ORCID

0009-0000-3628-6571 (Ahn), 0000-0002-2231-3564 (Admire), 0000-0002-6642-8953 (Sill)

Document Type

Article

Publication Date

2026

DOI

10.1007/s44470-026-00110-x

Publication Title

Journal of Clinical Sleep Medicine

Volume

22

Issue

1

Pages

102

Abstract

Introduction

Obstructive sleep apnea (OSA) is a well-established risk factor for cardiovascular disease. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated potential in reducing cardiovascular risk and improving OSA severity. However, a significant knowledge gap remains regarding the impact of GLP-1RAs on cardiovascular events in OSA patients.

Methods

We examined patients with a BMI over 30 diagnosed with OSA between January 2010 and November 2021 without a previous diagnosis of heart failure, pulmonary hypertension, or myocardial infarction. Two cohorts were created: those prescribed GLP-1RAs within 1 year of their OSA diagnosis and patients who were never prescribed GLP-1RAs. Propensity score matching was performed using TriNetX software with greedy nearest neighbor methodology. Cox proportional hazards analyses were conducted over a 3-year follow-up period. The primary outcome was newly diagnosed heart failure. Secondary outcomes included pulmonary hypertension, death from all causes, ischemic stroke, and acute myocardial infarction (AMI).

Results

We included 18,774 patients in the GLP-1RA cohort and 847,137 patients in the non-GLP-1RA cohort. Propensity score matching resulted in 18,523 patients remaining in each cohort, which were well-matched in demographics, comorbidities, medications, BMI, and HbA1c. After 3 years, the GLP-1RA cohort had a significantly lower risk of newly developed heart failure (HR, 0.76; 95% CI, 0.71-0.82), pulmonary hypertension (HR, 0.67; 95% CI, 0.59-0.75), AMI (HR, 0.76; 95% CI, 0.67-0.86), and death from all causes (HR, 0.57; 95% CI, 0.51-0.63).

Conclusion

GLP-1RAs were associated with reduced risks of heart failure, pulmonary hypertension, AMI, and death from all causes in obese OSA patients. Prospective studies are needed for validation.

Brief summary

GLP-1 receptor agonists (GLP-1RAs) have shown promising potential in reducing cardiovascular risk and alleviating the severity of obstructive sleep apnea (OSA), a well-known risk factor for cardiovascular disease. However, a significant knowledge gap remains regarding the impact of GLP-1RAs on cardiovascular events specifically in patients with OSA. With 3 years of follow-up, the GLP-1RAs reduced newly developed heart failure by 24%, pulmonary hypertension by 33%, acute myocardial infarction by 24%, and death by 43%, with notable early separation in heart failure and all-cause mortality. This finding supports the potential for broader use of GLP-1RAs in this population, not only to improve OSA severity, but also to reduce cardiovascular risk.

Rights

© 2026 The Authors.

This article is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original authors and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Data Availability

Article states: "Data used in this study were obtained from the TriNetX research network. Restrictions apply to the availability of these data, which were used under license for the current study and are therefore not publicly available. Data supporting this study may be shared upon reasonable request to the corresponding author."

Original Publication Citation

Ahn, J., Song, J., Admire, K., Chang, Y., Chi, K. Y., Gordon, N. T., & Sill, J. M. (2026). Glucagon-like peptide receptor agonists (GLP-1RAs) as cardiovascular risk modifiers in obstructive sleep apnea and obesity: A real-world study. Journal of Clinical Sleep Medicine, 22(1), Article 102. https://doi.org/10.1007/s44470-026-00110-x

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