In short
- On December 20, 2024, the FDA approved tirzepatide for moderate to severe obstructive sleep apnea in adults with obesity, to be used with a reduced-calorie diet and more physical activity. The FDA called it the first drug treatment option for certain patients with the condition.
- In the two SURMOUNT-OSA trials, published in the New England Journal of Medicine in 2024, AHI fell by about 25 and 29 events per hour after 52 weeks on tirzepatide, compared with about 5 per hour on placebo.
- Participants on tirzepatide lost about 18% to 20% of their body weight over a year, compared with about 2% on placebo.
- Between 42% and 50% of people on tirzepatide reached an AHI under 5, or an AHI of 5 to 14 with little daytime sleepiness, compared with 14% to 16% on placebo.
- The most common side effects in the trials were gastrointestinal. About a quarter of people on tirzepatide in the first trial had diarrhea or nausea.
- In a separate withdrawal trial, people who switched from tirzepatide to placebo regained 14% of their body weight over the following year.
Weight-loss drugs now have a real place in sleep apnea care. In December 2024, the FDA approved tirzepatide, a once-weekly injection, for moderate to severe obstructive sleep apnea in adults with obesity. In two year-long trials it roughly halved the number of breathing pauses per hour, mostly by helping people lose weight.
It's a genuine step forward, but it isn't for everyone with sleep apnea, and it doesn't replace CPAP for everyone who takes it. This article covers what the approval says, what the trials found, the side effects, and what to ask your doctor.
Is there an FDA-approved drug for sleep apnea?
Research: strong (what this means)Yes, tirzepatide is the first FDA-approved drug for obstructive sleep apnea. The FDA approved it on December 20, 2024, for moderate to severe obstructive sleep apnea in adults with obesity, to be used with a reduced-calorie diet and increased physical activity. The FDA described it as the first drug treatment option for certain patients with the condition.
The approval is specific. It covers adults, it covers moderate to severe sleep apnea, and it covers people who also have obesity. It doesn't cover mild sleep apnea, central sleep apnea, or people of a healthy weight with sleep apnea caused by jaw shape, tonsils or other anatomy.
The NHLBI's treatment page now lists the medicine, noting that it's injected under the skin and that your provider will also recommend physical activity and a healthy eating plan.
How does tirzepatide help sleep apnea?
Tirzepatide helps sleep apnea mainly by helping people lose weight. The FDA explains that it activates receptors for two gut hormones, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), to reduce appetite and food intake. The FDA says the improvement in sleep apnea is likely related to the weight loss.
That fits with what's known about sleep apnea. The NHLBI says people with obesity can have extra fat deposits in the neck that block the upper airway, and that keeping a healthy weight can help prevent or treat sleep apnea caused by obesity. Our article on sleep apnea and weight gain explains how the two feed each other.
MedlinePlus says tirzepatide is injected once a week, at any time of day. Doctors usually start with a low dose and raise it gradually, no more often than every 4 weeks.
What did the SURMOUNT-OSA trials show?
The SURMOUNT-OSA trials showed large drops in sleep apnea severity over a year. The results were published in the New England Journal of Medicine in 2024. The two trials enrolled 469 adults with moderate to severe sleep apnea (an AHI of 15 or more) and obesity. People with diabetes weren't included.
Trial 1 enrolled people who weren't using positive airway pressure (PAP) therapy such as CPAP. Trial 2 enrolled people who were. Participants got the highest dose they could tolerate, 10 mg or 15 mg a week, or a placebo, for 52 weeks. Everyone started with an average AHI of about 50 events per hour, which is severe.
| Result at 52 weeks | Trial 1 (no PAP): tirzepatide | Trial 1: placebo | Trial 2 (on PAP): tirzepatide | Trial 2: placebo |
|---|---|---|---|---|
| Change in AHI (events per hour) | −25.3 | −5.3 | −29.3 | −5.5 |
| Percent change in AHI | −50.7% | −3.0% | −58.7% | −2.5% |
| AHI cut by at least half | 61.2% | 19.0% | 72.4% | 23.3% |
| Remission or mild sleep apnea with little sleepiness | 42.2% | 15.9% | 50.2% | 14.3% |
| Change in body weight | −17.7% | −1.6% | −19.6% | −2.3% |
The "remission or mild" row counts people who reached an AHI under 5, or an AHI of 5 to 14 with an Epworth Sleepiness Scale score of 10 or less. The authors noted that at these levels, PAP therapy may not be recommended.
