If you or a loved one has sleep apnea, you may be considering different treatment options. A new treatment you may hear about is Zepbound (tirzepatide).
In December 2024, Zepbound became the first FDA-approved medicine for treating obstructive sleep apnea. More specifically, Zepbound received approval for treating moderate to severe obstructive sleep apnea (OSA) in adults with obesity, alongside a reduced-calorie diet and increased physical activity.
Zepbound was first approved by the FDA in November 2023 for weight loss and long-term weight management in certain people. The active ingredient, tirzepatide, is also available under the brand name Mounjaro. It was approved by the FDA in 2022 for improving blood sugar levels in people with type 2 diabetes.
Zepbound may also be used for other conditions as determined by your health care provider. This article focuses on frequently asked questions and answers about Zepbound for OSA.
How Does Zepbound Work for OSA?
Obstructive sleep apnea (OSA) is a long-term condition where your airway becomes blocked during sleep. This causes brief pauses in breathing while you sleep. During these pauses (apneas), your chest and belly muscles continue to work hard to pull in air, but the airway is partly or fully blocked.
Your breathing may stop and restart many times every hour, and you may gasp for air or snore loudly – even if you are not aware of it happening. This can leave you feeling very tired during the day. Untreated sleep apnea can lead to other serious health problems.
To diagnose sleep apnea, your health care provider may recommend a sleep study to monitor your breathing while you sleep. Other common treatments include breathing devices, such as continuous positive airway pressure (CPAP) machines and lifestyle changes to promote weight loss.
Having obesity increases the risk of OSA. Extra weight around your neck can put pressure on your airway while you sleep, making it harder for air to freely pass through. Zepbound works for OSA by helping to reduce excess body weight.
Zepbound works by activating two receptors (proteins) in the body: glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1). These receptors help regulate appetite and how your body uses insulin. Both are found in areas of the brain that control hunger and fullness. By stimulating these receptors, Zepbound can help you feel less hungry and reduce how much you eat, leading to weight loss. It works to support weight loss and reduce fat around the upper airway, which can help improve breathing during sleep.
In studies, Zepbound helped people lose more fat than muscle, which is important for improving breathing during sleep. While Zepbound was originally developed for weight loss, later studies found that this weight loss can help treat sleep apnea that is linked with obesity.
Is Zepbound Right for My Sleep Apnea?
Zepbound can be an effective treatment for sleep apnea in certain people. The FDA has approved this medicine specifically for adults who have both of the following conditions.
- Obstructive sleep apnea (OSA) that is moderate to severe
- Moderate OSA is defined as more than 15 to 30 breathing pauses (also called apnea events) per hour, while severe OSA is more than 30 apnea events per hour. You may need to complete a sleep study to find out how severe your OSA is.
- Obesity
- Obesity is commonly defined as having a body mass index (BMI) of 30 or more. BMI is a measurement that compares weight to height.
For this treatment, Zepbound is approved for use with a reduced-calorie diet and increased physical activity.
Zepbound is not recommended if you are already using another medicine that contains tirzepatide (the active ingredient in Zepbound and Mounjaro) or any other medicine known as a GLP-1 receptor agonist. Examples are liraglutide (Saxenda, Victoza) and semaglutide (Ozempic, Wegovy).
A health care provider can help you find out if Zepbound is right for you.
How Was Zepbound Studied for Obstructive Sleep Apnea?
Two clinical trials studied how well Zepbound treated OSA. These studies involved 469 adults, all of whom had moderate to severe OSA and obesity. Trial 1 focused on people who could not or did not want to use positive airway pressure therapy, or PAP for short, while Trial 2 included people who were already using PAP.
People in the studies ranged in age from 20 to 79. Most were in their 40s or 50s, and the average age was 48-52. About two-thirds (70%) were male and one-third (30%) were female.
People from a variety of racial backgrounds took part in the trials: About 69% were White, 17% were Asian, 8% were American Indian or Alaska Native, 5% were Black or African American, and the rest of them identified as multiple races. As for ethnicity, about 37% of the people in the studies identified as Hispanic or Latino.
In both studies, people were randomly assigned to inject either Zepbound or a placebo (a shot with no active drug) once a week for 52 weeks. No one knew if the injection they were using was the medicine or placebo. Everyone in the study also received guidance on a reduced-calorie diet and increased exercise.
