Tirzepatide in Obesity-Related Obstructive Sleep Apnea: Beyond Weight Loss Toward Disease Modification?

Background: Obesity is a major driver of obstructive sleep apnea (OSA), traditionally managed as a mechanical disorder of upper airway collapse. However, growing evidence supports a broader pathophysiological model involving metabolic dysfunction, systemic inflammation, and ventilatory instability. Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, has demonstrated substantial weight loss and cardiometabolic benefits, raising the possibility of a paradigm shift in OSA management. Objective: To critically evaluate whether tirzepatide may act as a disease-modifying therapy in obesity-related OSA beyond its effects on weight reduction. Methods: A narrative review was conducted using PubMed, Scopus, and Web of Science up to January 2026. Evidence from randomized controlled trials, meta-analyses, and mechanistic studies on incretin-based therapies in obesity and OSA was synthesized, with emphasis on clinical outcomes and underlying biological pathways. Results: Tirzepatide is associated with significant reductions in apnea–hypopnea index (AHI), accompanied by substantial weight loss. However, emerging data suggest that improvements in OSA severity may not be entirely explained by weight reduction alone. Potential weight-independent mechanisms include modulation of systemic inflammation, improvements in insulin sensitivity, alterations in adipokine profiles, and effects on autonomic regulation and ventilatory control. These pleiotropic effects may influence key components of OSA pathophysiology, including upper airway stability and chemosensitivity. Despite these findings, current evidence remains insufficient to definitively distinguish weight-dependent from weight-independent effects. Conclusions: Tirzepatide represents a promising therapeutic advance in obesity-related OSA, with potential implications extending beyond weight loss toward disease modification. While current data support a substantial role in reducing OSA severity, definitive confirmation of disease-modifying effects requires further mechanistic and long-term clinical studies. This emerging paradigm points to a shift from purely device-based management toward integrated, pathophysiology-driven treatment strategies.