Tirzepatide also reduced hypoxic burden (a measure of how much oxygen drops overnight), a marker of inflammation and systolic blood pressure, and people reported less sleep-related impairment. If AHI is new to you, our guide to what AHI means explains the scale.
Does it replace CPAP?
Tirzepatide doesn't replace CPAP for everyone, and the trials show why. Even after a year and nearly a fifth of their body weight lost, about half or more of the people on tirzepatide still had sleep apnea above the "remission or mild with little sleepiness" level. For them, CPAP or another treatment is still needed.
A 2026 network meta-analysis compared CPAP and GLP-1-based drugs across 34 trials with 3,964 participants. CPAP produced the largest drop in AHI and improved sleepiness, while the GLP-1 drugs mainly improved weight and blood sugar. The authors concluded that CPAP remains the most effective therapy for controlling breathing, and supported combining airway and weight treatment.
The practical reading is that the two work well together. The second SURMOUNT-OSA trial tested tirzepatide in people who kept using PAP, and their sleep apnea improved too. If you use CPAP, don't stop because you've started a weight-loss drug. Ask your sleep doctor when to retest, and let the sleep study decide. Our guides to sleep apnea treatment options and can sleep apnea go away? cover what happens next.
What are the side effects?
The most common side effects of tirzepatide are gastrointestinal, and in the trials they were mostly mild to moderate. In the first SURMOUNT-OSA trial, 26.3% of people on tirzepatide had diarrhea, 25.4% had nausea, 17.5% had vomiting and 15.8% had constipation. Rates in the second trial were similar or a little lower. The authors said these effects were most common while the dose was being raised.
Few people stopped because of side effects. In trial 1, 4.4% on tirzepatide stopped the drug because of an adverse event, compared with 1.7% on placebo. In trial 2, it was 3.4% on tirzepatide and 7.0% on placebo.
The FDA lists a longer set of possible side effects and warnings. These include stomach pain, injection site reactions, fatigue, allergic reactions, burping, hair loss and reflux. It also carries warnings for pancreatitis, gallbladder problems, low blood sugar, acute kidney injury, suicidal behavior or thinking, and a risk of breathing in stomach contents during anesthesia or deep sedation. The FDA says to tell your provider about any planned surgery or procedure.
Tirzepatide caused thyroid C-cell tumors in rats, and the FDA says it's unknown whether it causes them in humans. It shouldn't be used by people with a personal or family history of medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2. MedlinePlus adds that it may make hormonal birth control pills less effective, and that your doctor may suggest another type of birth control for 4 weeks after starting and after each dose increase.
What about other GLP-1 drugs?
Other GLP-1 drugs have been studied for sleep apnea, with smaller effects than tirzepatide. Liraglutide, a GLP-1 drug, was tested in the SCALE Sleep Apnea trial, published in 2016. People with obesity and moderate or severe sleep apnea took liraglutide 3.0 mg or placebo for 32 weeks alongside diet and exercise.
AHI fell by 12.2 events per hour on liraglutide, compared with 6.1 on placebo. The authors found that the more weight people lost, the more their sleep apnea improved, and concluded that the results confirm weight loss improves sleep apnea.
Tirzepatide acts on GIP receptors as well as GLP-1 receptors, and its trials ran longer and produced more weight loss. It's the one approved by the FDA specifically for sleep apnea, so it's the drug your doctor would discuss for this purpose.
What happens when you stop?
When you stop tirzepatide, much of the lost weight usually comes back. The SURMOUNT-4 trial gave 670 adults tirzepatide for 36 weeks, during which they lost an average of 20.9% of their body weight. Then half switched to placebo and half continued.
