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

Design

Active-comparator, new-user cohort (UK CPRD)

Population

206,381 adults with type 2 diabetes and BMI of 30 or more

Primary outcome

Incident obstructive sleep apnoea diagnosis

Effect

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

An active-comparator, new-user cohort in the American Journal of Respiratory and Critical Care Medicine (September 2026) used the UK CPRD from 2007 to 2023 to compare 47,315 adults with type 2 diabetes and BMI of 30 or more starting a GLP-1 receptor agonist with 159,066 starting a DPP-4 inhibitor, excluding anyone with known sleep apnoea.

Over up to three years, incident obstructive sleep apnoea occurred at 5.8 against 5.4 per 1,000 person-years (HR 1.07, 95% CI 0.93 to 1.23), consistent across BMI strata, sex and drug type.

This concerns diagnosed sleep apnoea, which is heavily under-recorded, and the older GLP-1 agonists in most of the study period produce less weight loss than current ones. It does not contradict trial evidence that these drugs reduce severity in established sleep apnoea.

• Keep screening for sleep apnoea in obese patients with type 2 diabetes, whatever their diabetes drug
• Do not assume a GLP-1 agonist will prevent sleep apnoea
• Ask about snoring, witnessed apnoeas and daytime sleepiness at diabetes reviews
• In established sleep apnoea, weight loss from any cause can reduce severity

Why it matters

It tempers expectations that incretin drugs will prevent the sleep apnoea that so often accompanies diabetes and obesity.

Don't overread it

Sleep apnoea is under-diagnosed in records, and most exposure was to older, less potent GLP-1 agonists.

The statistics, in plain English

A hazard ratio of 1.07 with an interval from 0.93 to 1.23 is compatible with no difference, a small reduction or a small increase — nothing to suggest protection.

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