A new study showed that the use of tirzepatide a component present in weight loss medications, can reduce the symptoms and severity of obstructive sleep apnea in patients with obesity. The results of the study were published in the New England Journal of Medicine on June 21 and presented this Friday (28) at the International Congress on Obesity (ICO) 2024, which takes place in São Paulo.
Tirzepatide is the active ingredient in weight loss medications, such as Zepbound, and in medications for the treatment of type 2 diabetes, such as Mounjaro, both from the pharmaceutical company Eli Lilly. The molecule acts as a dual agonist of GLP-1 and GIP, hormones produced in the intestine and released after meals. This means that the medication has the ability to increase insulin production by the pancreas to maintain blood sugar control and induce a feeling of satiety.
Sleep apnea is a disorder characterized by temporary pauses in breathing during sleep. These pauses, known as apneas, occur when the upper airway becomes blocked or collapses, preventing airflow to the lungs. One of the main risk factors for the condition is obesity.
Given this, the SURMOUNT-OSA study set evaluated the use of tirzepatide in adults with obesity and moderate to severe obstructive sleep apnea. For this, two analyzes were carried out: one with patients who were not using positive airway pressure therapy (CPAP), a conventional treatment for sleep apnea, and another with patients who were already using and planned to continue with CPAP during the study.
In total, the two studies had 469 participants from different countries, including Brazil. Randomly, part of the patients received the maximum tolerated dose of tirzepatide (10 mg or 15 mg), while the other part received placebo. The study lasted 52 weeks.
Reduction of up to 62.8% in apnea events
According to research, patients who used tirzepatide to treat obstructive sleep apnea achieved a reduction of up to 62.8% in the Apnea-Hypopnea Index (which represents the number of respiratory events per hour and determines the severity of the disease), compared with those who used placebo. This is equivalent to about 30 fewer events that restrict or block a person’s airflow per hour of sleep.
Furthermore, among participants not on CPAP therapy, 43% who used tirzepatide at the highest dose met the criteria for “remission” of the disease. Among those on CPAP therapy, the rate was even higher: 51.5%. This means that they had fewer than five apnea events per hour of sleep. In addition, these participants also scored below 10 on the Epworth Sleepiness Scale (ESS), a standard questionnaire developed to assess daytime sleepiness.
“On average, patients had 50 respiratory arrest events in one hour of sleep before the intervention. The results of the study showed that those participants treated with tirzepatide had 30 fewer respiratory arrest events per hour of sleep”, explains Luiz Magno, medical director at Eli Lilly do Brasil, to CNN .
Additionally, patients treated with tirzepatide in both studies experienced significant improvements in health conditions related to obstructive sleep apnea, such as improvements in blood pressure, hypoxic burden (low oxygenation during sleep) and levels of C-reactive protein (CRP), a marker of inflammation, compared with placebo.
“OSA can disrupt patients’ quality of life and affects a person’s long-term health when left untreated, because it can lead to serious cardiometabolic complications. These data support the effectiveness of tirzepatide in adults with obesity living with moderate to severe OSA and increase our therapeutic arsenal for treating the disease,” said Atul Malhotra, professor of medicine at the University of California San Diego School of Medicine, and Peter C. Farell, director of sleep medicine at UC San Diego Health, in a statement.
How does tirzepatide work in sleep apnea?
To understand how tirzepatide works in the treatment of sleep apnea, it is first necessary to understand the relationship between the disease and obesity. According to Luciano Drager, cardiologist and president of the Brazilian Sleep Association, one of the main risk factors for sleep apnea is excess body weight.
“In obesity, there is generally a deposit of fat not only in the abdomen region, but also in the neck region, tongue and throat. This fatty tissue, when there is muscle relaxation caused by sleep, surrounds the airway, helping to close the air passage during sleep”, he explains to CNN .
Currently, the main treatment for sleep apnea is the use of CPAP, however, lifestyle changes that promote weight loss — such as healthy eating and physical activity — are also fundamental to the success of the treatment.
“However, the accession [a essas mudanças de estilo de vida] It’s difficult. People have difficulty losing weight for a number of reasons,” says Drager. “Nowadays, we have a number of more effective treatments to combat obesity, which in turn can improve a number of diseases related to the condition, including sleep apnea,” he adds.
In Drager’s view, the use of tirzepatide in patients with obesity and sleep apnea may be effective in promoting weight loss and, consequently, treating sleep disorders. “This is a medication that acts on both the release of insulin and the central nervous system, inhibiting and controlling hunger,” he explains.
However, during the presentation of the study at ICO 2024, Richard Schwab, one of the authors of the study and professor of Medicine at the Hospital of the University of Pennsylvania, in the United States, states that it is not yet known whether the action of tirzepatide in reducing symptoms of Obstructive sleep apnea is directly related to the action of the molecule on the disease, or whether it is a consequence of the weight loss caused by the medication.
“It is too early to say that pharmacological treatment with tirzepatide will replace traditional treatment, firstly because not all patients with apnea are obese. But tirzepatide can be an important option to add to the treatment of apnea, especially among patients who do not adhere well to lifestyle changes aimed at losing weight”, adds Drager.
Tirzepatide is approved in Brazil for the treatment of type 2 diabetes
Tirzepatide is currently approved by the National Health Surveillance Agency (Anvisa) for the treatment of type 2 diabetes under the trade name Mounjaro, from Eli Lilly. According to Magno, the pharmaceutical company has already requested approval of the molecule for the treatment of obesity from the agency. “We also plan to submit an indication for tirzepatide to treat sleep apnea in Brazil as soon as possible,” he says.
Asked when Mounjaro will be available for sale in Brazil, the medical director of Eli Lilly do Brasil replied that there is no forecast yet. “There is a large global demand for the medicine and we want to ensure that we have sufficient supplies to serve these patients before we launch the medicine in Brazil, so that there is no shortage of product,” he says.
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Source: CNN Brasil
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