Nearly a billion adults are affected by obstructive sleep apnea (OSA), sometimes without knowing it. The cause: airways that become blocked repeatedly during the night, resulting in fatigue, drowsiness, hypertension and increased cardiovascular risk.
The standard treatment remains continuous positive airway pressure (PPC, or CPAP). But its regular use remains difficult: only 30 to 60% of patients use it sufficiently each night. It is in this space that drugs acting on GLP-1 could find their place.
Tirzepatide: up to 24 fewer respiratory events per hour
A review published in JAMA Otolaryngology–Head & Neck Surgery was interested in the data available on GLP-1 receptor agonists, in particular tirzepatide, marketed under the names Zepbound and Mounjaro.
In the SURMOUNT-OSA phase 3 trials, the treatment reduced the apnea-hypopnea index (AHI) by 20 to 24 events per hour compared to the placebo. Between 42 and 50% of participants reached remission criteria, compared to 14 to 16% in the placebo groups.
These criteria corresponded in particular to an apnea-hypopnea index (AHI) less than 5, or less than 15 in the absence of symptoms.
In the United States, tirzepatide became the first drug approved by the FDA to treat moderate to severe OSA in adults with obesity in December 2024.
But these results do not mean that the drug is more effective than CPAP. According to data cited in the review, CPAP allows a reduction in AHI of approximately 31 events per hour.
Why losing weight can change breathing
The main explanation is relatively simple: tirzepatide helps you lose weightand being overweight is one of the main risk factors for OSA.
The data shows that a loss of 10% of body weight is associated with approximately a 26% decrease in AHI. The reduction in fatty deposits around the neck, tongue and pharynx can thus leave more room for the passage of air.
The pharynx, between the hard palate and the larynx, is the only segment of the airway without rigid support. It is a tube that can collapse, held open only by muscle tone.
However, researchers are considering other mechanisms. GLP-1 could notably act on inflammation, oxidative stress or even leptin signals involved in the control of breathing. These hypotheses are still largely based on animal data.
A promising drug, but not a replacement for CPAP
Enthusiasm must therefore remain measured. Tirzepatide acts mainly on a risk factor: obesity. However, OSA can also be linked to the morphology of the airways.
“Other factors are involved in the development of OSA, including simple structural anatomy unrelated to fatty deposits that cannot be corrected by weight loss.”underlines Ruchir P. Patel, sleep doctor, in
HealthLine.
Even significant weight loss does not guarantee the disappearance of apnea. “We have known for many years, thanks to data from bariatric surgery, that significant weight loss does not always resolve OSA.”recalls the specialist.
In other words, an improvement in symptoms does not necessarily mean that the risk has disappeared.
The real challenge: maintaining results
GLP-1 agonists could especially constitute an additional option for obese patients who poorly tolerate CPAP or who need to lose weight before another procedure. They could also be associated with certain other strategies, such as stimulation of the hypoglossal nerve.
In HealthlineDr. James J. Chao, surgeon and weight loss specialist, nevertheless recommends that patients continue their CPAP while losing weight and perform a new sleep study after about 12 months to check the progress of OSA.
Another major question: what happens when treatment is stopped? The benefits appear to depend on maintaining weight loss. For Alexandria Harris, it is therefore about the management of a chronic illness, not a short-term treatment.
For people who spend their nights feeling suffocated, wake up exhausted and struggle with daytime sleepiness, this perspective remains important. These medications do not make PCP go away, but may provide
a new way to regain control of nights long disrupted by apnea.