Comparative clinical outcomes of adults with obstructive sleep apnea and comorbid obesity receiving tirzepatide versus bariatric metabolic surgery: A Multi-Institutional propensity score matched study.

OBJECTIVE: This study compared clinical outcomes of tirzepatide versus bariatric metabolic surgery (BMS) in adults with obstructive sleep apnea (OSA) and obesity. METHODS: A retrospective cohort analysis was conducted using the TriNetX Global Collaborative Network. Patients with OSA and comorbid obesity were stratified into tirzepatide and BMS groups. Propensity score matching (PSM) balanced baseline characteristics. Primary outcomes included a composite of all-cause mortality, major adverse cardiovascular events (MACE), and major adverse kidney events (MAKE). RESULTS: Following PSM, each 10,269 patients with well-balanced characteristics were classified into the tirzepatide and BMS groups. No significant difference was observed between groups for the primary composite outcome (hazard ratio [HR], 0.87; 95 % CI, 0.66-1.15, p = 0.335). Similarly, no significant differences were found in all-cause mortality (HR, 0.90; 95 % CI, 0.56-1.46, p = 0.672) or MACE (HR, 1.16; 95 % CI 0.85-1.56, p = 0.344). However, tirzepatide was associated with a lower rate of MAKE compared to BMS (HR, 0.60; 95 % CI, 0.42-0.87, p = 0.006). CONCLUSIONS: In adults with OSA and obesity, tirzepatide demonstrated similar overall clinical outcomes to BMS. While no significant differences were observed in composite outcomes, all-cause mortality, or MACE, tirzepatide was associated with a significantly lower rate of kidney-related complications.