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Sleep Medicine

(1309) Comparative Effectiveness of Incretin-Based Pharmacotherapy and Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

Saturday, October 17, 2026

Presenting Author(s)

Ramapoza O'Dwyer

Medical Student
Georgetown University School of Medicine
Arliington, Virginia, United States

Co-Author(s)

RM

Ruth Kassahun Mizu, MD

Resident Physician PGY-3
MedStar Georgetown University Hospital
Washington, District of Columbia, United States
Bailee A. Monjazeb, BA, MS

Medical Student
Georgetown University School of Medicine
Washington, District of Columbia, United States
HL

Hudson Liu, BS

Medical Student
Georgetown University School of Medicine
District of Columbia, District of Columbia, United States

Senior Author(s)

Michael Hoa, MD

Professor
Georgetown University Medical Center
Potomac, MD, United States
MR

Mark E. Russo, MD

Dr
Georgetown University School of Medicine
Washington, District of Columbia, United States

Introduction: GLP-1 and GLP-1/GIP receptor agonists and hypoglossal nerve stimulation (HGNS) treat obstructive sleep apnea (OSA), but comparative effectiveness is unclear. We compared changes in apnea–hypopnea index (AHI), oxygen desaturation index (ODI), and Epworth Sleepiness Scale (ESS) at short (≤6 months), intermediate (>6 to < 12 months), and long-term (≥12 months) follow-up.

Methods: PRISMA-guided review of PubMed/MEDLINE, Embase, and Cochrane Library. Screening and extraction were performed in Covidence. Included randomized trials and prospective/retrospective cohorts of adults with OSA treated with GLP-1/GLP-1-GIP pharmacotherapy or implantable HGNS with numeric AHI, ODI, or ESS. Excluded central sleep apnea, prior upper-airway surgery, recent bariatric surgery, or uncontrolled cardiometabolic disease. Outcomes used the longest available follow-up.

Results: Twenty studies were included: 17 HGNS studies (1,359 patients) and three GLP-1/GLP-1-GIP studies (638 patients). Baseline OSA severity was greater in GLP-1/GLP-1-GIP studies (mean AHI 48.6 events/hour) than in HGNS studies (35.7 events/hour).
At short-term follow-up, GLP-1/GLP-1-GIP therapy reduced AHI by 4.9 events/hour, ODI by 9.5 events/hour, and ESS by 2.5 points. Mean AHI reduction increased to 12.2 events/hour at intermediate follow-up and 25.3 events/hour at long-term follow-up, though long-term ODI and ESS data were limited. HGNS produced larger and more durable effects, with short-term reductions in AHI of 22.5 events/hour, ODI of 10.7 events/hour, and ESS of 5.5 points, persisting long-term with reductions in AHI (19.4 events/hour), ODI (15.7 events/hour), and ESS (3.8 points).

Conclusions: Both GLP-1/GLP-1-GIP pharmacotherapy and HGNS improve OSA through distinct mechanisms. GLP-1-based therapies showed progressive AHI improvement over time but limited long-term symptom data, whereas HGNS produced consistently large and sustained improvements across objective and patient-reported outcomes. These findings support individualized treatment selection for CPAP-intolerant patients with OSA.