Cardiometabolic improvements, sleep apnea reduction, and biomarker modulation under dual GLP-1RA and SGLT2i therapy: a prospective study

This prospective cohort study explored the cardiometabolic, sleep-related, and biomarker effects of glucagon-like peptide-1 receptor agonists (GLP-1RA), sodium–glucose cotransporter-2 inhibitors (SGLT2i), and their combination in patients with heart failure with preserved ejection fraction (HFpEF), type 2 diabetes mellitus (T2DM), obesity, and obstructive sleep apnea (OSA). The findings revealed that therapies including GLP-1RA – either alone or in combination – consistently improved sleep apnea severity, inflammatory and glycemic biomarkers, and right ventricular–pulmonary arterial coupling. In contrast, SGLT2i monotherapy had modest effects in these domains. Notably, the addition of SGLT2i to GLP-1RA did not yield substantial additive benefits regarding sleep-related or inflammatory parameters, suggesting a dominant role of GLP-1RA. These results underscore the clinical relevance of GLP-1RA-based therapies in patients with multimorbid cardiometabolic conditions, particularly in targeting systemic inflammation and obstructive sleep apnea, both of which are critical yet often overlooked contributors to adverse outcomes in HFpEF.