Episode 146: Tirzepatide and Sleep Apnea

[00:00:00] Welcome back to the Back on Track, Achieving Healthy Weight Loss, where I help you get

[00:00:05] on track and stay on track with your weight loss journey. I'm your host, Dr. Alicia Shelly.

[00:00:11] So let's get started. Welcome to the Back on Track, Achieving Healthy Weight Loss podcast.

[00:00:33] I'm your host, Dr. Alicia Shelly. So approximately 39 million US adults have

[00:00:40] obstructive sleep apnea, and 936 million adults worldwide are estimated to have mild to severe

[00:00:49] obstructive sleep apnea. Now, obstructive sleep apnea is a common condition where the upper airway

[00:00:56] becomes blocked while sleeping, and one of the most common risk factors for obstructive sleep

[00:01:02] apnea is obesity. So it was no surprise to me when I learned that last week there was a press release

[00:01:11] about a study looking at terzepatide, which is the generic for manjarro and zephan,

[00:01:17] and sleep apnea. But before we get to that press release, let's learn a little bit more

[00:01:23] about what sleep apnea actually is. Now, there are two types of sleep apnea. Obstructive

[00:01:29] sleep apnea, which is when the upper airway becomes blocked during sleep and interferes with

[00:01:35] breathing. And then you have central sleep apnea. And that's when the muscles and nerves

[00:01:41] aren't activated enough for breathing while asleep. And it can cause pauses in airflow.

[00:01:47] Now, and the reason why we care about sleep apnea is because if untreated, sleep apnea can

[00:01:55] increase your risk for insulin resistance, type 2 diabetes, high blood pressure,

[00:02:02] abnormal cholesterol levels, high blood sugar, stroke, kidney disease, sexual dysfunction,

[00:02:09] coronary artery disease like heart failure and age refibulation. So it can cause a lot of medical

[00:02:16] problems just because it's untreated. And you know what? There are many health conditions

[00:02:22] that can increase the risk of sleep apnea, such as hypothyroidism, cleft lip or cleft palate.

[00:02:29] Heart disease can make it worse, kidney disease can make it worse,

[00:02:33] large tonsils can make it worse, having obesity or higher weight, PCOS and even menopause

[00:02:41] can increase your risk for sleep apnea just due to the changes in the hormone

[00:02:46] that impact the weight and upper airway anatomy. So there are many things that can put you at risk.

[00:02:53] Now, how do you know if you have sleep apnea? Well, some of the most common symptoms are just

[00:02:59] excessive daytime sleepiness. You go to sleep, you wake up and you feel like you didn't sleep,

[00:03:05] like you just wake up unrested. You can have loud snoring. I know I went camping and I heard

[00:03:12] all types of loud snoring, so it can happen. But then you can have observed episodes of just you

[00:03:18] stop breathing where you're sleeping and then all of a sudden you're like, oh, and then you may,

[00:03:23] somebody may have to nudge you for you to wake up, for you to breathe again, or you may wake

[00:03:28] up gasping or coughing. And then sometimes people may have a dry mouth or sore throat when

[00:03:33] they wake up in the morning. And then people can have morning headaches as well. And sometimes

[00:03:39] we notice that people may have or suspect they may have sleep apnea if their blood pressure is

[00:03:44] really hard to control. That can be another increased risk or common symptoms for sleep

[00:03:50] apnea. Now, let's say if you want to be diagnosed or you're trying to diagnose with

[00:03:54] sleep apnea. Well, the first thing is to get diagnosed, you need to do a sleep study. And

[00:03:59] so they have several types of sleep studies. The most common one is when you go into the

[00:04:04] sleep clinic, and they have you sleep there overnight, they put leads on your head, oxygen,

[00:04:10] put something on your chest to check your heart or check your breathing, make sure your

[00:04:15] oxygen levels okay, and to check your brain waves. So that's the most common one. And

[00:04:20] that's called your polysomnography. But then they have one where you can go home or a home

[00:04:24] sleep test where you do it in your bed. And that one doesn't have all the leads, but usually

[00:04:30] they'll either have a watch or they put a lead around your chest and something in your nose to

[00:04:35] check your oxygen and something on your finger. So it just depends, there's many different ones

[00:04:39] out there. But that one is a little bit easier because it's in your bed. And because it's

[00:04:43] portable is a little bit less expensive. Sometimes depending on insurance, these tests can be a

[00:04:48] little bit pricey, but it just depends on the insurance too. But once you get the sleep

[00:04:54] study, they look at this number called the hypoapnea index. And so this index actually

[00:05:03] will diagnose you whether you're mild, moderate or severe sleep apnea. And it measures the

[00:05:08] number of times that your breathing was stopped or hindered you as you sleep.

[00:05:14] And so the difference between so you can have mild sleep apnea if your AHA is between five

[00:05:22] and 14. Between that range, you may just feel maybe a little bit tired, feel a little asymptomatic.

[00:05:29] But when you go up to the moderate level, which is 15 to 30 events per hour, then you

[00:05:35] can have a lot of occasional daytime sleepiness where you're falling asleep while driving,

[00:05:41] you may be sitting in your chair recliner after eating a meal and you're like knocked out.

