound
Both are weekly injectable medications that can be prescribed to help people lose weight if they meet specific requirements. The criteria are that they must be obese (BMI greater than 30) or overweight (BMI between 27 and 30) with a related health problem. Zepbound contains tirzepatide, which works on both GLP-1 and GIP receptors. Wegovy contains semaglutide, which only works on GLP-1 receptors. It is also approved for teens aged 12 to 18 with a BMI at or above the 95th percentile.Â
What else could these new weight loss drugs treat?
There’s growing interest in using these drugs for more than just obesity and diabetes, and now to treat obstructive sleep apnea.
Already, there is evidence that they could help with conditions like liver disease, addiction, neurogenerative diseases, lipid disorders, and cardiovascular and kidney issues. Let’s look at what is in the pipeline for GLP-1/GIP medications.
Liver disease
A new drug called retatrutide cleared liver fat in ninety percent of the participants in a small study.
Right now, there’s no FDA-approved treatment for fatty liver disease. Tirzepatide is called a dual agonist because it works on both GLP-1 and GIP. Retatrutide is called a tri-agonist because it adds an extra hormone called glucagon. Glucagon helps increase blood sugar levels, so in the past, doctors didn’t think it could be used to treat diabetes, but studies now show that when combined with a GLP-1 agonist, glucagon can help people eat less and burn more calories at rest. It also seems to break down fat in the liver, which could be helpful for people with fatty liver disease.
Addiction
A recent study published in the journal Addiction found that people with substance abuse disorders who take weight-loss medications are less likely to have an opioid overdose or alcohol-related intoxication than those who don’t take these substances. Researchers reviewed medical records from over 1.3 million people across 136 health systems in the U.S. All participants had either an opioid addiction or alcohol use disorder, and some were also using these weight-loss medications.
People with opioid-use disorders who took these medications were 40% less likely to experience an overdose during the study compared to those who didn’t take them. Similarly, individuals with alcohol-use disorders who used these prescriptions had a 50% lower chance of intoxication than those who did not use the medications.
Neurodegenerative diseases
GLP-1 receptor agonists may do more than just help with insulin release and weight loss. They also have anti-inflammatory and anti-insulin resistance effects by working through specific receptors in different parts of the body. Because of this, they could be effective in treating some neurological disorders such as Parkinsons and Alzheimers..Â
GLP-1 can help lower brain inflammation by changing microglia, the brain’s immune cells, from a harmful, pro-inflammatory state to a helpful, anti-inflammatory state. By activating GLP-1, scientists have found it can calm microglia activity, which is a major cause of brain inflammation, and protect nerve cells from damage. These drugs might help the brain respond better to insulin, lower harmful oxidative stress, and protect brain cells.
Lipid disorders
Semaglutide can help lower cholesterol and triglycerides, which are fats in the blood that can raise the risk of heart disease. The research on Ozempic and Wegovy showed similar results, and the pill version, Rybelsus, may also lower cholesterol as effectively as a statin.
Knee osteoarthritis
In late October 2024, researchers shared the results of a 68-week study that looked at how semaglutide affects obese patients with moderate knee pain caused by osteoarthritis. Participants were given either 2.4 mg of semaglutide once a week or a placebo. Along with this, they followed a low-calorie diet and received guidance on staying physically active.
Pain was assessed using the WOMAC scale, which rates pain from 0 to 100, with higher numbers showing more severe pain. Initially, participants reported a mean pain score above 70 on the WOMAC scale.
After 68 weeks, those on semaglutide had a more significant reduction in pain, with an average 41.7-point drop in the WOMAC pain score, compared to a 27.5-point drop for the placebo group.Â
Kidney problems and heart disease
A study involving 3,533 participants, split between those receiving semaglutide those receiving a placebo, found that semaglutide helped lower the risk of serious kidney problems and deaths related to heart disease in people with type 2 diabetes and chronic kidney disease. Those taking semaglutide had a lower risk of experiencing kidney-related outcomes and deaths from cardiovascular issues. Secondary outcomes also included a slower decline in kidney function, an 18% lower risk of major cardiovascular events, and a 20% lower risk of death from any cause.
FAQs
What is the best way to sleep with sleep apnea?
Sleeping on your side or stomach can help keep your airways open. This may reduce snoring and ease mild sleep apnea, making it easier to breathe at night.
What is suggested to treat obstructive sleep apnea?
A CPAP machine is the most widely used way to treat sleep apnea. It works by sending a steady flow of air into the airways to keep them open, making it easier to breathe while aleep.
Can sleep apnea be cured?
Sleep apnea is a chronic condition. In some cases, it can be managed or even eliminated through weight loss or specific treatments. However, for many individuals, it remains a lifelong issue.
