Effects of semaglutide on obstructive sleep apnea risk and outcomes in patients with obesity.

OBJECTIVES: This study investigates the impact of semaglutide on obstructive sleep apnea (OSA) risk and clinical outcomes in individuals with obesity. METHODS: A retrospective cohort study was conducted using the TriNetX platform, which includes electronic health records from approximately 150 million patients across 149 healthcare organizations. Two cohorts were analyzed: (1) individuals with obesity to evaluate the incidence of new-onset OSA and (2) individuals with OSA and obesity to assess clinical outcomes. Propensity score matching was applied to balance baseline characteristics between semaglutide users and control groups. Primary outcomes included new-onset OSA incidence (obesity cohort) and a composite endpoint of all-cause mortality, major adverse cardiovascular events (MACEs), and major adverse kidney events (MAKEs) (OSA with obesity cohort). RESULTS: In the obesity cohort (n = 191 273 in each group), semaglutide use was significantly associated with a reduced the risk of new-onset OSA (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.60-0.63; P < .0001). Stratified analyses confirmed consistent benefits across subgroups. In the OSA with obesity cohort (n = 40 123 in each group), semaglutide use was associated with lower risk of adverse composite outcomes (HR, 0.72; 95% CI, 0.66-0.78; P < .0001), as well as reductions in all-cause mortality (HR, 0.37; 95% CI, 0.31-0.45), MACE (HR, 0.72; 95% CI, 0.65-0.79), and MAKE (HR, 0.54; 95% CI, 0.48-0.60). Sensitivity analyses confirmed robustness against unmeasured confounders. CONCLUSIONS: Semaglutide was associated with a significant reduction in OSA risk among individuals with obesity and improved clinical outcomes in those with comorbid obesity and OSA.