[00:05:46] Yeah. So that would be more your moderate. And then the severe is when your events per

[00:05:53] hour is greater than 30. And that is interfering with your normal daily activities, your waking

[00:06:00] up just feeling like you ran a marathon during your sleep. Sometimes it can be hard

[00:06:04] to focus during the day, you have morning headaches, your blood pressure is out of

[00:06:08] control. And so that's when definitely you need to get treated. And so how they treat

[00:06:15] sleep apnea is actually through using a CPAP or a BiPAP, depending on which one you need.

[00:06:22] And this is a machine that is like either a mask or they have like the different nasal prongs

[00:06:28] or they have different ones out there and you wear it at night time and it's giving

[00:06:33] you oxygen so that your oxygen level is not dropping while at night and the pressures like

[00:06:38] it's giving you pressure. So sometimes people can find it a little much because there's a lot of

[00:06:42] air coming at you, but I have to admit the patients that stick with it at least,

[00:06:47] at least a good month, they start to feel better. They don't feel quite as tired.

[00:06:53] They feel like, okay, I'm getting the oxygen I need. I'm getting the sleep that I need.

[00:06:56] So if you suffer with sleep apnea, definitely keep with the CPAP, talk with your sleep

[00:07:04] specialist, talk with your primary care doctor if it's not working for you so they can maybe

[00:07:08] find a way to help. And then also too, there is a surgery called the Inspire where they can place

[00:07:15] that in your body to help with sleep apnea without having to do the mask. So you can talk

[00:07:20] to your sleep specialist for that information. Now, if you're concerned based on what we talked

[00:07:26] about, that you may have symptoms of sleep apnea, then I definitely recommend that you

[00:07:32] talk with your provider about getting you the sleep study and ordering that for you so

[00:07:36] that you can see where you are. Sometimes it's good just to know where you sit. Now,

[00:07:41] now that we learned a little bit more about what sleep apnea is and how they calculate it,

[00:07:45] let's talk a little bit about this press release. So in this press release,

[00:07:49] it talks about this international study that looked at over 469 participants.

[00:07:55] And these were adults living with moderate to severe obstructive sleep apnea,

[00:08:00] and they had obesity. Now, the first study looked at adults who had moderate to severe

[00:08:05] sleep apnea, but they did not want to be on a CPAP or unable to get on a CPAP. For the last

[00:08:11] couple of years, the CPAP had been on backorder. So a lot of people that wanted to get on it,

[00:08:16] they weren't. So those people who were unable to do this. And so they looked at what

[00:08:21] happened over a span of 52 weeks or one year to see what would happen as far as with their

[00:08:27] sleep apnea. And so some individuals were on the terzepotide, and terzepotide is the generic

[00:08:34] for manjarro and zeppon. Half of the other part were on placebo, basically taking a sugar shot.

[00:08:39] And so what they noted at the end of that 52 weeks was that their AHI number was reduced

[00:08:47] by 55% with those who took terzepotide versus 5% of those who took the placebo shot. Like,

[00:08:56] amazing. So they basically decreased their AHI by 55%. So imagine if they had like an AHI of 30,

[00:09:07] it made them go from severe to moderate. And if they were in that moderate range,

[00:09:11] went from moderate to mild. And so that is amazing because a lot of people, I mean,

[00:09:17] it's a lot bad to carry this mass, especially if you go traveling and things of that nature,

[00:09:22] but it's almost reducing your risk of having sleep apnea. And when they looked at the average

[00:09:28] weight loss, it was like 18.1% with those taking terzepotide versus 1.3% of those taking the

[00:09:36] placebo. So definitely terzepotide was really helping people to lose weight.

[00:09:41] Now, the second study looked at people who were already on a CPAP machine and to see how

[00:09:48] terzepotide worked for them. And so once again, they had them same similar study. They just had

[00:09:54] people who were taking terzepotide and a group of people who were taking the placebo shot.

[00:09:59] And after that 52 weeks, they noted that their AHI was reduced by 62.8%

[00:10:08] versus 6.4% with placebo. So it was even higher with the terzepotide as far as the

[00:10:15] reduction of their AHI with the CPAP versus 6.4% of those with placebo. And the average weight

[00:10:22] loss of those taking the terzepotide was 20.1% weight loss, which is what it is normally if you

[00:10:29] normally were to take the 15 milligram. And they only did 10 and 15 milligram doses in this

[00:10:33] study. But what's so impressive is that in this study, people were able to not only lose

[00:10:40] weight, but they were able to improve their sleep apnea, which of course, improved their risk of

[00:10:46] high blood pressure, kidney disease, heart disease, atrial fibrillation, all the things

[00:10:50] that I just mentioned earlier, which is number one, making people be able to have less medical

[00:10:55] complications, live better and be able to live a more healthier life. Now we still need to

[00:11:02] wait for the full study to come out. This was a press release, but it's so reassuring to

[00:11:07] know that terzepotide can help adults improve their sleep apnea and allow them to have a better

[00:11:13] night's rest. Because oh my gosh, how many of us need to get a good night's rest? I know I do,

[00:11:19] and I feel so much better when I do. So I hope this helps. We'll see what happens in the future.

[00:11:25] I know terzepotide is being studied in other different medical conditions like fatty liver,

[00:11:30] PCOS. So it'll be really nice to see the effect and how it can help others live a more healthier

[00:11:37] and have a better life. So I thank you again for joining us on the Back on Track, Achieving

[00:11:44] Healthy Weight Loss. If you liked this episode, please share with others, like it and subscribe,

[00:11:49] and don't forget to leave a five star review, and we'll see you next time.