Can Zepbound (daridorexant) be used to treat Obstructive Sleep Apnea (OSA)?

Zepbound (Tirzepatide) is NOT Indicated for Obstructive Sleep Apnea Treatment

Zepbound (tirzepatide) is not indicated for the treatment of obstructive sleep apnea (OSA) and should not be used for this purpose. There appears to be confusion in the question, as Zepbound contains tirzepatide (a GLP-1/GIP receptor agonist), not daridorexant (which is a dual orexin receptor antagonist sold under the brand name Quviviq).

Clarification of Medications

1. Zepbound (tirzepatide):

   • A GLP-1/GIP receptor agonist approved for weight management
   • Not indicated for OSA treatment

2. Daridorexant (Quviviq):

   • A dual orexin receptor antagonist
   • Approved for insomnia treatment
   • Has been studied in patients with mild-to-moderate OSA

Evidence-Based OSA Treatment Algorithm

First-Line Therapy

• CPAP therapy is the gold standard first-line treatment for all OSA severities, particularly moderate to severe cases (AHI ≥15/h) 1
• CPAP provides the most effective reduction in AHI, improvement in oxygen saturation, and reduction in daytime sleepiness 1

Second-Line Therapies (for CPAP-intolerant patients)

1. Mandibular Advancement Devices (MADs):

   • Recommended for mild to moderate OSA in patients who cannot tolerate CPAP or prefer alternate therapy 2, 1
   • Custom, titratable oral appliances are superior to non-custom devices 2
   • Requires adequate healthy teeth, no significant TMJ disorder, and adequate jaw range of motion 2

2. BiPAP therapy:

   • Alternative for patients who cannot tolerate CPAP 1

3. Positional therapy:

   • For patients with position-dependent OSA (symptoms primarily when supine) 2, 1
   • Most effective in younger, less obese patients with lower AHI 1

Role of Daridorexant in OSA

While not approved for OSA treatment, research on daridorexant (not Zepbound) shows:

• In patients with mild-to-moderate OSA and comorbid insomnia, daridorexant 50 mg did not worsen respiratory parameters 3, 4, 5
• No clinically relevant effect on AHI or oxygen saturation was observed 5
• It improved sleep parameters (increased total sleep time, decreased wake after sleep onset) 4, 5
• It was well-tolerated in patients with mild-to-moderate OSA 4

However, these studies were limited to mild-to-moderate OSA and focused on safety rather than efficacy for OSA treatment.

Important Considerations and Pitfalls

1. Medication confusion: Zepbound (tirzepatide) and daridorexant are entirely different medications with different mechanisms of action and indications.

2. Off-label use risks: Using medications off-label for OSA without sufficient evidence may delay appropriate treatment and worsen outcomes.

3. Weight management: While weight loss can improve OSA symptoms, and Zepbound is approved for weight management, it should not be prescribed specifically for OSA treatment.

4. Comprehensive approach: Patients with OSA require proper diagnosis and evidence-based treatment, starting with CPAP as first-line therapy 2, 1.

5. Treatment resistance: For CPAP-intolerant patients, a structured approach using established second-line therapies should be followed rather than experimental medications 6.

In conclusion, Zepbound (tirzepatide) should not be used for OSA treatment. Patients with OSA should be treated according to established guidelines, with CPAP as first-line therapy and appropriate second-line options for those who cannot tolerate CPAP.