What is the clinical evidence from this study?

Study design: RCT. Population: Obesity and established CVD without diabetes. Intervention: Semaglutide vs. placebo. Primary outcome: first occurrence of MACE (composite of non-fatal myocardial infarction, nonfatal stroke, or CV death) in patients with OSA (HR 0.93, 95% CI 0.72-1.20, p=0.203 for interaction).

What does this research mean for the field?

Semaglutide provides consistent cardiovascular benefits in patients with obesity and cardiovascular disease regardless of baseline obstructive sleep apnea (OSA) status, and significantly reduces the risk of developing incident OSA. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This analysis aims to determine the cardiovascular effects of semaglutide in individuals with and without obstructive sleep apnea.

June 7, 2026

2840-LB: Semaglutide and Obstructive Sleep Apnea (OSA): A Post Hoc Analysis from SELECT

Key Result

Semaglutide 2.4mg was associated with a 52% reduction in incident OSA vs placebo (HR 0.48; 95% CI 0.31-0.73) and showed consistent MACE reduction regardless of baseline OSA status.

Key Points

This analysis aims to determine the cardiovascular effects of semaglutide in individuals with and without obstructive sleep apnea.
Post hoc analysis of SELECT trial data
Patients aged ≥45 years with BMI ≥27 and established cardiovascular disease
Adverse event reports used to assess incident obstructive sleep apnea.
Semaglutide showed numerically fewer major adverse cardiovascular events (115 vs 121) in those with obstructive sleep apnea; HR 0.93 (95% CI 0.72-1.20)
In the absence of obstructive sleep apnea, semaglutide reduced major adverse cardiovascular events significantly (454 vs 580); HR 0.78 (95% CI 0.69-0.88)
Semaglutide therapy resulted in a 52% reduction in incident obstructive sleep apnea compared to placebo (HR 0.48 [95% CI 0.31-0.73]).

Study Design

Type

RCT

Structured PICO

Does semaglutide 2.4 mg reduce MACE and prevent incident OSA in patients aged ≥45 years with BMI ≥27 and established CVD without diabetes?

Population

Patients aged ≥45 years with BMI ≥27 and established CVD without diabetes, analyzed to assess the impact of semaglutide on MACE by OSA status and incident OSA.

Intervention

Semaglutide 2.4 mg

Comparator

Placebo

Outcome

First occurrence of MACE (composite of non-fatal myocardial infarction, nonfatal stroke, or cardiovascular death)composite

In patients with obesity and established CVD, semaglutide 2.4 mg reduces the risk of incident obstructive sleep apnea by 52% and provides consistent cardiovascular benefits regardless of baseline OSA status.

Main Result

Hazard Ratio: 0.93 (95% CI 0.72–1.2)

p-value: p=0.203 for interaction

Abstract

Introduction and Objective: Semaglutide 2.4mg (sema) reduces MACE in people with obesity and CVD. Obstructive sleep apnea (OSA) is common in this population, but it is unknown if sema’s CV benefits are seen in those with OSA or if it can prevent OSA. This post hoc analysis of SELECT assessed the impact of sema on the risk of first occurrence of MACE (composite of non-fatal myocardial infarction, nonfatal stroke, or CV death) in patients with vs without OSA and explored the impact of sema on incident OSA. Methods: SELECT included patients aged ≥45 years with BMI ≥27 and established CVD without diabetes. Preexisting OSA was identified by baseline questionnaire, with incident OSA captured by adverse event reports in those without baseline OSA. MACE risk was evaluated by OSA status and cumulative incidence analyses evaluated incident OSA for sema vs placebo. Results: At baseline, 2,550 participants (14.5%) reported OSA. Sema was associated with numerically fewer MACE events vs placebo in those with (115 vs 121 events, HR 95% CI=0.93 0.72-1.20) and without (454 vs 580 events, HR 95% CI=0.78 0.69-0.88) OSA (interaction P=.203). Among those without OSA, sema was associated with a significantly lower risk of incident OSA (HR 95% CI=0.48 0.31-0.73) (Figure). Conclusion: The CV benefits of sema were consistent among those with and without OSA. Sema therapy was associated with a 52% reduction in incident OSA vs placebo. Disclosure S. Inzucchi: Consultant; Current; Boehringer Ingelheim International GmbH. Consultant; Ended; Bayer AG. Consultant; Current; Novo Nordisk, AstraZeneca, Corcept Therapeutics. N.M. Harder-Lauridsen: Employee; Current; Novo Nordisk A/S. S. Fjelstrup: Employee; Current; Novo Nordisk A/S. I. Neeland: Speaker's Bureau; Current; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Bayer AG. Research Support; Current; American Heart Association, National Heart, Lung, and Blood Institute. Advisory Panel; Current; MJH Life Sciences. A. Traina: Employee; Current; Novo Nordisk. Stock/Shareholder; Current; Novo Nordisk. L. Wilson: Employee; Current; Novo Nordisk. D.H. Ryan: Advisory Panel; Current; Abbvie, Altimmune, Amgen, AstraZenica, Boehringer Ingelheim, Biohaven, Carmot/Roche/Genentech. Advisory Panel; Ended; eMed, Fractyl, Nestle. Consultant; Current; Pfizer, Source Bio, Protagonist, PPD, Regeneron, Regor. Advisory Panel; Current; Currax, Structure Therapeutics, Tenvie, Kailera. Speaker's Bureau; Current; LIlly, Novo Nordisk,. Other - I am a consultant to both and received stock options and consulting fees.; Current; Calibrate, Epitomee. Other - Data Monitoring Committee member; Current; CinRx, Rhythm, Lilly. Advisory Panel; Current; Viking, Weight Watchers, Wonder Health, Zealand. Other - ! received non-negotiable stock options from these companies years ago and have not worked for them in years.; Ended; Roman, Scientific Intake.

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