Can a person with mild obstructive sleep apnea (OSA) qualify for Zepbound (gepasiran)?

Eligibility for Zepbound in Patients with Mild Obstructive Sleep Apnea

Yes, a person with mild obstructive sleep apnea (OSA) can qualify for Zepbound (tirzepatide) if they also have obesity, as the FDA has approved tirzepatide for managing OSA in adults with obesity regardless of OSA severity.

Understanding OSA and Zepbound Approval

Zepbound (tirzepatide) received FDA approval in 2024 for managing obesity in adults with obstructive sleep apnea 1. The approval was based on clinical trials showing significant improvements in OSA parameters, including:

• Reduction in apnea-hypopnea index (AHI)
• Decreased hypoxic burden
• Improved sleep-related patient-reported outcomes
• Reduced high-sensitivity C-reactive protein (hsCRP) concentration
• Lowered systolic blood pressure 2

Eligibility Criteria for Zepbound in OSA

To qualify for Zepbound with mild OSA, patients must meet these criteria:

1. Diagnosis of OSA: Confirmed by sleep study with AHI of 5-15 events/hour (mild OSA classification)
2. Obesity: Must have obesity (typically BMI ≥30 kg/m²)
3. Age: Adult (18 years or older)

Clinical Considerations for Mild OSA

While mild OSA may seem less concerning, it's important to recognize that:

• Sleep-disordered breathing tends to worsen over time and does not spontaneously resolve 3
• REM-predominant OSA (common in mild OSA) can cause significant oxygen desaturation despite a "mild" overall AHI 3
• Mild OSA is associated with increased cardiovascular risk, particularly if REM-predominant 3

Treatment Algorithm for Mild OSA

1. First-line approaches for all patients with mild OSA:

   • Weight reduction to BMI ≤25 kg/m² (if overweight/obese)
   • Behavioral modifications (avoiding alcohol/sedatives before bedtime, physical exercise)
   • Positional therapy for position-dependent OSA 3

2. For patients with mild OSA and obesity:

   • Consider Zepbound (tirzepatide) if other approaches have been insufficient
   • Especially appropriate if patient has:
     • Excessive daytime sleepiness (ESS ≥10)
     • Comorbidities like hypertension, diabetes, or cardiovascular disease
     • Intolerance to PAP therapy or mandibular advancement devices

3. Alternative treatments to consider:

   • Mandibular advancement devices (MADs) - recommended for mild to moderate OSA 4
   • CPAP therapy - gold standard but limited effectiveness in milder OSA 5

Monitoring and Follow-up

For patients with mild OSA on Zepbound:

• Regular assessment of symptoms and treatment adherence
• Follow-up sleep study to assess treatment efficacy
• Monitoring of cardiovascular and metabolic parameters 3

Potential Benefits Beyond OSA

Zepbound may provide additional benefits for patients with mild OSA:

• Significant weight reduction
• Improved metabolic parameters
• Potential reduction in OSA-associated comorbidities like hypertension (39%), depression (19%), and diabetes (15%) 6

Caution

The most common adverse events with tirzepatide are gastrointestinal in nature (mostly mild to moderate in severity) 2. Patients should be counseled about these potential side effects before starting treatment.

Remember that while the FDA has approved Zepbound for OSA with obesity, the treatment approach should prioritize addressing the underlying causes of OSA, particularly weight management, which remains a cornerstone of therapy for mild OSA 4, 3.