American Academy of Sleep Medicine publishes prescribing guidance for tirzepatide in OSA

The American Academy of Sleep Medicine (AASM) published guidance on September 3, 2025, walking sleep clinicians through how to prescribe tirzepatide, sold as Zepbound, for obstructive sleep apnea (OSA) ^[1]. The guidance follows the FDA's December 2023 approval of tirzepatide as the first medication indicated for moderate-to-severe OSA in adults who also have obesity ^[1].

The core message: tirzepatide is "a tool, not a cure," and works best when combined with lifestyle interventions and continued OSA therapy such as CPAP ^[1]. The AASM specifically warns that CPAP should not be discontinued without proper reassessment ^[1]. Patients should also understand this may be long-term therapy, similar to blood pressure medication, because stopping the drug may reverse improvements in apnea-hypopnea index (AHI) and OSA severity gained while on it ^[1].

The guidance draws on the SURMOUNT-OSA trial, which tested tirzepatide against placebo in adults with moderate-to-severe OSA (AHI of 15 or higher) and obesity, including both CPAP users and non-users ^[1]. All participants in the trial also received lifestyle counseling on diet and exercise, which the AASM says is essential to replicating the results in real-world practice ^[1]. The trial found clinically meaningful improvements in AHI and patient-reported sleep quality, along with improvements in cardiovascular risk factors tied to both OSA and obesity ^[1]. Side-effect dropout rates were low, and the safety profile matched other incretin-based drugs ^[1].

The AASM also flags practical barriers. Board certification in obesity medicine is not required to prescribe tirzepatide, but the guidance recommends prescribers understand side effects, titration, nutrition and drug interactions, and consider partnering with a dietitian or behavioral specialist ^[1]. The drug is contraindicated for people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia type 2, and requires caution in patients with gastroparesis, pancreatitis, gallbladder disease, kidney failure or eating disorders ^[1]. On cost, Eli Lilly's list price for Zepbound is $1,086.37 per fill, though out-of-pocket costs vary by insurance ^[1]. Some Medicare plans cover Zepbound for OSA but not for weight loss alone, and CMS is weighing expanded coverage of anti-obesity medications starting in 2026 ^[1]. CVS Health has said it will drop Zepbound from its covered drug list as of July 1, 2025, which the AASM calls an access issue for many patients ^[1].

Why it matters for patients

For people with sleep apnea and obesity considering or already taking tirzepatide, this guidance sets expectations clinicians are being told to convey: the drug is meant to work with existing OSA treatment, not instead of it, and stopping CPAP on your own without medical reassessment carries risk ^[1]. It also signals that many patients should plan for tirzepatide as an ongoing medication rather than a short course, since the SURMOUNT-4 trial found that stopping treatment was linked to weight regain and loss of cardiometabolic benefits ^[1]. The guidance additionally warns clinicians to counsel patients away from compounded tirzepatide products sold online, saying they are not FDA-regulated, may not contain the correct active ingredient, and carry safety risks ^[1]. Insurance coverage remains inconsistent and prior authorization is often required, meaning access can vary widely depending on a patient's specific plan ^[1].

What happens next

CMS is considering expanding Medicare coverage of anti-obesity medications beginning in 2026, which could affect access for OSA patients on tirzepatide ^[1]. CVS Health's exclusion of Zepbound from its covered drug list took effect July 1, 2025, and its practical impact on patients is likely to continue playing out ^[1]. The AASM says it expects clinics to field more patient questions about treatment duration and CPAP discontinuation as tirzepatide use in sleep medicine grows ^[1].