Obstructive Sleep Apnea in Obesity: The Role of Tirzepatide and Incretin Therapies
DOI:
https://doi.org/10.12775/JEHS.2026.92.72391Keywords
obstructive sleep apnea, obesity, tirzepatide, GLP-1 receptor agonists, positive airway pressure, weight lossAbstract
Background. Obesity is one of the most important modifiable contributors to obstructive sleep apnea (OSA). Recurrent upper-airway obstruction during sleep produces intermittent hypoxemia, sleep fragmentation, sympathetic activation, and clinically relevant daytime and cardiometabolic consequences.
Aim. This review evaluates tirzepatide and other incretin-based therapies in the management of obesity-related OSA, with emphasis on randomized evidence, clinically relevant endpoints, safety, and integration with positive airway pressure (PAP) therapy.
Material and methods. A narrative review with a structured literature search was conducted. PubMed/MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for publications from January 2014 to April 2026, with older foundational studies included when required for mechanistic or historical context. Priority was given to randomized trials, prespecified secondary analyses, regulatory documents, clinical guidelines, and recent meta-analyses.
Results. The SURMOUNT-OSA phase 3 program enrolled 469 adults with obesity and moderate-to-severe OSA. Tirzepatide reduced AHI by 25.3 events/hour versus 5.3 with placebo in participants not using PAP, and by 29.3 events/hour versus 5.5 with placebo in established PAP users after temporary PAP withdrawal. Treatment also produced substantial weight loss, lower sleep-apnea-specific hypoxic burden, and favorable changes in systolic blood pressure, systemic inflammation, triglycerides, fasting insulin, and insulin resistance.
Conclusions. Among incretin-based therapies, tirzepatide has the strongest direct randomized evidence for adults with obesity-related moderate-to-severe OSA. Its role is best framed as phenotype-directed obesity treatment integrated with, rather than automatically replacing, PAP. Objective reassessment of OSA remains necessary before any reduction or discontinuation of device therapy.
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Copyright (c) 2026 Natalia Kasterka, Milena Kasterka, Jagienka Perzyńska, Weronika Bagińska, Kinga Krzyżowska, Jaśmina Podkościelna, Kamila Ryszkowska, Aleksandra Purska
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