GLP-1 agonists were not associated with less new sleep apnoea than DPP-4 inhibitors in obese type 2 diabetes

Design

Population-based active-comparator new-user cohort, propensity-score weighted

Population

206,381 UK adults with type 2 diabetes and BMI ≥30 without prior OSA

Primary outcome

Incident clinical diagnosis of OSA, up to 3 years

Effect

5.8 vs 5.4 per 1,000 person-years; HR 1.07 (95% CI 0.93 to 1.23)

A UK primary care cohort (CPRD, 2007 to 2023) compared 47,315 new users of GLP-1 receptor agonists with 159,066 new users of DPP-4 inhibitors, all with type 2 diabetes, BMI 30 or more and no prior sleep apnoea. Propensity-score weighting balanced the groups within BMI strata.

Incident obstructive sleep apnoea (OSA) diagnoses occurred at 5.8 against 5.4 per 1,000 person-years (HR 1.07, 0.93 to 1.23). Results were consistent across BMI, sex, drug type and sensitivity analyses.

Trials show tirzepatide reduces OSA severity in people who have it. This study suggests routine GLP-1 agonist use, largely older agents with modest weight loss, does not prevent a new diagnosis. It is a reminder not to assume a patient on a GLP-1 agonist is protected from OSA.

• Keep screening obese patients with diabetes for OSA symptoms, whatever their glucose-lowering drug
• Ask about snoring, witnessed apnoeas and daytime sleepiness
• Refer for sleep study when symptoms or resistant hypertension suggest OSA
• Do not use a GLP-1 agonist as a substitute for OSA assessment

Why it matters

It tempers the assumption that metabolic drugs will prevent sleep apnoea in routine care.

Don't overread it

Outcome was a recorded clinical diagnosis, which depends on who gets tested; most users took older GLP-1 agonists, not tirzepatide.

The statistics, in plain English

A hazard ratio of 1.07 with an interval from 0.93 to 1.23 is a precise null: a protective effect larger than about 7% is unlikely. But because OSA is underdiagnosed, patients having more contact with services could be tested more, which could hide a small true benefit.

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