• Atul Malhotra, Ronald R Grunstein, Ingo Fietze, Terri E Weaver, Susan Redline, Ali Azarbarzin, Scott A Sands, Richard J Schwab, Julia P Dunn, Sujatro Chakladar, Mathijs C Bunck, Josef Bednarik, and SURMOUNT-OSA Investigators.
• From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.).
• N. Engl. J. Med. 2024 Jun 21.

BackgroundObstructive sleep apnea is characterized by disordered breathing during sleep and is associated with major cardiovascular complications; excess adiposity is an etiologic risk factor. Tirzepatide may be a potential treatment.MethodsWe conducted two phase 3, double-blind, randomized, controlled trials involving adults with moderate-to-severe obstructive sleep apnea and obesity. Participants who were not receiving treatment with positive airway pressure (PAP) at baseline were enrolled in trial 1, and those who were receiving PAP therapy at baseline were enrolled in trial 2. The participants were assigned in a 1:1 ratio to receive either the maximum tolerated dose of tirzepatide (10 mg or 15 mg) or placebo for 52 weeks. The primary end point was the change in the apnea-hypopnea index (AHI, the number of apneas and hypopneas during an hour of sleep) from baseline. Key multiplicity-controlled secondary end points included the percent change in AHI and body weight and changes in hypoxic burden, patient-reported sleep impairment and disturbance, high-sensitivity C-reactive protein (hsCRP) concentration, and systolic blood pressure.ResultsAt baseline, the mean AHI was 51.5 events per hour in trial 1 and 49.5 events per hour in trial 2, and the mean body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) was 39.1 and 38.7, respectively. In trial 1, the mean change in AHI at week 52 was -25.3 events per hour (95% confidence interval [CI], -29.3 to -21.2) with tirzepatide and -5.3 events per hour (95% CI, -9.4 to -1.1) with placebo, for an estimated treatment difference of -20.0 events per hour (95% CI, -25.8 to -14.2) (P<0.001). In trial 2, the mean change in AHI at week 52 was -29.3 events per hour (95% CI, -33.2 to -25.4) with tirzepatide and -5.5 events per hour (95% CI, -9.9 to -1.2) with placebo, for an estimated treatment difference of -23.8 events per hour (95% CI, -29.6 to -17.9) (P<0.001). Significant improvements in the measurements for all prespecified key secondary end points were observed with tirzepatide as compared with placebo. The most frequently reported adverse events with tirzepatide were gastrointestinal in nature and mostly mild to moderate in severity.ConclusionsAmong persons with moderate-to-severe obstructive sleep apnea and obesity, tirzepatide reduced the AHI, body weight, hypoxic burden, hsCRP concentration, and systolic blood pressure and improved sleep-related patient-reported outcomes. (Funded by Eli Lilly; SURMOUNT-OSA ClinicalTrials.gov number, NCT05412004.).Copyright © 2024 Massachusetts Medical Society.

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