Type 2 diabetes patients taking GLP-1 drugs demonstrated significantly lower one-year mortality rates, with those also diagnosed with sleep apnea showing disproportionate survival benefits, according to new research presented at the American College of Chest Physicians meeting in Chicago.
The large-scale analysis of nearly 1.8 million patients with type 2 diabetes found that while all patients taking GLP-1 drugs had reduced short-term death risk, those with sleep apnea experienced an additional 20% lower risk compared to those without the breathing disorder.
Mortality Risk Reduction Data
The study revealed striking differences in absolute mortality risk based on sleep apnea status. Among patients without sleep apnea, the death risk was 0.9% for those on GLP-1 drugs versus 1.8% for those not taking the medications. However, sleep apnea patients showed even more pronounced benefits, with a 1% mortality risk for those on GLP-1 therapy compared to 2.5% for those who weren't taking the drugs.
"We observed one-year mortality in patients with type two diabetes who were prescribed GLP-1RAs to be substantially lower than patients not prescribed GLP-1RAs, with a disproportionate benefit observed in those also diagnosed with obstructive sleep apnea," said lead researcher Dr. Cosmo Fowler, a sleep medicine physician at Piedmont health system in Atlanta.
Study Population and Design
Researchers analyzed data from approximately 1.8 million patients with type 2 diabetes, of whom about 28% had been prescribed a GLP-1 drug. The findings suggest that obstructive sleep apnea status may act as an effect modifier in the association between GLP-1 receptor agonist prescription and mortality outcomes.
Clinical Context and FDA Approval
The results align with the U.S. Food and Drug Administration's December 2024 decision to approve Zepbound (tirzepatide) as the first drug specifically indicated to treat sleep apnea in adults with obesity. This regulatory milestone established a new therapeutic approach for managing the breathing disorder that affects millions of patients.
Sleep apnea occurs when the upper airway becomes blocked during sleep, causing breathing interruptions that repeatedly awaken patients and result in poor sleep quality. The condition is more prevalent in individuals with overweight or obesity because excess weight from fatty deposits increases pressure on the upper airways, causing them to collapse. Additional weight also reduces lung capacity.
Mechanism of Action
Glucagon-like peptide-1 drugs mimic the GLP-1 hormone, which helps control insulin and blood sugar levels, decreases appetite, and slows food digestion. Originally developed to treat diabetes, these medications gained attention for their significant weight loss benefits, which may explain their particular effectiveness in sleep apnea patients where obesity is a contributing factor.
Clinical Implications
Based on these findings, researchers suggest that physicians should consider whether a patient has sleep apnea when making decisions about GLP-1 drug prescriptions. The data indicate that sleep apnea status could influence treatment outcomes and potentially guide therapeutic decision-making.
However, the research team emphasized that additional studies are needed to better understand the mechanisms behind GLP-1 drugs' apparent benefits in sleep apnea patients and to evaluate potential longer-term effects. The findings were presented at a medical meeting and should be considered preliminary until published in a peer-reviewed journal.
