Abstract Rationale Obstructive sleep apnea (OSA) is highly prevalent in older adults and is associated with cardiopulmonary complications, frailty, and increased mortality. GLP-1 receptor agonists (GLP-1a), widely prescribed for type 2 diabetes and obesity, provide established cardiovascular and metabolic benefits and are increasingly used in older adults with multimorbidity. Emerging evidence suggests GLP-1a may also improve OSA severity through weight loss and systemic anti-inflammatory effects. However, real-world data evaluating their impact on clinical outcomes in elderly patients with OSA remains limited. Methods We analyzed data from the TriNetX US Network. Adults aged ≥70 years with a diagnosis of OSA were identified and stratified into two cohorts: those with GLP-1a exposure and those without. Outcomes were assessed up to 3 years after the index event. Propensity score matching (1:1) was performed to balance comorbidities, yielding 97,277 patients per cohort. Survival analyses were conducted using Kaplan-Meier methods, log-rank tests, and Cox proportional hazards models with hazard ratios (HRs) and 95% confidence intervals (CIs). Results GLP-1a use was associated with lower all-cause mortality (HR 0.462, 95% CI 0.445-0.479; p 0.001). Healthcare utilization was reduced, including hospitalizations (HR 0.911, 95% CI 0.882-0.940; p 0.001) and ER visits (HR 0.918, 95% CI 0.890-0.947; p 0.001). Risk of aspiration pneumonitis was also lower (HR 0.543, 95% CI 0.500-0.589; p 0.001).Cardiopulmonary outcomes demonstrated consistent benefit. Overall heart failure incidence was reduced (HR 0.774, 95% CI 0.748-0.800; p 0.001). Subtype analyses showed decreased acute systolic HF (HR 0.600, 95% CI 0.548-0.656; p 0.001) and acute diastolic HF (HR 0.586, 95%CI 0.543-0.634; p 0.001). Pulmonary hypertension (HR 0.644, 95% CI 0.615-0.675; p 0.001) and cor pulmonale (HR 0.398, 95% CI 0.332-0.477; p 0.001) were likewise reduced. Frailty-related outcomes improved with GLP-1a: falls (HR 0.918, 95% CI 0.884-0.952; p 0.001), overall fractures (HR 0.928, 95% CI 0.879-0.979; p = 0.006), fragility fractures (HR 0.853, 95% CI 0.788-0.923; p 0.001), and severe protein-calorie malnutrition (HR 0.567, 95% CI 0.515-0.625; p 0.001).Conversely, gastrointestinal adverse events were more frequent in GLP-1a users, including gastroparesis (HR 1.294, 95% CI 1.147-1.460; p 0.001) and nausea/vomiting (HR 1.111, 95% CI 1.073-1.150; p 0.001). Conclusion In adults aged ≥70 years with OSA, GLP-1a exposure was associated with substantially lower all-cause mortality and broad reductions in cardiopulmonary complications, healthcare utilization, and frailty-related outcomes. These benefits were accompanied by increased risks of gastrointestinal adverse events, particularly gastroparesis and nausea/vomiting. Collectively, these findings highlight both the therapeutic potential and safety considerations of GLP-1a use as part of comprehensive OSA management in older adults. This abstract is funded by: None
Khan et al. (Fri,) studied this question.
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