New research to be presented at the European Congress on Obesity 2026 (ECO 2026, Istanbul, Turkey, May 12–15) reveals that individuals living with Obstructive Sleep Apnea (OSA) face a 71% higher risk of cardiovascular events (CVEs) or death from any cause compared to those without the condition.
The study is a collaboration between Imperial College Health Partners, Imperial College Healthcare NHS Trust, and Eli Lilly and Company, which also sponsored the research. The company manufactures obesity and diabetes treatments, including tirzepatide.
OSA is characterised by repeated upper airway obstruction during sleep, leading to poor sleep quality, reduced quality of life, and increased cardiovascular risk. Between 40% and 70% of individuals with OSA are overweight or obese, and obesity is strongly associated with more severe forms of the condition.
Previous studies have shown that weight loss can significantly reduce the severity of OSA and, in some cases, lead to remission or improvements in cardiometabolic risk. However, despite guideline-recommended treatments such as continuous positive airway pressure (CPAP) therapy, OSA remains underdiagnosed and undertreated, with significant implications for morbidity, mortality, and healthcare resource use.
The primary objective of the new study was to evaluate the increased risk of combined CVEs or all-cause mortality among adults aged 18 and older diagnosed with OSA, compared to those without the condition. Secondary objectives included assessing the risk of comorbidities such as diabetes and osteoarthritis, as well as comparing healthcare resource utilisation (HCRU), including primary care visits and hospital admissions.
Researchers analysed de-identified electronic health records from 2.9 million residents in North-West London, UK. A total of 20,300 individuals with OSA were matched with 97,412 controls based on demographic and clinical factors, including age, socioeconomic status, smoking, obesity, prior cardiovascular events, and comorbidities. Participants were followed for up to four years, until March 2025 or until loss to follow-up.
The analysis found that 57.2% of individuals with OSA were living with obesity, compared to 56.7% in the control group. Over the follow-up period, 26.3% of individuals with OSA experienced cardiovascular events or died, compared to 17.5% of those without OSA.
Additionally, among participants without pre-existing conditions at baseline, those with OSA showed higher rates of developing several comorbidities, including obesity (5.6% vs 4.0%), diabetes (6.8% vs 4.6%), osteoarthritis (4.2% vs 3.0%), anxiety (5.2% vs 3.2%), and depression (4.7% vs 3.0%).
Healthcare utilisation was also significantly higher among individuals with OSA. Median annual primary care visits were 21 per person-year (ppy), compared to 14 among controls. Outpatient visits averaged 4 ppy versus 1 ppy, while inpatient days were 1 ppy compared to none in the control group.
Co-author Heather Fitzke of Imperial College Health Partners said, “In adults, obstructive sleep apnea is linked to a significantly higher risk of cardiovascular events or all-cause mortality, particularly among those with obesity, even after adjusting for confounding factors. These findings highlight the urgent need for effective obesity management, as well as early screening and timely diagnosis of OSA. To our knowledge, this is the largest matched case-control study of obstructive sleep apnea conducted outside the United States.”
