(1325) GLP-1RA Use and Sleep Apnea Outcomes: A Database Study and Systematic Review

Introduction: The purpose of this systematic review and database study is to assess the pharmacologic effects of GLP-1 receptor agonists (GLP-1RAs) on obstructive sleep apnea (OSA) outcomes.

Methods: One-hundred and six Ovid MEDLINE and PubMed articles (inception-Jan 2026) with OSA and GLP-1RA keywords were screened; 6 English articles were included. A multicenter, retrospective cohort study was conducted via the TriNetX database to assess adults in the United States with obesity and/or type 2 diabetes, stratified by GLP-1RA exposure (dulaglutide, exenatide, semaglutide, liraglutide). Outcomes included OSA incidence, CPAP utilization, and sleep surgery interventions. Relative risks with 95% CIs were calculated, and propensity score matching controlled for demographic and metabolic covariates.

Results: Included studies reported improved apnea-hypopnea index, oxygenation, and weight reduction with GLP-1RA. In TriNetX, GLP-1RA exposure was associated with lower incident OSA (p < 0.001, RR 0.917, 95% CI[0.887,0.948]) and CPAP initiation (p < 0.001, RR 0.711, 95% CI[0.685,0.738]), but increased risk for CPAP continuation (p=0.0023, RR 2.264, 95% CI[1.319,3.884]). OSA-specific procedures (necessitation of tonsillectomy, adenoidectomy, uvulopalatopharyngoplasty, tongue base/airway remodeling, or septum resection/nasal airway repair) were less frequent in GLP-1RA users overall aside from palatal procedures and hypoglossal nerve stimulation. Medication-specific analyses demonstrated lower incident OSA specifically with dulaglutide (p < 0.0001, RR 0.742, 95% CI[0.674,0.816]).

Conclusions: GLP-1RA exposure was associated with reduced incident OSA, OSA-related testing, and treatment escalation, supporting a potential role of GLP-1RA therapy as an adjunct in OSA management. Increased continuation codes and individual medication differences highlight a need for prospective studies to clarify causal effects.