Impact of GLP-1 and dual agonists on the incidence of new cases of physician-reported sleep apnea: a real-world study

RATIONALE: Previous studies have shown that glucagon-like peptide-1 (GLP-1) agonists and dual GLP-1/glucose-dependent insulinotropic peptide (GIP) agonists (tirzepatide) reduced severity of sleep apnea. However, whether these medications impact incidence of new cases of physician-reported sleep apnea (PRSA) is unknown. OBJECTIVE: To determine the potential impact of GLP-1 and dual agonists on the incidence of sleep apnea reports and to explore potential treatment consequences for this sleep-disordered breathing. METHODS: We conducted a retrospective cohort study using the TriNetX Global Health Research Network through anonymized electronic medical records. We identified adult patients with obesity and/or type 2 diabetes mellitus never prescribed GLP-1 or dual agonist therapy (reference arm) and those new initiators of these medications. The index event (June 2022) was chosen to coincide with the launching of tirzepatide in the market. We excluded patients with type 1 diabetes; previous diagnosis of PRSA; previous use of GLP-1/dual agonists, orlistat, phentermine/topiramate, or bupropion/naltrexone; or previous bariatric surgery. Initiators were matched to the reference cohort using propensity score matching in a 1:1 ratio for age, sex, ethnicity, body mass index, and menopause. We used a validated algorithm to identify PRSA using International Classification of Diseases, 10th Revision codes. RESULTS: The follow-up time was 1044 days. After propensity score matching, a total of 1 253 188 patients were included in the reference arm and GLP-1/dual agonist comparison. Overall, GLP-1/dual agonists were associated with a 54% lower incidence of PRSA (HR, 0.46 [95% CI, 0.45-0.49]). Individually, all drugs were able to reach this outcome as compared to the reference arm: liraglutide (HR, 0.64 [95% CI, 0.51-0.80]), dulaglutide (HR, 0.32 [95% CI, 0.28-0.36]), semaglutide (HR, 0.57 [95% CI, 0.54-0.61]), and tirzepatide (HR, 0.74 [95% CI, 0.67-0.92]). Exploratory analysis revealed a 79% lower incidence of positive airway pressure reports in the GLP-1/dual agonist group as compared to controls. CONCLUSIONS: GLP-1/dual agonists reduced the incidence of new cases of PRSA in patients with obesity and/or type 2 diabetes.