Receipt of GLP-1 receptor agonists among rural patients with obstructive sleep apnea

The National Heart, Lung and Blood Institute awarded the University of Washington $363,556 on January 30, 2026, under the Cardiovascular Diseases Research program (CFDA 93.837) to conduct a mixed-methods study examining receipt of GLP-1 receptor agonists among rural patients with obstructive sleep apnea and excess weight.

The research will test the association of rurality with initiation and discontinuation of GLP-1 receptor agonists among patients with obstructive sleep apnea and excess weight, accounting for patient, provider, and health system factors. The study will also examine perspectives of patients, sleep specialists, and primary care providers to identify barriers and facilitators to GLP-1 receptor agonist use in rural settings. The work addresses underutilization of weight management pharmacotherapy and bariatric surgery in rural populations, who face greater comorbidity burdens than urban peers. GLP-1 receptor agonists, recently FDA-approved medications that increase clinically meaningful weight loss and reduce obstructive sleep apnea severity, offer a scalable treatment option with a favorable toxicity profile and less intensive monitoring requirements.

Performance will occur at the University of Washington in Seattle, Washington, with work concluding July 30, 2027. The award is a project grant, the assistance type used by NIH to support discrete, circumscribed research projects of specified duration and defined objectives.

Abstract

Excess weight is the greatest modifiable risk factor for the development of obstructive sleep apnea (OSA). Successful weight management improves OSA severity and symptoms but is hard to achieve. Weight management pharmacotherapy and bariatric surgery are effective adjunctive strategies, but our analyses indicate they are rarely delivered. Delivery of these health services is particularly low among patients living in rural settings, who already face a greater comorbidity burden relative to urban peers. Glucagon-like peptide-1 receptor agonists (GLP-1RAS) are recently FDA-approved medications that dramatically increase the rates of clinically meaningful weight loss, improve comorbidities, and reduce OSA severity. Due to their favorable toxicity profile and less intensive monitoring, GLP-1RAS are a scalable treatment that may help bridge the GAP to rural areas. However, early evidence suggests GLP-1RAS are underutilized. We hypothesize that rurality will be independently associated with lower usage for GLP-1RAS for chronic weight management among patients with OSA and excess weight, while accounting for other patient-, provider-, and health system factors embedded in the access to care model. Informed by domains of the health equity implementation framework, we also anticipate that patient and provider perspectives will identify multi-dimensional barriers to GLP-1RA access and delivery. The specific aims of this mixed methods proposal are to: 1A) test the association of rurality with initiation of GLP-1 RAS among patients with OSA and excess weight; 1B) test the association of rurality with discontinuation of GLP-1 RAS among patients with OSA and excess weight; and 2) examine perspectives of patients, sleep specialists, and primary care providers to understand the barriers and facilitators to GLP-1RA use among rural patients with OSA and excess weight. These aims will be completed using a national cohort of patients with OSA and excess weight assembled from administrative data within the veterans health administration (VHA). This proposal will identify intervenable barriers to weight management care among rural patients with OSA and excess weight in order to develop strategies to overcome these barriers. DR. Leonhard will achieve his training aims of gaining expertise in advanced biostatistical and epidemiologic methods, qualitative research methodologies, and employing health equity frameworks through the completion of this project. He will be well supported in his training environment at the university of washington and the veterans affairs health systems research center of innovation for veteran centered and value driven care. He will be mentored by a multidisciplinary team with a strong track record of collaborative mentorship and with extensive experience in quantitative and qualitative research, health systems research, and research to reduce disparities in the delivery of care. These resources will prepare DR. Leonhard to become an independent health systems investigator whose work improves care delivery for patients with sleep and pulmonary disorders in ways that achieve patient-centered outcomes and reduce disparities.