{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T21:03:23Z","timestamp":1791407003047,"version":"4.3.3"},"reference-count":59,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"NIH\/NHLBI","award":["5T32 HL007287-45"],"award-info":[{"award-number":["5T32 HL007287-45"]}]},{"name":"NIH\/NHLBI","award":["1F32HL179793-01"],"award-info":[{"award-number":["1F32HL179793-01"]}]},{"name":"American Thoracic Society through the ATS Academic Sleep Pulmonary Integrated REsearch\/Clinical"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Successful weight loss is difficult for those with obstructive sleep apnea (OSA), and gaps in weight management care are more pronounced in rural areas. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are promising agents to improve the effectiveness of weight management care in patients with OSA and excess weight living in rural areas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We sought to examine the association of rural residence (vs urban) with receipt of GLP-1RAs among patients with OSA and excess weight.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using medical record and administrative data from the Veterans Health Administration, we constructed a national cohort of patients with OSA (defined by the presence of an International Classification of Diseases, 10th revision, code for OSA and procedure code for a sleep study) and excess weight (defined as body mass index\u2009\u2265\u200927\u2009kg\/m2) who participated in a lifestyle program for weight loss. The exposure was a rural home address as compared to an urban home address as defined by Rural-Urban Commuting Area codes. The outcome was the receipt of GLP-1RAs in the year after index date. We performed a mixed-effects logistic regression analysis of the association between rurality and receipt of GLP-1RAs while adjusting for confounding variables. We then performed a model-based causal mediation analysis evaluating two potential mediators of this association: (1) drive time to care and (2) drive distance to care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 68\u2009680 patients meeting inclusion criteria from January 1, 2018, to August 1, 2023, 26.0% lived in a rural area, and 74.0% lived in an urban area. Overall, 8.0% received a GLP-1RA in the year after the index date. Rural residents had \u223c10% lower odds of receipt of a GLP-1RA approved for chronic weight loss in comparison to urban peers, after adjusting for confounders. Drive distance and drive time to primary and specialty care did not mediate this association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Rural patients with OSA and excess weight were less likely to receive a GLP-1RA compared to urban peers. This association was not mediated through drive time or drive distance to care. Further work is needed to understand the factors that contribute to rural-urban differences in healthcare delivery beyond geographic domains of access.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/annalsats\/aaoag047","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T05:31:48Z","timestamp":1772602308000},"page":"1087-1096","source":"Crossref","is-referenced-by-count":3,"title":["Receipt of glucagon-like peptide-1 receptor agonists among rural patients with obstructive sleep apnea and excess weight"],"prefix":"10.1093","volume":"23","author":[{"given":"Aristotle G","family":"Leonhard","sequence":"first","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington , Seattle, WA,","place":["United States"]},{"name":"Seattle Division, VA Puget Sound Healthcare System, Health Systems Research , Seattle, WA,","place":["United States"]},{"name":"Seattle Division, Division of Pulmonary, Critical 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H","family":"Au","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington , Seattle, WA,","place":["United States"]},{"name":"Seattle Division, VA Puget Sound Healthcare System, Health Systems Research , Seattle, WA,","place":["United States"]},{"name":"Seattle Division, Division of Pulmonary, Critical Care, and Sleep Medicine, VA Puget Sound Healthcare System , Seattle, WA,","place":["United States"]},{"name":"Department of Veterans Affairs, Center of Care and Payment Innovation, Office of Healthcare Innovation and Learning , Washington, DC,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura C","family":"Feemster","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington , Seattle, WA,","place":["United States"]},{"name":"Seattle Division, VA Puget Sound Healthcare System, Health Systems 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