PATIENTS with type 2 diabetes and obstructive sleep apnea experienced significantly greater survival benefits from GLP-1 receptor agonist therapy than those without sleep apnea, according to a large-scale analysis of nearly 1.8 million medical records.
OSA Status May Amplify GLP-1 Survival Effect
GLP-1 receptor agonists, commonly prescribed for type 2 diabetes to improve glycaemic control and reduce cardiovascular risk, were associated with a 20% greater mortality reduction among patients also diagnosed with obstructive sleep apnea (OSA). The finding suggests that OSA status may modify the survival advantage conferred by this therapy.
Researchers assessed one-year all-cause mortality outcomes in patients prescribed metformin alone or in combination with a GLP-1 receptor agonist. Propensity score matching accounted for demographics and comorbidities, with further statistical testing evaluating the impact of OSA.
Among nearly 1.8 million individuals with type 2 diabetes, 8.1% had both OSA and a GLP-1 prescription. In this cohort, mortality rates at one year were 1.0% compared with 2.5% in matched non-GLP-1 users (relative risk 2.45; 95% CI 2.29–2.61; p < 0.001). Patients without OSA also benefited, though to a lesser extent (0.9% vs 1.8%; RR 2.04; 95% CI 1.95–2.13).
Clinical Implications for Patient Selection
The observed survival advantage implies that sleep apnea may serve as a marker of enhanced responsiveness to GLP-1 therapy in diabetes management. “We observed one-year mortality in patients with type 2 diabetes prescribed GLP-1 receptor agonists to be substantially lower than in those not prescribed these agents, with a disproportionate benefit in those diagnosed with OSA,” said lead researcher Cosmo Fowler.
These findings may encourage clinicians to consider OSA status when selecting glucose-lowering therapy, particularly among high-risk cardiometabolic patients. Future research is expected to explore prospective mechanisms linking OSA and the survival benefits of GLP-1 receptor agonists.
Reference: CHEST. Patients With Type 2 Diabetes and Sleep Apnea Derive Greater Survival Benefit From GLP-1 Receptor Agonist Therapy: Analysis of 1.8 Million Records. 2025. Available at: https://www.chestnet.org/-/media/documents/news/patients-with-type-2-diabetes-and-sleep-apnea-derive-greater-survival-benefit-from-glp.ashx. Last accessed: 25 October 2025.
