Harneet Walia, MD, the medical director of sleep at Miami Cardiac & Vascular Institute, a part of Baptist Health South Florida.

Harneet Walia, MD

PAP Therapy for Sleep Apnea Linked to Improved Blood Pressure, With Harneet Walia, MD

spoke with Harneet Walia, MD, a sleep medicine specialist at Baptist Health, on new research linking positive airway pressure (PAP) therapy to improved 

“We know that PAP therapy not only improves the symptoms related to sleep apnea, such as impairment in sleep quality or impairment in quality of life, but it may also have beneficial effects [on] the blood pressure as well,” Walia told 

. “This has been known even in the past, but our study reinforces these findings, particularly as it relates to the real-world setting.”

The study demonstrated that PAP therapy was associated with a reduction in hemoglobin A1c (HbA1c), as well as in systolic and diastolic blood pressure.

“Every millimeter reduction in blood pressure is associated with improved cardiovascular outcomes,” Walia continued. “So even though the reduction was noted to be modest, which is 2 to 4 millimeters of mercury reduction, this still could have huge implications in terms of improvement in cardiovascular risk reduction.”

PAP therapy, used in patients with sleep apnea, has previously demonstrated benefit on cardiovascular outcomes. A study published in August and led by Ali Azarbarzin from Brigham and Women’s Hospital in Boston found that continuous positive airway pressure (CPAP) lowered the risk of heart attack, stroke, and death from cardiovascular disease by around 17% in patients with high-risk obstructive sleep apnea (OSA).

 This improvement was 31% better than the effect of treatment in patients without high-risk OSA; investigators cautioned that among these individuals, CPAP may increase the risk of serious cardiovascular events by 22%.

In this new study, Walia and colleagues aimed to investigate the relationship between PAP therapy and various cardiometabolic factors in patients with sleep apnea, including HbA1c, systolic and diastolic blood pressure, triglycerides, and body mass index (BMI).

 The team collected 1575 patients (median age: 65 years; range: 58 - 71) with cardiometabolic disease from a multicenter cardiometabolic registry from January 2019 to August 2023. Among the 447 patients with sleep apnea, comprising 65.4% of the sample, 447 (65.4%) participants reported routine PPAP use.

In an unadjusted logistic regression analysis, PAP use was associated with lower HbA1c (-0.31%; 95 % confidence interval [CI], -0.59 to -0.04,

 =.025), though it was no longer associated when adjusted for demographic factors, cardiac comorbidities, medications, and medication adherence (-0.19%; 95 % CI -0.46 to 0.08, 

Moreover, in an analysis adjusted by demographic factors, cardiac comorbidities, medications, and medication adherence, PAP therapy was associated with a lower systemic blood pressure (-3.99 mmHg, 95% CI -7.18 to -0.8, 

 =.014) and a lower diastolic blood pressure (-2.52 mmHg, 95% CI -4.45 to -0.6, 

“We do need long-term randomized control trials to validate these findings,” Walia said. “There have been certain randomized control trials that [have] been done in the past, which have shown sort of inconclusive results. However, [they] have also been limited in the interpretability because of the duration of the treatment, and more importantly, because of the PAP adherence…was not found to be optimal in those studies. So the future studies should certainly focus on long-term duration and [homing] in on optimal PAP adherence for the most periods of time.”

Relevant disclosures for Walia include Eli Lilly and Company, Resmed Corp, JAZZ Pharmaceuticals, Boston Scientific Corporation, Itamar Medical, Harmony Biosciences, Lilly USA, Fisher & Paykel Healthcare, Novo Nordisk, and Merck Sharp & Dohme.

Körfer D, Cardenas W, Davis L, et al. Impact of sleep apnea treatment on cardiometabolic parameters in a large national multicenter alliance registry. 

