Zepbound® for Sleep Apnea: What Patients Need to Know

What Patients Should Know About Zepbound®

Zepbound® as a sleep apnea treatment option

The FDA approved Zepbound® (tirzepatide) in December 2024 as the first medication specifically for obstructive sleep apnea. Zepbound® may be used alongside device-based therapies when appropriate and is not a replacement for CPAP for many patients.

Clinical trials with Zepbound® demonstrated significant results over 52 weeks. Zepbound® significantly reduced apnea-hypopnea index (AHI) from baseline compared to the placebo at one year. The medication improved the severity of OSA for many participants. Some patients met criteria for remission or mild, non-symptomatic OSA at the one-year mark. Patients taking Zepbound® also experience weight loss compared to the placebo at 52 weeks. Individual results vary.

How does Zepbound® work in the body?

Zepbound® targets two key hormone receptors in your body through a dual-action mechanism. The medication activates receptors for glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP).

These hormone receptors control several important functions:

• Appetite and food intake regulation
• Slower gastric emptying 
• Support for weight reduction when used as directed

The improvement in sleep apnea symptoms is believed to be mediated by weight reduction. Excess weight is a major contributing factor to OSA, and patients experienced greater weight loss with Zepbound® than with placebo over one year.

Who qualifies for Zepbound® treatment?

Zepbound® is approved specifically for adults who meet both of these requirements:

• Moderate-to-severe obstructive sleep apnea
• Obesity, typically defined as BMI ≥30 kg/m²

Zepbound® is used alongside a reduced-calorie diet and increased physical activity. The medication is used as part of a comprehensive treatment plan that your clinician will tailor to your specific needs (when clinically appropriate).

Certain patients should not use Zepbound®. Do not use if you or a family member has a history of medullary thyroid carcinoma (MTC) or if you have Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). You should not use Zepbound® with other tirzepatide-containing products; simultaneous use with other GLP-1 receptor agonists is not recommended unless directed by your clinician.

Sleep apnea can result from factors other than obesity, including jaw structure and upper airway anatomy. Some patients may benefit from combining Zepbound® with other sleep apnea treatments.

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How to Use Zepbound® for Sleep Apnea

Proper use of Zepbound® requires following specific dosage guidelines, proper injection technique, and making important lifestyle changes. Your success depends on understanding these aspects of treatment.

Recommended dosage and schedule

Start with 2.5 mg once weekly for 4 weeks, then increase to 5 mg once weekly. After that, your doctor may increase your dose in 2.5 mg increments every 4 weeks as tolerated. The maintenance dose is typically 10 mg or 15 mg once weekly (maximum is 15 mg). If you miss a dose, take it within 4 days (96 hours) of the scheduled time. If it has been more than 4 days, skip and resume on your regularly scheduled day. You may change your weekly dosing day if more than 72 hours have passed since the last dose. All dosing decisions will be made at the clinician's discretion.

How to inject Zepbound® safely

Inspect the pen (the solution should be clear to slightly yellow, without particles). Choose the abdomen/thigh/upper arm, rotate the sites, clean the skin, and inject as directed. Dispose of the pen in a sharps container.

Tips for diet and exercise success

It’s recommended to combine Zepbound® with a reduced-calorie diet and increased physical activity. Sustained weight management is considered important for long-term improvement in sleep-apnea severity. Your care team can help design a nutrition and activity plan, including resistance training, to support healthy weight loss and preserve strength.

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Benefits and Risks of Zepbound

It’s important to weigh both the potential benefits and risks before starting sleep apnea treatment.

Expected improvements in sleep apnea symptoms

Zepbound® improved key sleep apnea measures, including AHI, compared to the placebo over 52 weeks in the SURMOUNT-OSA phase 3 trials. Additionally, many patients improved to less-severe categories, and some even met remission or mild, non-symptomatic OSA compared to the placebo group.

Weight loss and other possible health benefits

Zepbound® was associated with greater body-weight reduction compared to the placebo at one year; individual results vary. The medication was also associated with improvements in some cardiometabolic and daytime functioning measures.

Possible side effects and how to manage them

Common side effects include nausea, diarrhea, vomiting, constipation, and abdominal pain; these may lessen over time.

Serious risks (not exhaustive):

• Risk of thyroid C-cell tumors; do not use if you or a family member has MTC or if you have MEN 2.
• Pancreatitis, gallbladder disease, acute kidney injury, severe GI adverse reactions, hypoglycemia (especially with insulin or sulfonylureas), and hypersensitivity.

Review the Medication Guide and discuss with your clinician. Following the prescribed titration (dosing increases) and eating smaller meals may help with GI symptoms. Stay hydrated and contact your physician if side effects persist or worsen.

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Zepbound® provides an option for sleep apnea, particularly for adults who also have obesity. Tirzepatide medication activates GIP and GLP-1 receptors and, when used as directed with diet and physical activity, supports weight reduction that may improve OSA severity. Trials showed improvements in breathing-related measures and weight reduction compared to the placebo.

This option may help patients who have difficulty maintaining CPAP therapy. However, Zepbound® isn’t appropriate for everyone. You must meet specific eligibility criteria, follow proper administration guidelines, and commit to dietary and exercise changes.

Talk with your healthcare provider before making any treatment decisions. Your doctor can help determine if Zepbound® aligns with your specific sleep apnea condition and overall health needs.

Eden coordinates care; licensed providers evaluate and prescribe when clinically appropriate; partner pharmacies dispense and label medications. Eden is an independent company and is not affiliated with, sponsored by, or endorsed by Eli Lilly and Company. Zepbound® and Mounjaro® are registered trademarks of Eli Lilly and Company. Names are used here for identification and educational purposes only.