Description

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Context

The United States Food and Drug Administration (FDA) recently approved Tirzepatide sold under the brand name Zepbound as the first drug for the treatment of Obstructive Sleep Apnea (OSA).

What is OSA?

OSA is a sleep disorder where throat muscles relax excessively during sleep obstructing the airway and causing intermittent breathing disruptions.

Symptoms

Frequent choking or gasping during sleep.

Daytime drowsiness due to unrefreshing sleep.

Loud snoring.

Risk Factors

Obesity: Major contributor to OSA with fat deposits around the neck and tongue aggravating airway blockage.

Other Factors: Anatomical abnormalities like smaller jaws or neuromuscular conditions.

The Role of Tirzepatide (Zepbound)

Mechanism of Action

Tirzepatide is a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 (GLP-1) receptor agonist.

Its weight-loss properties address key OSA risk factors by:

Reducing Fat Accumulation: Especially around the neck and abdomen which alleviates pressure on the respiratory system.

Improving Lung Function: Reduced abdominal fat enhances lung expansion, mitigating airway collapse.

Current Treatment Landscape for OSA

Mechanical Aids

Continuous Positive Airway Pressure machines deliver pressurized air to keep the airway open during sleep. Oral appliances or positional therapy are used in some cases.

Lifestyle Changes

Weight management and regular physical activity. Avoidance of alcohol or sedatives before bedtime.

Surgical Options

For structural abnormalities causing OSA.

Despite these interventions, no pharmacological treatment was available before Tirzepatide's approval.

Other Types of Sleep Apnea

Type of Sleep Apnea	Description	Causes	Symptoms
Central Sleep Apnea (CSA)	Occurs when the brain fails to send the proper signals to the muscles that control breathing.	Disruption in the brain's respiratory control centers, can be caused by heart failure, stroke or brain injury.	Pauses in breathing during sleep, irregular breathing, shortness of breath, difficulty staying asleep.
Complex Sleep Apnea Syndrome (Mixed Sleep Apnea)	A combination of obstructive and central sleep apnea.	A mix of the causes of both OSA and CSA.	Symptoms of both OSA and CSA including snoring, gasping, fatigue and difficulty staying asleep.

Sources:

IndianExpress

PRACTICE QUESTION

Q.Consider the following statements about Sleep Apnea:

Obstructive Sleep Apnea (OSA) occurs when the airway collapses or becomes blocked during sleep due to throat muscle relaxation.
Central Sleep Apnea (CSA) involves the brain's failure to send proper signals to muscles that control breathing.
Both OSA and CSA can lead to disrupted sleep cycles.

Which of the statements given above is/are correct?

(a) 1 only

(b) 1 and 3 only

(d) 1, 2 and 3

Answer: (d)

Explanation:

Statement 1 is correct. Obstructive Sleep Apnea occurs due to physical obstruction in the airway often caused by throat muscle relaxation or fat deposition around the neck.

Statement 2 is correct. Central Sleep Apnea is a neurological condition where the brain fails to send signals to breathing muscles causing pauses in breathing.

Statement 3 is correct. Both conditions can lead to reduced oxygen levels (hypoxemia), fragmented sleep and excessive daytime sleepiness.