GLP-1 RECEPTOR AGONISTS AND RISK OF PULMONARY COMPLICATIONS IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA AND TYPE 2 DIABETES MELLITUS

SOO YOUNG Hwang; MARTIN Borissov; JENNIFER SO

doi:10.1016/j.chest.2025.07.3955

PURPOSE: GLP-1 receptor agonists (GLP-1RA) have become the first drug approved for obstructive sleep apnea (OSA) after prior research demonstrated improvement in the severity of sleep apnea through the apnea-hypopnea index (AHI). However, the potential effect of GLP-1RA on OSA related pulmonary complications, most representatively pulmonary hypertension, has not been explored. Our study aims to compare GLP-1RA and other diabetes medications in the development of pulmonary hypertension and severe respiratory failure in patients with OSA and type 2 diabetes mellitus (T2DM). METHODS: We analyzed patients with OSA and T2DM in the TriNetX database between January 2010 to December 2022. We compared outcomes among patients who received either a GLP1-RA or other diabetes medications such as metformin, DPP-4 inhibitor, SGLT-2 inhibitor, sulfonylurea, or thiazolidinedione (TZD). Outcomes of interest included intubation by the CPT code, chronic obstructive pulmonary disease (COPD) and pulmonary hypertension defined by ICD-10 code during a 5-year follow-up. A propensity score model adjusted factors including demographics, cardiac and pulmonary comorbidities, diabetes and diabetes medications, hemoglobin A1c, body mass index, and blood pressure values. A Kaplan-Meier analysis was performed on the two cohorts after propensity matching. Patients with outcome prior to the index date were excluded from the analysis. The hazard ratio (HR) and 95% confidence interval for pulmonary outcomes are presented. RESULTS: The GLP-1RA group had a lower risk in the development of pulmonary hypertension and intubation in comparison to all other diabetes medication groups. The HR of new onset pulmonary hypertension was 0.724 (95%CI 0.678-0.772) in the GLP-1RA versus DPP-4 inhibitor group, 0.845 (95%CI 0.785-0.909) in the GLP1-RA versus metformin group, 0.738 (95%CI 0.692-0.787) in the GLP-1RA versus SGLT-2 inhibitor group, and 0.686 (95%CI 0.646-0.729) in the GLP-1RA versus sulfonylurea group. The HR of intubation was 0.603 (95%CI 0.548-0.664) in the GLP1-RA versus DPP-4 inhibitor group, 0.814 (95%CI 0.73-0.906) in the GLP-1RA versus metformin group, 0.783 (95%CI 0.712-0.86) in the GLP-1RA versus SGLT-2 inhibitor group, and 0.616 (95%CI 0.563- 0.674) in the GLP-1RA versus sulfonylurea group. The HR of new onset COPD was 0.886 (95%CI 0.838-0.936) in the GLP1-RA versus metformin group and 0.812 (95%CI 0.777-0.848) in the GLP-1RA versus sulfonylurea group. There was no statistically significant difference when comparing GLP-1RA versus SGLT-2 inhibitor group or TZD group in the development of COPD. CONCLUSIONS: The use of GLP-1 receptor agonists were associated with lower risk of developing pulmonary hypertension and respiratory failure needing intubation in those with OSA and T2DM compared to those receiving other oral diabetes medications. Further prospective studies should investigate the clinical efficacy of GLP-1 receptor agonist in prevention of potential pulmonary complications of OSA. CLINICAL IMPLICATIONS: Our study shows that GLP-1 receptor agonists are effective in preventing pulmonary hypertension and acute respiratory failure in patients with obstructive sleep apnea and type 2 diabetes.

GLP-1 RECEPTOR AGONISTS AND RISK OF PULMONARY COMPLICATIONS IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA AND TYPE 2 DIABETES MELLITUS

Files and links (1)

Abstract

Details

Metrics