# A Weight-Loss Drug Became the First Medicine for Sleep Apnea > Tirzepatide cut breathing interruptions by more than half in a yearlong trial and won FDA approval for obstructive sleep apnea in adults with obesity. Here is who it helps and where CPAP still fits. - Publication: New England Anti-Aging (https://newenglandantiaging.com) - Section: Mind & Sleep - Author: Lena Whitcomb, Contributing Writer, Mind and Sleep - Published: 2026-11-06 - Lead photograph: A man asleep face down on a bed, by Shane on Unsplash (https://unsplash.com/photos/man-in-blue-shirt-sleeping-hfvFunLkFgg) - Canonical URL: https://newenglandantiaging.com/mind-sleep/zepbound-sleep-apnea/ ## The Short Version - In December 2024 the FDA approved Zepbound, the brand of tirzepatide for weight management, for moderate to severe obstructive sleep apnea in adults with obesity. - In the SURMOUNT-OSA trials, breathing interruptions fell by about 25 to 29 events an hour on the drug, compared with about 5 on placebo. - The approval covers people with obesity, and the drug works largely by reducing weight, so it is not an option for everyone with apnea. - Medicare Part D plans can cover Zepbound for this use, often with prior authorization. For decades, the treatment for obstructive sleep apnea has been mechanical. A CPAP machine pushes air through a mask to keep the airway open at night. It works well for people who use it, but many find the mask uncomfortable and stop. Others try oral appliances or, less often, surgery. On December 20, 2024, the [FDA approved](https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-obstructive-sleep-apnea) the first medicine for the condition. It was not a new sleep drug. It was Zepbound, the version of tirzepatide sold for weight management. ## What obstructive sleep apnea does In obstructive sleep apnea, the soft tissue at the back of the throat collapses during sleep and partly or fully blocks the airway. Breathing stops or becomes shallow, oxygen levels dip and the brain briefly wakes the sleeper to restore airflow. This can happen dozens of times an hour without the person remembering it. Severity is measured with the apnea hypopnea index, or AHI, which counts those events per hour. Fifteen or more is moderate, and 30 or more is severe. Loud snoring is the classic sign, but many people notice only daytime sleepiness, morning headaches or trouble concentrating. Untreated apnea is linked with high blood pressure, atrial fibrillation and other cardiovascular problems. Excess weight is one of the strongest risk factors, because fat around the neck and tongue narrows the airway. ## What the trials found The approval rested on two trials known as SURMOUNT-OSA, published in the [New England Journal of Medicine](https://doi.org/10.1056/NEJMoa2404881). Together they enrolled 469 adults with obesity and moderate to severe apnea. People with diabetes were excluded. One trial included people who could not or would not use CPAP. The other included people who were already using it. Participants took the highest dose of tirzepatide they could tolerate, 10 or 15 milligrams once a week, or a placebo, for 52 weeks. At the start, they averaged about 50 breathing events an hour, which is severe apnea. By the end, the [results were clear](https://www.acc.org/latest-in-cardiology/clinical-trials/2024/06/24/16/16/surmount-osa). In the trial without CPAP, AHI fell by 25.3 events an hour on tirzepatide and 5.3 on placebo. In the trial with CPAP, it fell by 29.3 compared with 5.5. That was a reduction of up to about 59 percent from where people started. The drug also lowered blood oxygen dips, blood pressure and a marker of inflammation, and people reported feeling less sleepy. Many participants improved enough to change category. According to [Eli Lilly's announcement](https://investor.lilly.com/news-releases/news-release-details/fda-approves-zepboundr-tirzepatide-first-and-only-prescription) of the approval, after one year 42 percent of people taking tirzepatide alone and 50 percent of those also using CPAP had either no apnea or mild apnea without symptoms. On placebo, those figures were 16 and 14 percent. The most common side effects were nausea, diarrhea and other digestive problems, mostly mild to moderate and most frequent while the dose was being increased. ## Who it is for The approval is specific. It covers adults with moderate to severe obstructive sleep apnea who also have obesity, and the drug is meant to be used with a reduced calorie diet and more physical activity. Much of the benefit comes from weight loss, so people with apnea who are not overweight are unlikely to gain as much. It also does not make CPAP obsolete. Many trial participants still had apnea at the end of a year, even if it was milder. For someone with severe apnea, CPAP works from the first night, while the drug takes months to reach full effect. A sleep physician may recommend both, at least at first, and then reassess with a new sleep study after weight loss. ## Coverage and cost The new indication changed the coverage picture. Medicare drug plans are barred by law from covering medicines used only for weight loss, but in January 2025 [CMS confirmed](https://www.biospace.com/policy/lilly-wins-medicare-coverage-for-zepbound-in-sleep-apnea) that Part D plans can cover Zepbound when it is prescribed for sleep apnea. Commercial insurers set their own rules, which commonly require a recent sleep study and prior authorization. ## What happens if you stop Tirzepatide is meant to be taken long term. In other trials of the drug, people who stopped regained much of the weight they had lost, and because the apnea benefit is tied to weight, it is reasonable to expect breathing problems to return as well. That makes the decision closer to starting a chronic medication than taking a short course. ## The first step is still a diagnosis Sleep apnea remains badly underdiagnosed. If a partner has noticed loud snoring or pauses in your breathing, or if you are sleepy during the day despite a full night in bed, the place to start is a sleep evaluation. Home sleep tests are now widely used and are often covered. Treatment choices, including whether a medication makes sense, follow from what that test shows. ## What the Evidence Doesn't Settle The trials lasted one year and excluded people with diabetes and those with central or mixed sleep apnea. They did not test whether the drug reduces heart attacks, strokes or deaths in people with apnea. Weight often returns when tirzepatide is stopped, and apnea may return with it. ## Notes and Sources 1. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. New England Journal of Medicine, 2024. https://doi.org/10.1056/NEJMoa2404881 2. FDA Approves First Medication for Obstructive Sleep Apnea. U.S. Food and Drug Administration, 2024. https://www.fda.gov/news-events/press-announcements/fda-approves-first-medication-obstructive-sleep-apnea 3. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity, SURMOUNT-OSA. American College of Cardiology, 2024. https://www.acc.org/latest-in-cardiology/clinical-trials/2024/06/24/16/16/surmount-osa 4. FDA approves Zepbound (tirzepatide) as the first and only prescription medicine for moderate-to-severe obstructive sleep apnea in adults with obesity. Eli Lilly and Company, 2024. https://investor.lilly.com/news-releases/news-release-details/fda-approves-zepboundr-tirzepatide-first-and-only-prescription 5. Lilly Wins Medicare Coverage for Zepbound in Sleep Apnea. BioSpace, 2025. https://www.biospace.com/policy/lilly-wins-medicare-coverage-for-zepbound-in-sleep-apnea --- Published by New England Anti-Aging, the health and longevity magazine of Align Wellness, 250 Centerville Rd, Building E, Warwick, RI 02886. General information only, not medical advice.