. 2025;23:101062. Published 2025 Jul 22. doi:10.1016/j.ajpc.2025.101062

Treatment for sleep apnoea is good for the heart in some patients but bad for others. Escardio.org. Published 2025. Accessed September 29, 2025. https://www.escardio.org/The-ESC/Press-Office/Press-releases/Treatment-for-sleep-apnoea-is-good-for-the-heart-in-some-patients-but-bad-for-others#

Videos

Positive airway pressure (PAP) therapy has shown potential benefits in improving cardiometabolic factors in sleep apnea patients, including reductions in hemoglobin A1c and blood pressure. While previous studies have indicated cardiovascular benefits, the current research highlights modest yet significant improvements in blood pressure, which could reduce cardiovascular risks. However, the association with HbA1c was not significant after adjusting for various factors. The study underscores the need for long-term randomized control trials to confirm these findings, emphasizing the importance of optimal PAP adherence for effective outcomes.

New research highlights the benefits of PAP therapy for sleep apnea, showing improvements in blood pressure and cardiometabolic health.

Tirzepatide Is A ‘Ray of Hope’ for Patients with OSA: Referral Uptick, Who Benefits 

Ever since the US Food & Drug Administration (FDA) approved tirzepatide (Zepbound) for 

 last December, there has been an increase in OSA referrals.

Tripeptide’s FDA approval, announced by Eli Lilly and Company on December 20, 2024, was based on positive findings from the Phase 3 SURMOUNT-OSA clinical trial.

 The pivotal trial assessed tirzepatide (10 mg or 15 mg), a dual-activating glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 agonist, in 469 adults with OSA and obesity over 52 weeks. Among this patient population, tirzepatide provided significant improvements in the apnea-hypopnea index, oxygenation, patient-reported outcomes, blood pressure, and C-reactive protein levels.

Participants on tirzepatide achieved an average of up to 20% weight loss and experienced ≥ 25 fewer breathing interruptions for each hour slept (

Among patients not on PAP therapy, tirzepatide was approximately 5 times more effective than placebo in reducing breathing disruptions. Tirzepatide led to 25 fewer hourly breathing disruptions, compared with 5 in patients on placebo. For those on PAP therapy, tirzepatide brought 29 fewer hourly breathing disruptions, compared with 6 for placebo.

Tirzepatide continued to demonstrate improvements at 1 year, with approximately 42% of adults treated with tirzepatide and 50% of adults on tirzepatide and PAP therapy experiencing remission or mild, non-symptomatic OSA. Whereas in the placebo arm, 16% and 14% experienced remission or non-symptomatic OSA, respectively.

Tirzepatide is the first and only prescription medicine available for adults with moderate-to-severe OSA and obesity, and since its approval, OSA awareness has risen among patients and healthcare providers. GLP-1s have driven attention to this previously underrecognized and undertreated sleep disorder.

“We're seeing lot of lots and lots of patients who are inquiring about GLP-1s as one of the potential treatment options for obstructive sleep apnea, and we also seeing that it has raised the awareness of sleep disorders, particularly obstructive sleep apnea,” Atul Malhotra, MD, lead investigator of the SURMOUNT-OSA trial and sleep medicine specialist at UC San Diego Health, told 

 spoke with 4 experts regarding GLP-1’s impact on sleep apnea, receiving insight from specialists in sleep medicine, pulmonology, and otolaryngology.

“A lot of the patients that do suffer from obstructive sleep apnea are overweight, and so their body mass index is an important component that's contributing to their disease, but there's a lot of patients that come into our practices that don't have weight issues, or that have weight issues and have additional structural issues, so I think it really just has to be thought of as a tool,” said Brian Weeks, MD, an ENT-Otolaryngologist is at Senta Clinic, during an interview with 

 “Now, obviously, for overweight patients, it's a ray of light, it's a ray of hope for them, but it's one tool in the armamentarium that we have.”

(sleep medicine and pulmonary medicine specialist)

Relevant disclosures: Malhotra (Eli Lilly and Company, LivaNova USA, ZOLL Respicardia, Itamar Medical, Avadel CNS Pharmaceuticals, Axsome Therapeutics, JAZZ Pharmaceuticals), Weeks (Stryker Corporation), Walia (Eli Lilly and Company, Resmed Corp, JAZZ Pharmaceuticals, Boston Scientific Corporation, Itamar Medical, Harmony Biosciences, Lilly USA, Fisher & Paykel Healthcare, Novo Nordisk, Merck Sharp & Dohme), and Kundel (ZOLL Respicardia, Eli Lilly and Company).

