Sue Clasen kept trying to manage her sleep apnea. She knew a CPAP machine would help her breathe through the night, but none of the masks she wore with it were comfortable enough to actually fall asleep. She bought a special hanger to hold the machine’s hose so she wouldn’t get tangled up in it. She found a pillow with cutouts to cradle the mask. Some nights, she woke up feeling as if she were drowning in the air that streamed out of the machine.

Ms. Clasen, 49, remembers one night a few years ago when she, her husband and her three children were sharing a hotel room. The CPAP’s mask felt bulky and irritating — she just couldn’t sleep with it on. But when she took it off and fell asleep, her husband soon nudged her awake: Her snoring, a common symptom of sleep apnea, was so loud it woke the whole room up.

But since Ms. Clasen started taking Ozempic in February 2023 to lose weight, she has stopped snoring. She no longer needs to nap throughout the day. The worst of her sleep apnea symptoms have vanished.

More Americans with obstructive sleep apnea, the most common form of the disorder, may soon turn to weight-loss drugs.

Two major new clinical trials showed that tirzepatide, which is in the same class of medications as Ozempic and is sold under the brand names Mounjaro and Zepbound, significantly improved symptoms of obstructive sleep apnea in people with obesity. The results were published Friday in a paper in the New England Journal of Medicine and presented at an American Diabetes Association conference in Orlando, Fla. Eli Lilly, which makes tirzepatide and funded the studies, said it had asked the Food and Drug Administration to broaden the use of the Zepbound to include obstructive sleep apnea.

If approved, it would become the first drug specifically cleared to treat the condition, and would give patients another option for managing their sleep apnea. And those who have already seen their symptoms improve after losing weight on similar drugs say the impact has been transformative.

“I’ve got my life back,” Ms. Clasen said.

‘A hot pursuit’

Millions of adults in the U.S. have obstructive sleep apnea, which occurs when someone’s upper airway is blocked during sleep. In some people, that’s because of the anatomy of their airways, necks, tonsils, jaws or tongues. In patients with obesity, the underlying issue is often a buildup of fatty tissue in the tongue, neck and upper airway, said Dr. Vivian Asare, the associate medical director of the Yale Centers for Sleep Medicine. By some estimates, 70 percent of people with obstructive sleep apnea also have obesity.

People with the condition briefly stop and restart breathing as they sleep, preventing them from fully resting. In severe cases, this can happen hundreds of times over the course of a night.

The condition doesn’t just disrupt sleep. If untreated, sleep apnea also raises the risk of heart failure, sudden cardiac death, diabetes, high blood pressure and neurodegenerative diseases, including dementia.

Ms. Clasen was well aware of these risks. Her father-in-law had a heart attack that his doctors attributed to untreated sleep apnea; she kept thinking about him as she tried to find a CPAP mask that fit better.

“I knew how serious it was — I was just like, OK, I have to keep at it, keep trying, I’ll get it right,” she said. “And I just never did.”

CPAP machines are the gold standard of treatment. They pump pressurized air into a mask to keep the upper airway open. Many patients say the devices have changed — and possibly saved — their lives. But many are also reluctant to use them: They may be anxious about what a bed partner will think or are worried the machine could make it harder to sleep. Some have also been affected by widespread recalls of CPAP machines in recent years.

There are other effective but less popular options, including oral appliances that pull the tongue or jaw forward during sleep to open the airway and a surgical implant that stimulates a nerve under the tongue. Doctors also often recommend that patients with obesity lose weight to improve their obstructive sleep apnea, though that can be challenging for many people.

Dr. Sigrid Veasey, a sleep medicine specialist at Penn Medicine, said that some of her patients were so desperate for a solution that they sewed tennis balls onto the backs of their shirts to stop them from sleeping on their backs, which makes snoring worse. The search for more sleep apnea treatments has been “a hot pursuit for a very long time,” she said.

That’s why sleep specialists are so intrigued by the results from the new studies. People with moderate to severe sleep apnea who took a weekly tirzepatide shot had fewer breathing interruptions or periods of shallow, restricted breathing during sleep than those on a placebo. In one trial of about 200 people already on CPAP machines, those who took tirzepatide experienced about 30 fewer of these events per hour on average, compared with six fewer per hour in the placebo group. Patients who were unable or unwilling to use CPAPs saw a similarly strong benefit in another trial.

Researchers don’t yet know whether the drug might benefit people who have less severe cases of obstructive sleep apnea or who do not have obesity, said Dr. Atul Malhotra, the lead author on the new paper. And it’s not clear if weight loss alone improved patients’ symptoms or if the drug had other effects.

“Definitely weight loss helps,” said Dr. Salma Batool-Anwar, a sleep specialist at Brigham and Women’s Hospital in Boston. “But does it actually cure the problem? That’s a question.”

Novo Nordisk, which makes Ozempic, is not studying whether the drug could help with sleep apnea. But the compound in Ozempic and Wegovy is very similar to tirzepatide, and some patients have found that these drugs help their symptoms. That was the case for Denise Cohen, 69, who started taking Ozempic in May 2022 to lose weight and improve her sleep apnea.

After about a year on Ozempic, she realized she had stopped biting her tongue in the night, which she used to do so often it scarred. And she felt rested enough to power through long shifts as a nurse practitioner without drifting off at her desk each afternoon. She eventually stopped using her CPAP machine altogether.

Ms. Clasen’s CPAP machine now sits on a shelf in her closet, collecting dust. On a recent flight to Las Vegas, she slept so soundly the man sitting next to her joked that she looked dead. “All I keep thinking about it is, if that was a year ago, I would have been snoring so loud,” she said.

And when Ms. Clasen arrived, she did something else she could not have imagined while her sleep apnea was severe: She shared a hotel room with her sister. She slept quietly all night.

Source link: https://www.nytimes.com/2024/06/21/well/sleep-apnea-weight-loss-drug.html