Tirzepatide Shows Consistent Benefit for OSA Regardless of Baseline Severity

Findings from a post-hoc analysis of the SURMOUNT-OSA clinical studies highlight the consistent benefit of treatment with tirzepatide in adults with moderate-to-severe obstructive sleep apnea (OSA) and obesity, regardless of their baseline OSA severity.1

The data were presented at the American Thoracic Society (ATS) International Conference 2025 by Birong Liao, PhD, and demonstrate consistent, significant improvements versus placebo in measures of OSA and cardiometabolic parameters, irrespective of participants’ OSA severity at baseline or positive airway pressure (PAP) therapy use.1

Tirzepatide (Zepbound) was initially approved by the US Food and Drug Administration in November 2023 for the treatment of adults with obesity or overweight who also experience weight-related medical problems, based on positive results from the SURMOUNT-1 and SURMOUNT-2 trials. In 2024, the US Food and Drug Administration additionally approved it for the treatment of adults with moderate-to-severe OSA and obesity based on positive data from SURMOUNT-OSA.2

The SURMOUNT-OSA clinical program comprised 2 phase 3 studies comparing the effects of tirzepatide 10 mg or 15 mg once weekly versus placebo in adults with moderate-to-severe OSA and obesity over 52 weeks. Results showed tirzepatide improved measures of OSA and cardiometabolic parameters, including apnea hypopnea index (AHI), sleep apnea specific hypoxic burden (SASHB), systolic blood pressure (SBP), C-reactive protein (CRP), and body weight (BW).1

To evaluate the associations between tirzepatide treatment and changes in these parameters versus placebo by baseline OSA severity, investigators classified on-treatment participants with non-missing baseline AHI measurements into approximately evenly weighted OSA severity subgroups by baseline AHI. They defined AHI ≥15 to <30 as moderate; AHI ≥30 to <70 as severe, and AHI ≥70 as very severe.1

Investigators did not report any consistent associations between baseline OSA severity and changes in measures of OSA or cardiometabolic parameters across either study. Of note, significant differences between severity subgroups were observed for change difference in AHI (P = .032) and percent body weight reductions (P = .042) among participants not on PAP in Study 1.1

In both studies, tirzepatide was associated with significant reductions versus placebo in AHI, SASHB, SBP, and BW across all severity subgroups. Additionally, in both studies, the odds of achieving ≥50% AHI reduction with tirzepatide were significantly greater than with placebo in all severity groups. The odds of achieving AHI <5 or AHI 5-14 with Epworth Sleepiness Scale ≤10 were also significantly increased with tirzepatide compared with placebo in all subgroups except the Study 1 very severe subgroup.1

Greater reductions were observed in high-sensitivity CRP with tirzepatide than placebo across all severity groups, but investigators noted significant differences were only associated with the severe subgroup in both studies.1

“In these post-hoc analyses of the SURMOUNT-OSA studies, tirzepatide was associated with significant improvements versus placebo in measures of OSA and cardiometabolic parameters irrespective of participants’ OSA severity at baseline or PAP therapy use,” investigators concluded.1

References

1. B Liao, B Falcon, J Bednarik, et al. Measures Related to Obstructive Sleep Apnea After Tirzepatide Treatment by Baseline OSA Severity: Post-hoc Analyses of SURMOUNT-OSA [abstract]. Am J Respir Crit Care Med. https://doi.org/10.1164/ajrccm.2025.211.Abstracts.A5207

2. Iapoce C. FDA Approves Tirzepatide for Obstructive Sleep Apnea in Obesity. HCPLive. December 20, 2024. Accessed May 18, 2025. https://www.hcplive.com/view/fda-approves-tirzepatide-for-obstructive-sleep-apnea-in-obesity