Iapoce, C. FDA Approves Tirzepatide for Obstructive Sleep Apnea in Obesity. Hcplive.com. Published December 20, 2024. Accessed September 25, 2025. 

https://www.hcplive.com/view/fda-approves-tirzepatide-for-obstructive-sleep-apnea-in-obesity

Malhotra A, Grunstein RR, Fietze I, et al. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. 

. 2024;391(13):1193-1205. doi:10.1056/NEJMoa2404881

FDA approval of tirzepatide for OSA sparks a surge in referrals as experts highlight weight loss benefits, symptom relief, and patient selection.

Tirzepatide Is A ‘Ray of Hope’ for Patients with OSA: Referral Uptick, Who Benefits

Hispanic Ethnicity Tied to Severe Sleep Disordered Breathing, with Harneet Walia, MD

A study using 2020 – 2022 Baptist Health’s sleep study data found that Hispanic ethnicity was significantly associated with moderate to severe 

Harneet Walia, MD, the medical director of sleep at Miami Cardiac & Vascular Institute, a part of Baptist Health South Florida, presented the findings of this retrospective study at 

SLEEP 2025, the 39th annual meeting of the Associated Professional Sleep Societies,

 in Seattle. HCPLive sat down with Walia at the meeting to discuss risk factors for SDB in Hispanic and non-Hispanic populations.

“We know that Hispanics have been understudied and have been underrecognized,” Walia said. “Therefore, we wanted to understand what risk factors contribute to Sleep Disorder Breathing in [the] Hispanic and non-Hispanic [population].”

To examine risk factors for SDB, Walia and colleagues analyzed Baptist Health’s sleep study database (2020 – 2022). Patients were diagnosed with SDB via polysomnogram, split-night polysomnogram, or home sleep apnea testing. Using an apnea-hypopnea index (AHI), SDB was classified as either negative/mild (AHI < 15) or moderate to severe (AHI ≥ 15). The study also compared AHI category, age, sex, body mass index (BMI), ethnicity, average and minimum blood oxygen saturation (Sp02), and secondary diagnoses between Hispanic and non-Hispanic patients.

The sample included 9111 patients, of whom 63.8% were Hispanic and 36.2% were non-Hispanic. About half of the Hispanic and non-Hispanic patients were male (53% and 57.4%, respectively; 

Obesity was observed slightly more in Hispanic (59.4%) vs non-Hispanic (57.4%) patients (

 < .001). Hispanic patients also had slightly greater cases of moderate to severe SDB (47.8%) compared with non-Hispanic patients (45.6%) (

 = .04). In a similar vein, median AHI (14.2 vs 13.5%; 

 = .01) and average Sp02 (94.1% vs 93.9%; 

 = .03) was greater among Hispanic patients vs non-Hispanic patients, respectively.

The multivariate logistic regression analyses showed that Hispanic ethnicity (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.09 – 1.31), male sex (OR, 2.07; 95% CI, 1.89 – 2.28), obesity (OR, 3.81; 95% CI, 3.24 – 4.49), hypertension (OR, 1.22; 95% CI, 1.10 – 1.36), and respiratory illnesses (OR, 1.28; 95% CI, 1.15 – 1.42) were associated with moderate or severe SDB.

Male sex (OR, 2.00), obesity (OR, 4.70), hypertension (OR, 1.22), and respiratory illnesses (OR,1.35) were the key risk factors for moderate or severe SDB among Hispanic patients. As for non-Hispanic patients, key risk factors for moderate or severe SDB included male sex (OR, 2.39), obesity (OR, 2.94), and diabetes (OR, 1.29).

“We know that obstructive sleep apnea is under-recognized and under-treated in [the] Hispanic population,” Walia said. “The study helped us identify some of the risk factors which may help clinicians identify… patients for screening, early intervention, and treatment more clearly than before.”

Azhar M, Cardenas W, Saxena A, et al. Risk Factors for Sleep Disordered Breathing Among Hispanics and Non-Hispanics – A Retrospective Study. Presented at SLEEP 2025, the 39th annual meeting of the Associated Professional Sleep Societies, from June 8 – 11th in Seattle.

At SLEEP 2025, Walia discussed findings showing Hispanic individuals may experience more severe cases of sleep disordered breathing compared to the non-Hispanic group.

Harneet Walia, MD

Articles