By Brandon Peters, M.D.

Zepbound (tirzepatide) is a prescription drug used to treat obesity, diabetes, and obstructive sleep apnea. As it induces weight loss, this may improve crowding of the upper airway that may contribute to snoring and sleep apnea. Research suggests that it may be an effective tool in long-term management. Zepbound may have side effects, however, and careful consideration of the risks and benefits may inform its use.

Use of Zepbound

Zepbound is available via prescription only. One of the glucagon-like peptide-1 (GLP-1) receptor agonist medications, Zepbound is self-administered via a weekly injection. The 2.5 mg dose is started once weekly for 4 weeks. If tolerated, it may be increased by 2.5 mg monthly to a maximum dose of 15 mg via weekly injection. Due to the gradual increase, it will take 5 months to reach the maximum dose.

It may reduce excess body weight in adults who are overweight or obese (the latter defined as a body mass index, or BMI, above 30 kg/m2). It is also approved to treat moderate-to-severe obstructive sleep apnea (OSA)—with an apnea-hypopnea index (AHI) >15 events per hour—in adults with obesity. It is meant to be used in combination with a reduced-calorie diet and increased physical activity.

It is the first medication to be approved for the treatment of sleep apnea. The use of Zepbound to treat sleep apnea was approved by the U.S. Food and Drug Administration (FDA) on December 20, 2024. This approval was based on the results of the SURMOUNT-OSA trial, reported in the New England Journal of Medicine in June 2024. This pivotal trial showed that people on Zepbound for 1 year reduced, on average, their weight by 20% and their sleep apnea severity by 50.7%. This means that a lot of study subjects with moderate to severe sleep apnea were able to normalize their breathing, although sleep apnea persisted to a lesser degree in many.

How It Works

More research is needed to fully understand how these medications work. Generally, Zepbound selectively binds to and activates glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors. This may help to reduce appetite and caloric intake. As weight loss occurs, fat tissue that is deposited at the base of the tongue and along the upper airway may be reduced and this will gradually increase airflow. It may also reduce pressure on the lungs, increasing lung capacity and allowing more air movement. These changes may resolve snoring and sleep apnea.

Pros

It may address excessive weight, the most reversible and frequent root cause of sleep apnea in certain people.
It may reduce the severity of sleep apnea, allowing for other treatment options (i.e., oral appliance, Inspire placement) or the cessation of treatment if the condition resolves.
It may benefit weight-related medical conditions, including diabetes, hyperlipidemia, hypertension, fatty liver disease, and cardiovascular (i.e., heart attack, heart failure, heart arrhythmia) and cerebrovascular (i.e., stroke, dementia) disease.

Cons

Weight loss is gradual and benefit may not be derived for months or years into treatment.
It may reduce sleep apnea severity, but the condition may persist.
It may not resolve sleep apnea in people who have other anatomy or risk factors contributing to the condition.
It must be used long-term (lifelong) to maintain the reduced weight. If stopped, the excessive weight may come back.
It may be expensive and not covered by insurance.
It may be inaccessible due to demand and production/inventory issues.

Who Should Not Use Zepbound

Zepbound should not be used in people with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). The signs of thyroid tumors include a mass in the neck, difficulty swallowing or breathing, and persistent hoarseness.

Anyone with a prior hypersensitivity reaction, such as anaphylaxis or angioedema, to the medication should also abstain from use.

Due to the delay of gastric emptying, Zepbound may reduce the efficacy of oral hormonal contraceptives for 4 weeks after initiating, or changing the dose of the medication, and barrier contraceptive (i.e., condom) use is recommended during this interval. Weight loss is not recommended during pregnancy. There are no data on its use during breastfeeding.

The medication should not be taken with other tirzepatide-containing products or with any glucagon-like peptide-1 (GLP-1) receptor agonists.

