The phase 3 SURMOUNT-OSA trial showed that tirzepatide reduced the apnea-hypopnea index (AHI) by up to 63%, highlighting its potential to meaningfully improve OSA severity in patients with obesity.3 Unlike CPAP therapy or surgery, tirzepatide addresses underlying metabolic drivers, offering a new pathway for patients who have struggled with conventional options. These findings signal a shift in how clinicians think about individualized care in OSA.
Weeks explored the promise and limitations of tirzepatide, the importance of patient selection, and the growing need for collaboration among sleep specialists, pulmonologists, and surgeons. As pharmacologic therapies gain traction, they may not replace existing interventions but expand the treatment toolkit.
HCPLive: From a pharmacological standpoint, how do you see individualized treatment strategies evolving for patients with sleep apnea?
Weeks: There’s been a lot of new changes in the way that [OSA] therapies are advertised and messaged to patients and delivered. One of those is certainly seeing the advent of pharmacological therapies, particularly GLP-1 receptor agonists. Most physicians now consider that as a very good option for some patients in the treatment armamentarium, but I think it’s one of many ways that we are approaching the problem now.
HCPLive: What impact has the growing use of GLP-1 receptor agonists, such as tirzepatide, had on the way clinicians think about managing sleep apnea?
Weeks: Tirzepatide was the one that was focused on with a sleep study or sleep trial, but the class of medications in particular has been impactful on obstructive sleep apnea for a variety of reasons. First and foremost, in most medical evidence that’s been published, patients with obstructive sleep apnea and elevated BMI have a direct correlation.
The study that you’re referring to is called the Surmount trial, and it was a study that looked at tirzepatide and its direct effect on obstructive sleep apnea. I think it’s important to think about it in two different ways. Firstly…many people [who] are normal weight have obstructive sleep apnea. And secondly, just because you’re overweight and you lose weight doesn’t mean your sleep apnea is going to go away.
HCPLive: What patient profiles or pharmacological considerations help you determine which GLP-1 therapy may be an appropriate path for sleep apnea care?
Weeks: When we think about sleep apnea and treatment with these types of medications…the medical evidence is probably the most powerful thing. [Tirzepatide is] probably the first medication that pops to a lot of people’s minds because of its correlation with the study.
General considerations when using these types of medications include the following. First and foremost, there are different doses. There are different dosing strategies. Some medications are delivered via an injection once a week… [or] taken orally daily. It’s really an individual consideration with the patient and the physician, but probably because of the study, tirzepatide is the most popular one that comes to mind with a lot of the patients that I deal with obstructive sleep apnea.
There are a number of other drugs that are being studied. Some of those medications are long-standing anti-anxiety medications. We have low-dose [depression] medications…There are a couple of other studies being done right now with new medications that have not published clinical data, but there are certainly other directions that are being taken for pharmacological treatment of sleep apnea, and I think there’s excitement, but we also are cautiously awaiting the results of many of these studies.
HCPLive: With tirzepatide showing strong results in OSA, how do you see pharmacologic therapies influencing the role of surgical approaches in sleep apnea management?
Weeks: It’s another tool in the tool belt of the physician who’s treating sleep apnea patients. A lot of the patients that do suffer from obstructive sleep apnea are overweight, and so their body mass index is an important component that’s contributing to their disease. But there’s a lot of patients that come into our practices that don’t have weight issues, or that have weight issues and have additional structural issues, so I think it really just has to be thought of as a tool. Now, obviously, for overweight patients, it’s a ray of hope for them.
I always consider non-surgical therapies for my patients [who] have obstructive sleep apnea. Traditional therapies like CPAP therapy and devices that we wear in our mouths are front and center. Those things have always been there. Pharmacological therapy is obviously an additional tool.
We’re also seeing a tremendously new kind of avenue of treatment that involves the upper airway muscle, and strengthening the muscle tone in the upper airway is now becoming something that I think a lot of people are excited about. We’ve also heard about stimulators that move nerves and open up [the] airway. So, there’s an array of treatments.
