By Kate Robards, senior writer

In December 2023, the U.S. Food and Drug Administration approved tirzepatide (Zepbound) as the first medication indicated for treating moderate-to-severe obstructive sleep apnea (OSA) in adults who also have obesity. This landmark approval, backed by data from the SURMOUNT-OSA trial, offers a new avenue for improving OSA outcomes in a large patient population that has historically had limited options beyond PAP therapy.

With this milestone comes the challenge of integrating tirzepatide into clinical practice. For sleep clinicians who are not already immersed in obesity medicine, questions may arise about patient selection, monitoring, contraindications, insurance hurdles and more. Here’s what you need to know to navigate this evolving treatment landscape.

OSA and the obesity gap

According to the World Health Organization, adult obesity is defined by a BMI of 30 or higher. In 2022, one in eight people in the world were living with obesity. A 2020 review published in the International Journal of Obesity notes that more than 80% of adult patients with OSA are overweight, and more than 50% meet the criteria for obesity. Despite this connection, obesity is not consistently treated as a chronic disease in clinical practice.

Key findings from the SURMOUNT-OSA trial

The SURMOUNT-OSA trial evaluated tirzepatide versus placebo in adults with moderate-to-severe OSA (AHI ≥15) and obesity, including both CPAP users and non-users. All participants received lifestyle counseling, emphasizing healthy eating and physical activity — elements essential to replicating the study’s outcomes in practice.

Key takeaways include:

• Tirzepatide led to clinically meaningful improvements in AHI and patient-reported sleep quality.
• The medication also significantly improved cardiovascular risk factors associated with both OSA and obesity.
• Its safety profile was consistent with other incretin-based therapies, and dropout rates due to side effects were low.

Importantly, the goal of tirzepatide therapy is not to replace traditional OSA treatments like CPAP, but to provide an adjunctive tool that targets the root cause in many patients: excess weight.

Clinical considerations for prescribing

Tirzepatide is a potent and generally well-tolerated medication, but prescribing it for OSA involves several key considerations.

Who can prescribe tirzepatide?

Board certification in obesity medicine is not required to prescribe tirzepatide. However, prescribers must understand how to manage its side effects, titration schedule, nutritional implications and drug interactions. Partnering with a registered dietitian or behavioral specialist is recommended. Clinicians may also consider collaborating with obesity medicine clinics or utilizing educational resources from the Obesity Medicine Association.

Baseline labs and monitoring

Although no labs are required by the FDA label, many experts recommend a baseline metabolic panel, especially for patients with comorbidities like chronic kidney disease. Regular monitoring can help track weight loss progress, assess hydration status and screen for adverse effects.

Contraindications

Tirzepatide is contraindicated in individuals with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2, as well as those with a known allergy to the medication.

Clinicians should also use caution in patients with conditions such as gastroparesis, pancreatitis, gallbladder disease, renal failure or eating disorders. Additional considerations include patients with uncontrolled diabetes or rapid correction of hyperglycemia, those with depression or suicidal ideation, and individuals who are pregnant or planning to become pregnant, as the drug may interfere with contraception and requires monitoring.

Patient education and support

Patients may arrive with high expectations about what the medication can accomplish. Clear messaging is essential: Tirzepatide is a tool, not a cure, and it works best when combined with lifestyle interventions and continued OSA therapy. CPAP should not be discontinued without proper reassessment.

Patients should also understand that this may be a long-term therapy, much like blood pressure medication. The results of the SURMOUNT-4 clinical trial, published in JAMA, emphasize the need to continue pharmacotherapy to prevent weight regain and ensure improvement in cardiometabolic risk factors.

Discontinuing tirzepatide may affect any reductions in AHI and improvements in OSA severity experienced while on the drug.

Insurance and access: A practical challenge

One of the most significant hurdles is insurance coverage, which varies by plan and provider. According to Eli Lilly, the list price for Zepbound is $1,086.37 per fill, but the out-of-pocket cost depends on insurance plan pricing.

Currently, some Medicare plans with drug coverage may cover Zepbound for treating OSA but not for weight loss alone. However, the Centers for Medicare & Medicaid Services (CMS) is considering expanding coverage of anti-obesity medications beginning in 2026.

Many insurers require prior authorization before covering Zepbound, which can be complex and time-consuming. Clinicians can increase their chances of success by:

• Submitting a clear, one-page letter of medical necessity that outlines FDA approval and the patient’s eligibility
• Documenting comorbid conditions, prior therapies and BMI trends
• Utilizing well-organized templates
• Engaging dedicated staff for navigating the prior authorization process

Despite these efforts, barriers remain. For example, CVS Health recently announced that Zepbound will be excluded from its list of covered drugs as of July 1, 2025, posing an access issue for many patients.

Safety concerns with compounded products

As demand for tirzepatide grows, some patients may turn to compounded formulations offered online or through direct-to-consumer platforms. These products are often cheaper but not FDA-regulated, may not contain the correct active ingredient and pose safety risks. Clinicians should counsel patients to avoid them.

Building a multidisciplinary framework

Implementing tirzepatide in sleep medicine may require a multidisciplinary approach, ideally involving obesity medicine specialists or clinics, registered dieticians, behavioral health professionals and well-trained administrative staff for coverage navigation.

Consider assigning staff members to conduct check-in calls, monitor adherence and side effects and reinforce patient education. Clinics should also prepare for an uptick in patient questions, many of which center on duration of treatment and potential discontinuation of CPAP.

Resources for continued learning

Sleep professionals interested in deepening their knowledge can explore recent educational webinars on tirzepatide and OSA available under the “My Learning” section when logged in to the AASM website.

Additionally, the Obesity Medicine Association offers practical, evidence-based CME and clinical tools for collaborative care.

Final takeaways

Tirzepatide, when combined with lifestyle interventions and existing OSA therapies, is an effective and safe treatment option for patients with moderate-to-severe OSA and obesity.

Successful implementation requires understanding clinical indications and contraindications, a thoughtful approach to patient monitoring and education, and strategies to overcome insurance barriers. As this approach becomes more common, coordinated care and continued education will be key.