The SURMOUNT-OSA trial evaluated the impact of the weight loss drug tirzepatide in obese patients with obstructive sleep apnea (OSA). The primary endpoint assessed was a change in the apnea-hypopnea index (AHI) after 52 weeks in individuals on the drug compared to placebo. There were robust decrements in AHI with resolution of OSA in approximately 50% of subjects. These impressive results raise the question: what role will this medication play in routine management of OSA? This Forum article asked four opinion leaders to give their views. All agreed that tirzepatide will play a major role, but there were different opinions as to what that role will be. There was a fairly broad view that the role in primary treatment would be limited, given how long it takes to get an effect, whereas CPAP gives immediate benefit. Thus, initially the drug will likely be used in concert with CPAP. After weight loss is achieved, there will be consideration as to whether CPAP can be stopped. Opinion leaders argued that there are opportunities for treatment of obesity hypoventilation syndrome that require study. Other primary outcomes need to be investigated as well. Moreover, studies comparing drug treatment with CPAP need to be considered. The high cost of the drug could increase already existing disparities in care. There are concerns about long-term adherence, but current data are largely about the initial drugs of this type. In conclusion, the precise guidelines for optimal tirzepatide use in OSA remain to be determined.
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