Metabolic miracle or misguided shift? Tirzepatide in the era of obstructive sleep apnea (OSA)

Obstructive sleep apnoea (OSA) is a prevalent disorder marked by recurrent upper airway obstruction during sleep, often linked to obesity and poor continuous positive airway pressure (CPAP) adherence. Tirzepatide, a dual GIP and GLP-1 receptor agonist approved for weight loss, has garnered interest as a potential pharmacologic option for OSA due to its weight-reducing effects. While early studies show modest reductions in apnoea-hypopnoea index and improved sleep quality, these benefits are indirect and fail to address the anatomical basis of OSA. Moreover, concerns about long-term efficacy, weight regain post-discontinuation, and adverse effects such as gastrointestinal symptoms and pancreatitis limit its standalone use. Tirzepatide may complement, but not replace, first-line therapies like CPAP. Future research should assess its role within integrated treatment models and clarify its impact on airway mechanics. Caution is warranted to avoid overreliance on pharmacologic solutions at the expense of established, effective interventions in managing this multifactorial condition. Further research should evaluate the integrated models that combine pharmaceutical therapy with lifestyle and mechanical therapies, investigate the direct impact on airway mechanics, and use the artificial intelligence to identify responders and optimize personalized treatment strategies.