At baseline (before the study treatment started), the average body mass index (BMI) of the people in the studies was around 39. (Obesity is defined as having a BMI of 30 or higher.) The average apnea-hypopnea index (AHI) score was 49.5-51.5 apnea events per hour at baseline. AHI measures how many times breathing stops or becomes shallow each hour during sleep.
What Are the Benefits of Zepbound for OSA Based on Studies?
The main goal of the studies of Zepbound for OSA was to see how much each person’s AHI score changed after 52 weeks. This measurement is described as the number of apnea events per hour.
At the end of the yearlong study, people in the Zepbound group had a bigger drop in their AHI scores, compared to those in the placebo group. At week 52, more people using Zepbound had a meaningful reduction in the number of breathing pauses (apnea events) per hour. The average AHI reduction was 25.3-29.3 in the Zepbound group and 5.3-5.5 in the placebo group.
After 52 weeks, some of the other results of these studies were as follows.
- More people using Zepbound had their symptoms of OSA either go away completely or become mild. More people had these benefits with Zepbound, compared to those using a placebo.
- More people using Zepbound had significant weight loss. The average body weight reduction in the Zepbound group was 17.7%-19.6%, while the average weight loss in the placebo group was 1.6%-2.3%.
Zepbound also helped improve blood pressure. And people who took Zepbound reported feeling less tired and more alert during the day, compared to those who received a placebo. This was measured using a questionnaire designed to assess how sleep problems affect daily life, including focus, mood, and energy levels.
Keep in mind that your results may differ from what was seen in studies.
How Do I Use Zepbound for OSA?
Zepbound is a once-weekly shot. It is given under the skin of the abdomen (belly area), thigh, or upper arm. A health care provider can show you or a caregiver how to inject it. You can inject Zepbound at any time of day.
The typical dosage of Zepbound for OSA is as follows.
- The recommended starting dosage is 2.5 milligrams (mg) once weekly.
- After four weeks on 2.5 mg, the dose is typically increased to 5 mg once weekly.
- After at least four weeks on 5 mg, the dose is typically increased to 7.5 mg once weekly.
- After at least four weeks on 7.5 mg, the dose is typically increased to 10 mg once weekly.
- You may continue on the 10 mg dosage long term, or your provider may continue increasing your dose by 2.5 mg every four weeks until they find the long-term (maintenance) dosage that is right for you.
The recommended maintenance dosage of Zepbound for OSA is 10 mg or 15 mg once weekly. The maximum dose of Zepbound is 15 mg.
After using your dose, place your Zepbound pen or needle in a sharps disposal container right away. Do not throw used pens or needles in the household trash. If you do not have a sharps container, you can use a sturdy household container made of heavy-duty plastic. It should have a tight-fitting, puncture-resistant lid. It should also be clearly labeled to show it contains hazardous waste.
When the container is nearly full, follow your local or state guidelines for safe disposal. To learn more, visit the FDA’s website at www.fda.gov/safesharpsdisposal.
This usage guidance is based on the standard dosage and administration information for Zepbound, but always follow the instructions from your health care provider. They may give you different instructions. Ask your pharmacist or health care provider if you have questions about using Zepbound for OSA.
What Are the Side Effects of Using Zepbound for OSA? How Can I Prevent or Manage Them?
The side effects seen in the studies of Zepbound for OSA were similar to those reported in past weight loss trials of Zepbound. The most common side effects are stomach issues, such as nausea, diarrhea, vomiting, constipation, or stomach pain. These side effects are usually mild or moderate and tend to ease over time as your body gets used to the medicine.
To help lessen side effects, be sure to follow the dosage schedule from your health care provider. Do not increase your dose unless your prescriber OKs it. Taking the medicine in higher doses or more often than prescribed raises the risk of side effects.
This is not a complete list of Zepbound side effects. Tell your health care provider if you have side effects that feel severe, are bothersome, or do not go away. They may let you know about other ways to prevent or manage side effects.
How Can I Get Zepbound? Can I Get It at Any Pharmacy?
Zepbound requires a prescription from a health care provider. You can fill your prescription at your local pharmacy, or you can use a mail-order pharmacy. You cannot get Zepbound over the counter.
Is There Any Cost Assistance Available?
A cost assistance program is available from Eli Lilly and Company, the maker of Zepbound. It may reduce the amount you pay. Whether you qualify to enroll may depend on what type of insurance you have or if you are uninsured. Visit this website from the drugmaker for more information about Zepbound costs and copay savings.
You can also contact the drugmaker at 866-923-1953 to connect with a representative for financial support information and other resources.
