July 22, 2024

A drug used for type 2 diabetes and weight loss may reduce the severity of obstructive sleep apnea (OSA) in people with obesity, research suggests, raising the possibility of the first pharmaceutical treatment for the condition.

Tirzepatidemade by Eli Lilly and Company, along with other medications such as Novo Nordisk’s Wegovy, are part of a new wave of medications sometimes referred to as “skinny jabs” because they can result in dramatic weight loss.

Now researchers say that tirzepatide may help people with OSA, a disorder in which breathing stops and starts during sleep due to the upper airway narrowing or collapsing.

“It is estimated that up to 3 million people in the UK may have OSA but have not yet been diagnosed,” says Dr Kunal Gulati, the executive director for diabetes and obesity medical affairs at Lilly Northern Europe.

“Tirzepatide has the potential to be the first pharmaceutical treatment for OSA, addressing the unmet need for people living with this condition.”

OSA can lead to disrupted sleep, excessive daytime sleepiness, an increased risk of serious heart problems and stroke, and cause relationship problems.

Many people living with OSA rely on a device called a Cpap (continuous positive airway pressure) machine, which – like the NHS notes – pumps air into a mask worn over the mouth or nose during sleep.

Writing in the New England Journal of Medicine, an international team of researchers, including scientists at Lilly, report how they conducted two phase-three randomized control trials in patients with obesity and OSA. According to Lilly, one trial involved 234 patients who did not use a Cpap machine, and the other 235 patients who did.

In each trial, patients were divided into equal-sized groups and given an injection containing either tirzepatide or a placebo for 52 weeks.

The team looked at the average number of instances of reduced breathing (hypopnea) and cessation of breathing (apnea) in an hour of sleep.

At the start of the first trial, patients experienced an average of 51.5 such events per hour. However, those given tirzepatide experienced an average of 25.3 fewer such events per hour at 52 weeks, while those given a placebo had an average reduction of 5.3 events per hour. In the second trial, the mean decrease in events per hour was 29.3 for tirzepatide and 5.5 for the placebo from a baseline of an average of 49.5 events per hour.

The team says the most common side effect of tirzepatide was mild to moderate stomach problems.

In both trials, participants given tirzepatide also experienced significant weight loss, had improvements in systolic blood pressure, and reported improved sleep-related outcomes, among other changes.

A Lilly spokesperson said about 70% of people diagnosed with OSA also live with obesity.

“In addition to reductions in body weight, we believe that reductions in tongue, airway and visceral ectopic fat deposits may have an additional beneficial effect in people living with OSA and obesity,” they said.

In an accompanying editorialDr Sanjay Patel of the University of Pittsburgh, said an evaluation of further measures would be needed “to fully understand the extent of clinical benefit and allow comparisons with existing therapies for obstructive sleep apnea”.

However, Prof Naveed Sattar, an expert in metabolic health at the University of Glasgow, said the results were really exciting and could revolutionize sleep apnea care in people living with obesity. He also noted that weight loss would provide patients with many other benefits that treatments such as Cpap do not.

“Significant evidence has shown that obesity is a strong risk factor for sleep apnea. To now see significant improvements in sleep-related patient-reported outcomes after large-scale weight loss with an anti-obesity drug is outstanding and will change practice,” Sattar said. “Such evidence further underscores the importance of tackling obesity in treating and preventing several chronic conditions that cause significant suffering for many people in society.”

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