Side Effects

Common

The most common side effects relate to gastrointestinal complaints, and the adverse reactions (listed from most to least common) may include:

Nausea
Diarrhea
Vomiting
Constipation
Stomach pain
Upset stomach
Injection-site reactions
Fatigue
Hypersensitivity
Belching
Hair loss
GERD
Flatulence (farting)
Bloating
Dizziness
Hypotension (low blood pressure)

Severe

At the highest dose (15 mg), 3.1% of people report severe gastrointestinal issues. Vomiting may contribute to dehydration and volume depletion, potentially triggering acute kidney injury or failure. Gallstones (cholelithiasis or cholecystitis) affected 1.1% of people, compared to 1% of controls. Acute pancreatitis, which may be fatal, has rarely been observed with GLP-1 treatment.

Hypersensitivity to the medication, including anaphylaxis, has been noted in 0.1% of users.

As Zepbound lowers blood glucose levels, this can lead to hypoglycemia, especially when used with other medications to treat diabetes. It may also worsen diabetic retinopathy and caution is advised in this condition.

As it delays gastric emptying, there may be an increased risk of pulmonary aspiration in the context of surgery.

Suicidal thoughts or behaviors have been reported with other weight management products and monitoring for mood changes may be indicated.

When to Check With Your Healthcare Provider

If you are experiencing side effects, especially with the initiation of the medication or an increase in its dose, check in with the prescribing provider. It may be necessary to lower the dose or discontinue the use of Zepbound. Any medication changes should be made in consultation with your medical professional.

Summary

Zepbound may be an effective long-term treatment for moderate to severe obstructive sleep apnea in people with obesity. The side effects are generally tolerable, and the gradual loss of weight may provide other health benefits. Due to the slow effects, people should initiate treatment with continuous positive airway pressure (CPAP) therapy for immediate relief of the condition. The CPAP pressure settings may be gradually reduced and a repeat sleep study may be indicated once weight loss plateaus to evaluate whether the condition has resolved. Insurance coverage may vary, and cost and access issues are common barriers to treatment. If stopped, gradual weight gain is likely to occur. Those who use Zepbound in combination with a reduced-calorie diet, increased physical activity, and ongoing CPAP therapy will derive the greatest benefit from its use.

Sleep apnea is a serious sleep disorder that affects millions of people worldwide, characterized by repeated interruptions in breathing during sleep. One of the factors that can significantly contribute to the development of obstructive sleep apnea (OSA) is neck size. A larger neck circumference can indicate excess fat deposition around the throat, which may lead to airway obstruction during sleep. Understanding the relationship between neck size, snoring, and sleep apnea can help in identifying at-risk individuals and implementing effective preventive measures and treatments.

Understanding Sleep Apnea

Sleep apnea primarily manifests as obstructive sleep apnea, where the muscles in the throat relax excessively during sleep, leading to partial or complete blockage of the airway. This condition can cause a range of symptoms, including loud snoring, gasping or choking during sleep, excessive daytime sleepiness, irritability, and difficulty concentrating. If left untreated, sleep apnea can lead to serious health complications such as cardiovascular disease, diabetes, and cognitive impairments.

The Role of Neck Size in Sleep Apnea

Anatomical Factors:

The size and shape of an individual's neck can play a significant role in the risk of developing sleep apnea. A larger neck circumference often indicates excess fatty tissue around the neck and throat, which can lead to constriction of the airway during sleep. This constriction can cause the airway to collapse, leading to apneic episodes where breathing temporarily stops.

Measurement of Neck Circumference:

Neck circumference is an important measurement that can be used to assess the risk of sleep apnea. Generally, a neck circumference of greater than 17 inches (43 cm) in men and greater than 16 inches (41 cm) in women is considered a risk factor for OSA. Health professionals often use neck circumference as part of a comprehensive assessment to identify individuals who may benefit from further evaluation through a sleep study.

Body Composition:

Neck size can also provide insight into an individual's body composition and distribution of fat. Excess weight, particularly around the neck, can significantly increase the risk of airway obstruction during sleep. Research has shown that individuals with higher body mass indexes (BMIs) and larger neck circumferences are at a greater risk for OSA. Research suggests an increased neck circumference is strongly associated with the severity of sleep apnea, independent of overall body weight.

Fat Distribution and Its Impact:

The way fat is distributed in the body can affect airway function. In some individuals, fat accumulation around the neck can lead to a narrowing of the upper airway. This is particularly concerning for those with a larger neck size, as the additional tissue can lead to increased pressure on the airway during sleep, increasing the likelihood of snoring and apnea events.

