Obstructive sleep apnea has been recognized as a significant factor contributing to cardiovascular risks due to repeated airway collapses leading to low oxygen levels and inflammatory stress. A recent study published in the Journal of Clinical Sleep Medicine suggests that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) can significantly reduce these risks. The study involved over 18,000 obese patients with sleep apnea who were prescribed GLP-1 RAs and found them to have lower rates of new-onset heart failure, pulmonary hypertension, heart attacks, and all-cause mortality during a three-year follow-up period.
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Research led by Jaeun Ahn and Joshua M. Sill at Eastern Virginia Medical School, in collaboration with Jacobi Medical Center and National Cheng Kung University Hospital, utilized the TriNetX Global Collaborative Network, which aggregates health records from over 160 million patients. They focused on adults diagnosed with obstructive sleep apnea between January 2010 and November 2021, all with a body mass index over 30, excluding those with pre-existing heart conditions to ensure the outcomes tracked were genuinely new.
The study utilized a retrospective propensity score-matched cohort analysis, with 18,774 patients prescribed GLP-1 RAs including semaglutide, liraglutide, or dulaglutide, compared to 847,137 untreated patients. After matching, each cohort comprised 18,523 individuals with balanced characteristics like age and BMI. Over the follow-up period, new-onset heart failure in the GLP-1 RA group was noted in 1,416 patients versus 1,791 in the untreated group, indicating a 24% reduced risk. Pulmonary hypertension showed a 33% reduction, while the risk of heart attack was also lower among the drug users.
All-cause mortality was markedly different, with 550 deaths in the treated group compared to 945 in the untreated group, equating to a 43% lower risk. Ischemic stroke also trended lower among those using GLP-1 RAs. Kaplan-Meier survival curves indicated that benefits emerged early, suggesting that effects might be due to improvements in endothelial function and reduced inflammation rather than solely weight loss.
Subgroup analyses indicated that each GLP-1 RA had independent associations with lower heart failure risk, with liraglutide, dulaglutide, and semaglutide showing hazard ratios of 0.73, 0.75, and 0.83, respectively. These findings align with growing evidence on the cardiometabolic effects of incretin-based therapies, including evidence from the SURMOUNT-OSA trial that showed improvements in sleep apnea metrics.
While these findings are promising, the authors noted limitations in the study, such as the inability to capture some important variables, including the severity of sleep apnea and adherence to traditional therapies. They emphasize that further prospective studies, particularly randomized controlled trials, are necessary to explore the cardiovascular impacts of GLP-1 RAs in this patient population.
Despite these limitations, the study presents a significant body of evidence indicating that GLP-1 RAs could potentially serve as a cardiovascular risk modifier for obese patients suffering from sleep apnea. As prescriptions for these medications increase, there is growing interest in their role in managing not only obesity and sleep disorders but also associated cardiovascular risks.