A New Treatment for Obstructive Sleep Apnea

The first FDA approved drug for OSA is a breakthrough, but the science is well established.

Although 6 million Americans have been diagnosed with sleep apnea, experts estimate that it likely affects 30 million people in the U.S., and potentially 1 billion people worldwide. And while many associate it with snoring and daytime sleepiness and fatigue, the potential health impacts are much more severe.

Among other conditions, complications related to sleep apnea include, but are not limited to:

• Hypertension
• Diabetes
• Stroke
• Heart failure

There are two primary types of sleep apnea:

• Obstructive sleep apnea (OSA), in which the flow of air into the lungs is partially or fully obstructed due to relaxed muscles or fat deposits
• Central sleep apnea (CSA), which results when the brain doesn't send proper signals to the muscles that control breathing

Of these two types, OSA is much more common. One community-based study of 5,804 men and women found that while 55.1 percent of participants experienced OSA, only .9 percent had CSA.

Although OSA may have a variety of causes, obesity is a leading risk factor. This is because, in overweight people, fat deposits can accumulate around the upper airway and obstruct breathing. The spiraling rates of obesity, now widely regarded as an epidemic, has contributed to the prevalence of OSA.

Commonly prescribed treatments for OSA include continuous positive airway pressure (CPAP) machine, an oral appliance, and surgery. For many, these can be inconvenient, uncomfortable, and only partially effective. For those who are overweight, changes in diet and increased physical activity are also recommended.

A breakthrough.

Now, however, the outlook for people with OSA may be about to change. In December, the FDA approved the first medication to treat moderate to severe OSA, Zepbound (tirzepatide). While the approval of a drug therapy for OSA may be a breakthrough in public health, its mechanism of action (MOA) is not novel.

Zepbound belongs to a wildly popular class of drugs, known as glucagon-like peptide-1 (GLP-1), that includes Ozempic, Mounjaro, Wegovy, Rybelsus, and several others. These drugs work by activating receptors of hormones secreted from the intestine glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP). This reduces appetite, food intake, and, consequently, body weight.

The first GLP-1, Exenatide, was approved to treat Type 2 diabetes in 2005. In 2014, Liraglutide became the first GLP-1 to be approved to treat obesity. Then, in 2021 when Semaglutide was approved to treat obesity, it sparked a celebrity and social media craze, and the popularity of these drugs skyrocketed. Between the end of 2022 and 2023, the number of prescriptions for GLP-1s for obesity without diabetes increased 133 percent.

Zepbound addresses sleep apnea by reducing obesity. Based on the clinical trials, up to 50% of adults taking Zepbound no longer had symptoms associated with OSA after one year.

Growing number of indications

Just as Zepbound highlighted the potential for GLP-1s to be used to treat other conditions, today drugs in the class are being studied as therapies for Alzheimer's, non-alcoholic fatty liver disease, kidney disease, and several other metabolic-related conditions.

In some of these cases, like Alzheimer's, for example, the effect of GLP-1s appears to be unrelated to overall body weight. GLP-1s may work for these diseases, in part, by reducing inflammation, improving blood flow to the brain, and protecting neurons from damage.

But for others, such as cardiovascular disease, non-alcoholic fatty liver disease, hypertension, and osteoarthritis, the drug’s ability to reduce food intake and body weight is critical.

Not for everyone.

What does all of this mean for consumers who seek to manage chronic conditions, such as sleep apnea, and improve their health and quality of life?

First, talk to your doctor. These drugs are not for everyone, and your physician can help you make an informed decision. Side effects include nausea, diarrhea, vomiting, tachycardia, and, in rare cases, pancreatitis and medullary thyroid cancer. Studies also suggest that 25 to 39 percent of weight lost may be muscle, not fat.

Additionally, absent lasting changes in diet and lifestyle, these drugs are only effective in treating obesity while you are taking the medication. Yet, according to one study, 85 percent of people taking GLP-1s for obesity abandoned treatment after 2 years, so for many, the benefits may be short-lived.

For this reason, experts widely agree that diet and lifestyle changes are essential for people taking GLP-1s. Healthier eating habits and exercise can mitigate the side effects, enhance the results while people are on the drugs, and support sustained weight loss when and if they discontinue treatment.

The bottom line.

GLP-1s have the potential to reduce the incidence and severity of countless metabolic diseases and other serious conditions, but they should not be viewed as a miracle drug. Instead, they should be part of a holistic approach to reducing weight, managing chronic conditions and promoting good health that include nutrition, exercise and behavior modification under the supervision of a trained professional.

This type of thinking is widely held in the medical community and, in fact, the FDA approved Zepbound for the treatment of moderate to severe obstructive sleep apnea in adults with obesity, “to be used in combination with a reduced-calorie diet and increased physical activity.”

References

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