Snoring and Its Connection to Neck Size

Snoring Mechanics: Snoring occurs when the flow of air through the mouth and nose is partially obstructed, leading to vibrations of the throat tissues. Larger neck circumferences correlate with increased fat tissue deposited in the base of the tongue and can contribute to snoring by narrowing the airway, causing turbulence in airflow. This turbulence can lead to the characteristic sound of snoring.
The Sleep Position Factor: Neck size can also influence a person's preferred sleep position. Individuals with larger necks may be more likely to sleep on their backs, which can exacerbate snoring and sleep apnea symptoms. In this position, gravity can cause the tongue and soft tissues of the throat to fall backward, further narrowing the airway.
Increased Resistance: The presence of excess tissue in the neck region can lead to increased resistance to airflow during sleep. This increased resistance can contribute to the development of both snoring and obstructive sleep apnea, as the body struggles to maintain adequate airflow despite the obstruction.

Risk Factors Associated with Larger Neck Size

Obesity: There is a strong correlation between obesity and increased neck circumference. Individuals who are overweight are more likely to have excess fat around the neck, and within the base of the tongue, which contributes to sleep apnea risk. Studies have shown that weight loss can lead to a significant reduction in neck circumference and improvements in sleep apnea symptoms.
Age: As individuals age, muscle tone and tissue elasticity decrease. This can contribute to an increase in neck circumference as well as a higher likelihood of airway obstruction during sleep. Older adults may experience more pronounced effects of neck size on sleep quality and apnea severity.
Gender: Research indicates that men are more likely to develop sleep apnea than women, in part due to differences in body composition and fat distribution. Men typically have larger necks and more fat deposition within the airway, increasing their risk of OSA. However, post-menopausal women may experience an increased risk due to hormonal changes that promote fat accumulation in the neck region.

Managing the Impact of Neck Size on Sleep Apnea

Weight Management:

Maintaining a healthy weight is crucial for reducing neck circumference and minimizing the risk of sleep apnea. Weight loss can lead to a decrease in fat deposits around the neck, improving airway patency during sleep. A combination of a balanced diet and regular physical activity is essential for effective weight management.

Sleep Positioning:

Individuals with larger neck sizes may benefit from adjusting their sleep positions. Sleeping on one’s side can help prevent airway collapse and reduce the risk of snoring and apneic events. Specialized pillows and positional therapy devices can assist in maintaining a side-sleeping position.

CPAP Therapy:

Continuous positive airway pressure (CPAP) therapy is a common treatment for sleep apnea that helps keep the airway open during sleep. For individuals with larger neck sizes, CPAP may be particularly beneficial in preventing airway obstruction and improving overall sleep quality.

Oral Appliances:

Dental devices designed to reposition the jaw and tongue can help keep the airway open during sleep. These oral appliances may be suitable for individuals with mild to moderate sleep apnea, particularly those who prefer not to use CPAP.

Regular Sleep Evaluations:

Individuals with larger neck sizes or other risk factors for sleep apnea should consider regular sleep evaluations. A sleep study can help diagnose sleep apnea and guide appropriate treatment options. Monitoring symptoms and undergoing periodic assessments can help manage the condition effectively.

Conclusion

Neck size is a significant factor in the development and severity of sleep apnea, particularly obstructive sleep apnea. A larger neck circumference can indicate excess fat deposition that may lead to airway obstruction during sleep, contributing to snoring and apneic episodes. Understanding this relationship can help identify at-risk individuals and implement effective prevention and treatment strategies.

Maintaining a healthy weight, making lifestyle changes, and consulting with healthcare providers can significantly improve sleep quality and overall health for those affected by sleep apnea. By addressing neck size and its implications, individuals can take proactive steps toward better sleep and a healthier life.

This article was created using OpenAI’s ChatGPT on August 2, 2024 and it was personally reviewed and edited by Brandon Peters, M.D. to ensure its accuracy. This use of augmented intelligence in this way allows the creation of health information that can be trusted.

Zepbound: Injection for Sleep Apnea Treatment