Tirzepatide – alternative to CPAP-therapy or new opportunity in the therapy of obstructive sleep apnea?

Sleep-disordered breathing is one of the most common sleep-related disorders. According to basic and clinical research, severe obstructive sleep apnea (OSA) is associated with increased all-cause mortality. Other adverse conditions associated with untreated OSA include cardiovascular disease and its complications, the development of type 2 diabetes, obesity and continued weight gain, cognitive impairment, decreased quality of life, excessive daytime sleepiness, and an increased risk of motor vehicle accidents. Their prevalence tends to increase with age. Tools for accurately diagnosing OSA and treatment options have been developed. Obesity is one of the most significant and independent risk factors for the development of OSA. Weight loss is a key aspect of treating patients with OSA, as it has been shown to improve daytime respiratory failure, pulmonary hypertension, sleep-related breathing parameters, and cardiovascular and metabolic outcomes. This review focuses on the results of the SURMOUNT-OSA trial, which assessed the safety and efficacy of tirzepatide, a drug with incretin activity and the first dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide 1 receptor agonist, for the treatment of adults with OSA and obesity. The pathogenic mechanisms of OSA in obesity are discussed based on the latest fundamental research and the mechanisms mediated by tirzepatide. In patients with moderate to severe OSA and obesity, tirzepatide reduced the apneahypopnea index, body weight, hypoxic load, high-sensitivity CRP concentration, and systolic blood pressure, and improved patient-reported sleep-related outcomes.