Claims analysis links tirzepatide for sleep apnea to fewer CPAP starts

A claims analysis published by Komodo Health found that in the six months after the FDA approved tirzepatide (Zepbound) for obstructive sleep apnea, new tirzepatide starts among people with OSA rose 16 percent ^[1]. In the same group, only 4 percent of patients with no prior CPAP use who started tirzepatide began CPAP therapy within six months, compared with 22 percent of patients who did not receive a GLP-1 drug — an 83 percent relative difference ^[1].

The FDA approved tirzepatide for OSA in adults with obesity in December 2024, the first drug approved for the condition ^[1]. Komodo, a health data company, said it analyzed claims from nearly 20 million adults diagnosed with OSA, comparing the periods before and after the approval, with data through June 2025 ^[1].

Fewer first-time CPAP starts

Among patients who had never used CPAP, 4 percent of those who started tirzepatide went on to start CPAP within six months, compared with 22 percent of those with no GLP-1 exposure ^[1]. The report describes this as a sign that tirzepatide is often used early in the treatment pathway rather than after a period of device use ^[1].

Among patients already using CPAP, 26 percent of those who started tirzepatide had a six-month gap with no CPAP-related claims, compared with 15 percent of matched patients who did not receive the drug — a 75 percent relative difference ^[1]. The report cautions that a gap in claims cannot be treated as confirmed clinical discontinuation, though it calls the difference a meaningful directional signal ^[1].

Before the approval, 14 percent of patients diagnosed with OSA had received any GLP-1 therapy, compared with 66 percent who received device-based treatment such as CPAP ^[1]. Looking further back into patients' histories, including before their OSA diagnosis, GLP-1 exposure rose to 24 percent ^[1].

The drug was often started soon after diagnosis. Nearly 30 percent of newly diagnosed OSA patients who started tirzepatide did so within 30 days of diagnosis, and 47 percent within 60 days; only 3 percent started more than 270 days after diagnosis ^[1].

Initiation was highest among middle-aged adults: 91 per 1,000 patients with OSA ages 45 to 54, and 87 per 1,000 ages 35 to 44. The rate was lowest among adults 75 and older, at 37 per 1,000 ^[1].

Who writes the prescriptions

Primary care and generalist settings accounted for about 84 percent of new tirzepatide prescriptions for patients with OSA ^[1]. Family medicine physicians wrote 31 percent, nurse practitioners 24 percent, internal medicine physicians 20 percent, and physician assistants 9 percent. Endocrinology, diabetes and metabolism specialists accounted for 6 percent, and sleep medicine for 0.2 percent ^[1].

For context, the report notes that OSA affects roughly 30 million adults in the United States and that obesity is a major risk factor ^[1]. Published estimates cited in the analysis suggest about 39 percent of adults with OSA have moderate-to-severe disease, and 43 to 54 percent of those patients meet criteria for obesity ^[1].

Why it matters for patients

For someone newly diagnosed with OSA, this data suggests the first treatment conversation may increasingly involve a weekly injection rather than a CPAP machine, and that conversation is most likely to happen in a primary care office rather than a sleep clinic ^[1].

The analysis is based on prescriptions and insurance claims. It did not measure breathing scores, daytime sleepiness or other symptoms, so whether patients do better or worse when CPAP is not started has not been reported ^[1]. It also does not show whether tirzepatide replaced CPAP for individual patients or was used alongside it ^[1].

Coverage may shape who gets the drug. Komodo writes that adding OSA to the label opened the door to payer-supported access for patients with obesity-associated OSA, but whether a given insurance plan covers tirzepatide for this use is not described in the analysis ^[1].

The findings also raise a question the data cannot answer: whether fewer sleep specialist visits and fewer CPAP starts translate into less evaluation of a condition linked to hypertension, cardiovascular disease, type 2 diabetes, stroke and cognitive decline ^[1].

What happens next

The figures cover the first six months after the December 2024 approval, from January through June 2025 ^[1]. No schedule for updated numbers has been disclosed.