Tirzepatide for Obesity-Related Obstructive Sleep Apnea: Beyond Weight Loss Toward Reductions in Hypoxic Burden and Cardiometabolic Risk Markers

Obesity is a major modifiable driver of obstructive sleep apnea (OSA), contributing to upper-airway obstruction, nocturnal hypoxemia, and cardiometabolic burden.Tirzepatide, a dual glucose-dependent insulinotropic polypeptide receptor/ glucagon-like peptide-1 receptor agonist, offers an upstream approach through weight reduction and improved metabolic regulation.This review examines the mechanistic rationale and clinical evidence for tirzepatide in obesity-related OSA, with attention to therapeutic positioning, Asian and Korean generalizability, and research priorities.In adults with obesity and moderate-to-severe OSA, tirzepatide substantially reduced the apnea-hypopnea index, body weight, and sleep apnea-specific hypoxic burden and improved selected cardiometabolic risk markers, with or without positive airway pressure (PAP).These findings supported the approval of tirzepatide by the U.S. Food and Drug Administration as the first medication for the treatment of moderate-to-severe OSA in adults with obesity.Post hoc analyses indicate that respiratory improvements are closely linked to achieved weight loss, while mediation analyses suggest that improvement in sleep-disordered breathing may contribute to selected inflammatory and metabolic benefits.Tirzepatide therefore expands treatment beyond airway stabilization toward upstream adiposity-related disease mechanisms, although its longterm role will depend on evidence regarding durability, broader patient populations, PAP integration, and cardiovascular outcomes.