Over the next 52 weeks, the placebo group regained 14.0% of their body weight, while the group that stayed on tirzepatide lost a further 5.5%. The authors concluded that stopping led to substantial regain, while continuing maintained and added to the weight loss.
SURMOUNT-4 didn't measure sleep apnea. But since the FDA says the sleep apnea benefit is likely related to weight loss, it's reasonable to expect sleep apnea to return if the weight does. That's worth discussing before you start, so you have a plan for the long term.
Who might be a good candidate?
A good candidate for tirzepatide for sleep apnea is an adult with moderate to severe obstructive sleep apnea and obesity, based on the FDA approval. Beyond that, it's a decision you make with your doctor, weighing side effects, other health conditions and how you'd manage long-term use.
Questions worth asking:
- Does my sleep study show moderate or severe obstructive sleep apnea?
- Do I meet the weight criteria, and are there reasons I shouldn't take it?
- Should I keep using CPAP while I start, and for how long?
- When should I have a repeat sleep study?
- What's the plan if side effects are hard to tolerate, or if I need to stop?
If you haven't been tested yet, start there. Our guide to the home sleep apnea test explains the first step, and our list of sleep apnea warning signs can help you decide whether to ask.
This article is general information, not medical advice. Don't start, stop or change any medication without your doctor.
Read next
Common questions
Is there a pill or medication for sleep apnea?
Tirzepatide is the first drug the FDA has approved for obstructive sleep apnea. It's a once-weekly injection, not a pill, and it's approved only for adults with moderate to severe sleep apnea who also have obesity. It works mainly by helping people lose weight, and it's used alongside diet and exercise.
Can tirzepatide replace CPAP?
For some people it may reduce sleep apnea enough that CPAP is no longer needed, but not for everyone. In the trials, about half or fewer reached remission or mild sleep apnea with few symptoms, and a 2026 review found CPAP still produced the largest drop in AHI. Only a repeat sleep study and your doctor can decide.
How much does tirzepatide lower AHI?
In the SURMOUNT-OSA trials, AHI fell by about 25 events per hour in people not using CPAP and about 29 in people using it, from starting levels near 50. That's roughly a 51% to 59% drop. Placebo groups improved by about 5 events per hour.
Do other GLP-1 drugs help sleep apnea?
Liraglutide was tested in a 32-week trial of people with obesity and moderate or severe sleep apnea. AHI fell by 12.2 events per hour on the drug compared with 6.1 on placebo. Tirzepatide, which acts on both GLP-1 and GIP receptors, produced larger drops in its trials. Tirzepatide is the drug the FDA has approved for this use.
What happens if you stop tirzepatide?
Weight tends to come back. In the SURMOUNT-4 trial, people who switched to placebo after 36 weeks regained 14% of their body weight over the next year. Because the sleep apnea benefit is thought to come mainly from weight loss, it's reasonable to expect sleep apnea to worsen if the weight returns.
Who should not take tirzepatide?
The FDA says it shouldn't be used by people with a personal or family history of medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome type 2, or by anyone who has had a severe allergic reaction to it. It also carries warnings about pancreatitis, gallbladder problems and other risks to discuss with your doctor.
Sources
- FDA approves first medication for obstructive sleep apnea
- Tirzepatide for the treatment of obstructive sleep apnea and obesity
- Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT-4 randomized clinical trial
- Effect of liraglutide 3.0 mg in individuals with obesity and moderate or severe obstructive sleep apnea: the SCALE Sleep Apnea randomized clinical trial
- Comparative effectiveness of continuous positive airway pressure and glucagon-like peptide-1 receptor agonists in obstructive sleep apnea: a network meta-analysis of randomised trials
- Tirzepatide injection
- Sleep apnea: treatment
- Sleep apnea: causes and risk factors
About this article
- Research
- 8 published sources, listed above.
- Evidence
- Strong. How we rate it
- Last checked
- October 26, 2026
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* This content is for informational and educational purposes only and is not medical advice. It is not intended to diagnose, treat, cure or prevent any disease or health condition. Talk to a qualified healthcare provider about your health.