HCPLive: Do you anticipate that fewer patients will need invasive interventions, or might these medications expand the pool of patients who are candidates for surgery by improving overall cardiometabolic health before procedures?
Weeks: It’s likely to be both. I think it will make some people improve their sleep and their sleep apnea so much that they don’t need additional therapies. There will be other people [who] reduce the severity of their apnea, maybe from a very severe level to a mild or moderate level. While those people are certainly improved from a health perspective, they’re still going to require additional treatment.
HCPLive: Have you observed an increase in referrals or diagnostic testing for OSA in your practice?
Weeks: Most definitely. It’s front of mind for most primary physicians. Now, obstructive sleep apnea is a very, very serious health problem. It’s not something that can be ignored. And when we look at the cumulative numbers of sleep apnea, there’s probably more than 30 million people in the United States alone that suffer from this condition, and probably 80% of those patients, statistically, have not been diagnosed.
What that means is, there’s a lot of people walking around in the world [who] really are not getting rest, and they’re suffering the health consequences of sleep apnea. I can’t tell you how many people come into my office, and the only thing they tell me is, ‘I don’t want to wear that mask…I can’t imagine my wife wanting to sleep next to me with me wearing a mask on my face.’ And I do understand that. I mean, you have to change your lifestyle. And so again, thinking about progressive treatments and pharmacological treatments fall into that. So the referrals are increasing because people are aware, and I think the treatments will increase as people are more aware of these non-lifestyle, noninvasive treatments.
HCPLive: Do you think that this increase in referrals is potentially linked to the patient demand for GLP-1 therapies?
Weeks: Listen, I think a lot of people in the world would like to lose weight. We know that obesity is a huge problem [in the US]. When a medication can help you [lose weight], a lot of people are excited about that.
HCPLive: How should a surgeon, sleep specialist, and pulmonologist collaborate in this new era where both structural and metabolic treatments are viable pathways for OSA?
Weeks: Collaboration is really important… I work extremely closely with my pulmonary colleagues. As a surgeon, I think there’s some thought about the non-surgeons protecting the patients from the surgeons because surgeons like to do surgery. But I will say, with the advent of all these new therapies, the pharmacological side, the surgical side, with the progressive surgical treatments, and also with the non-surgical treatments…I think that there’s a lot more opportunity for collaboration when we have a patient who’s morbidly obese or very overweight [to] start that patient on a pharmacological therapy, drop their severity level down a significant amount.
HCPLive: What do we still need to learn about combining surgical and pharmacologic strategies to optimize long-term OSA outcomes?
Weeks: My philosophy has always been that…if you can fix a patient with surgery in a way that they’re happy with that doesn’t affect their lifestyle and that treats their underlying disease condition, by all means you should do so. Many patients can’t tolerate a lot of the non-surgical therapies.
Every patient [who] comes into my practice gets a proper airway evaluation. The…upper airway, the tongue, the throat…need to be directly [examined] to determine what type of treatment will be best for the patient. So, whether it’s a CPAP device or a mandibular device, whether it’s oral muscular stimulation, whether it’s an implant or just some small changes in the airway, all of those things need to be considered.
References
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Learn About Obstructive Sleep Apnea (OSA). American Lung Association. https://www.lung.org/lung-health-diseases/lung-disease-lookup/sleep-apnea/learn-about-sleep-apnea
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Faria A, Allen AH, Fox N, Ayas N, Laher I. The public health burden of obstructive sleep apnea. Sleep Sci. 2021 Jul-Sep;14(3):257-265. doi: 10.5935/1984-0063.20200111. PMID: 35186204; PMCID: PMC8848533.
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Tirzepatide reduced sleep apnea severity by up to nearly two-thirds in adults with obstructive sleep apnea (OSA) and obesity | Eli Lilly and Company. Eli Lilly and Company. Published 2022. https://investor.lilly.com/news-releases/news-release-details/tirzepatide-reduced-sleep-apnea-severity-nearly-two-thirds