A study of nearly 1.8 million adults with diabetes suggests patients with obstructive sleep apnea derive a 20% greater mortality reduction from GLP-1 therapy than those without the sleep disorder.

Key takeaways:

  • Patients with diabetes prescribed GLP-1 receptor agonists had lower one-year mortality regardless of OSA status.
  • The mortality benefit was 20% greater among those with OSA, indicating OSA may modify the survival impact of GLP-1 therapy.
  • Semaglutide was the most prescribed GLP-1, followed by dulaglutide and tirzepatide.
  • Findings were presented at CHEST 2025 and align with prior evidence that GLP-1s improve cardiometabolic outcomes.
  • Researchers recommend further prospective studies to clarify how OSA influences GLP-1 treatment outcomes in diabetes.

A real-world study of nearly 1.8 million patients found that individuals with type 2 diabetes and obstructive sleep apnea (OSA) prescribed glucagon-like peptide-1 receptor agonists (GLP-1s) experienced greater survival benefits than those without OSA, suggesting that OSA status may enhance the mortality benefit of GLP-1 therapy. These findings were presented at the CHEST Annual Meeting 2025. 

While GLP-1s such as tirzepatide, semaglutide, and dulaglutide are known to reduce cardiovascular and all-cause mortality in patients with type 2 diabetes, their effects in patients who also have OSA remain unclear. 

Building on the findings from the SURMOUNT-OSA trial, which demonstrated tirzepatide’s efficacy in improving OSA in nondiabetic patients, this study investigated whether OSA modifies the mortality benefit associated with GLP-1 use among individuals with diabetes in a large, real-world population. The primary endpoint was all-cause mortality within one year of metformin ± GLP-1 prescription. 

The study identified 1,799,261 patients with diabetes prescribed metformin, of which 1,083,492 (60.2%) had neither OSA diagnosis nor GLP-1 prescription; 361,492 (20.1%) were prescribed GLP-1 without OSA diagnosis; 207,947 (11.6%) were diagnosed with OSA without GLP-1 prescription; and 146,330 (8.1%) were diagnosed with OSA and prescribed a GLP-1. (The most prescribed GLP-1RA was semaglutide, followed by dulaglutide and tirzepatide.)

GLP-1-prescribed groups continued to show lower 1-year mortality, both without and with OSA. The study found a 20% greater relative mortality reduction in patients with OSA.

“We observed 1-year mortality in patients with type 2 diabetes who were prescribed GLP1-RAs to be substantially lower than patients not prescribed GLP1-RAs with a disproportionate benefit observed in those also diagnosed with OSA,” says Cosmo Fowler, MD, lead researcher and CHEST 2025 presenter, in a release. “This large-scale analysis suggests that OSA status may act as an effect modifier in the association between GLP-1-RA prescription and mortality.” 

The results of this study may lead to OSA diagnosis identifying diabetes patients more likely to derive mortality benefit from GLP-1 therapy—the 20% greater relative mortality reduction in patients with OSA supports considering OSA status when making GLP-1 prescribing decisions, the investigators say. Future research should examine, prospectively, the relationship between OSA and type 2 diabetes diagnosis and long-term outcomes of GLP-1 therapy. 

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