GLP-1 receptor agonists, SGLT-2 inhibitors, and obstructive sleep apnoea: can new allies face an old enemy?

Papaetis, Georgios S.

doi:10.5114/amsad/161170

Cited by 13 publications

(5 citation statements)

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“…We did not find a statistically significant relationship between weight loss and improvement in ESS, perhaps because fewer studies reported sleepiness scores and ESS is less treatment responsive in OSA than AHI. Weight loss may improve cardiometabolic risk independent of CPAP treatment, 65 and several of the studied medications, such as SGLT2 inhibitors 66 and GLP‐1 receptor agonists, 67 have proposed mechanisms of benefit unique to patients with OSA but not necessarily reflected by changes in the AHI. Conversely, weight regain generally occurs after cessation of anti‐obesity medications, 68 while the weight loss, 69 and therefore AHI improvements, 39,70 persist to a greater degree with bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

The association of weight loss from anti‐obesity medications or bariatric surgery and apnea‐hypopnea index in obstructive sleep apnea

Locke,

Gomez‐Lumbreras,

Tan

et al. 2024

Obesity Reviews

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SummaryIntroductionWeight loss is recommended for individuals with obstructive sleep apnea (OSA) and overweight or obesity, but there is limited evidence to guide the selection of weight management strategies for patients who do not lose sufficient weight with diet and lifestyle changes. We evaluated the relationship between weight loss caused by pharmacologic or surgical interventions and subsequent improvement in OSA by the apnea‐hypopnea index (AHI).MethodsPubMed, Cochrane CENTRAL, and EMBASE were searched for randomized trials comparing pharmacologic or surgical obesity interventions to usual care, placebo, or no treatment in adults with OSA. The association between percentage weight loss and AHI change between randomization and last follow‐up was evaluated using meta‐regression. PROSPERO: CRD42022378853.ResultsTen eligible trials (n = 854 patients) were included. Four (n = 211) assessed bariatric surgery, and 6 (n = 643) assessed pharmacologic interventions over a median follow‐up of 13 months (interquartile range 6–26 months). The linear best estimate of the change in AHI is 0.45 events per hour (95% Confidence Interval 0.18 to 0.73 events per hour) for every 1% body weight lost.ConclusionsWeight loss caused by medication or surgery caused a proportionate improvement of the AHI. Providers could consider extrapolating from this relationship when advising patients of the expected effects of other pharmacologic or surgical interventions without direct evidence in OSA.

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Section: Discussionmentioning

confidence: 99%

The association of weight loss from anti‐obesity medications or bariatric surgery and apnea‐hypopnea index in obstructive sleep apnea

Locke,

Gomez‐Lumbreras,

Tan

et al. 2024

Obesity Reviews

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“…The mechanism for therapeutic GLP-1RA effects on OSAHS outcomes is currently unknown. However, the leading posited theory is its property as an anti-obesity drug, especially since obesity is a major risk factor, driver and exacerbator of OSA [ 14 ]. In particular, studies have shown that improvements in ESS and AHI due to GLP-1RA interventions are significantly correlated with reductions in weight loss, BMI and waist circumference [ 5 , 6 , 7 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Glucagon-like Peptide 1 Receptor Agonists on Obstructive Sleep Apnoea: A Scoping Review

Le,

Foo

2024

Pharmacy

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Background: Obstructive sleep apnoea (OSA) and associated hypopnoea syndromes are chronic conditions of sleep-disordered breathing with significant sequelae if poorly managed, including hypertension, cardiovascular disease, metabolic syndrome and increased mortality. Glucagon-like peptide 1 receptor agonists (GLP-1RA) have recently garnered significant interest as a potential therapeutic, attributed to their durable effects in weight loss and glycaemic control in metabolic syndromes, such as obesity and type 2 diabetes mellitus. This has led to significant investment into companies that produce these medications and divestment from traditional gold standard methods of OSA management such as continuous positive airway pressure machines. Despite these sentiments, the impacts of these medications on OSA outcomes are poorly characterised, with no high-quality evidence at this stage to support this hypothesis. This scoping review therefore aims to address the research question of whether GLP-1RAs lead to a direct improvement in OSA and associated hypopnoea syndromes. Methods: A scoping review was performed following a computer-assisted search of Medline, Embase and Cochrane Central databases. Papers that evaluated the use of GLP-1RA medications related to sleep-disordered breathing, OSA or other sleep-related apnoeic or hypopnoeic syndromes were included. Results: Literature search and evaluation identified 9 articles that were eligible for inclusion. Of these, 1 was a study protocol, 1 was a case report, 1 was an abstract of a randomised controlled trial (RCT), 1 was a non-randomised clinical trial and the remaining 5 were randomised clinical trials of variable rigour. All studies evaluated the outcomes of GLP-1RAs in patients with diagnosed OSA or symptoms suggestive of this condition. Conclusion: This scoping review identified early evidence to suggest that GLP-1RAs may improve OSA as defined by reduction in apnoea-hypopnoea index (AHI). This evidence is however conflicting due to contradicting results demonstrated from other studies. Overall, these medications were tolerated well, with minor gastrointestinal side-effects reported in some cases. Of all included studies, the quality of evidence was low, with short lengths of follow-up to identify durable effects of these medications on OSA outcomes and identify adverse events. More rigorous, RCTs with sufficient length of follow-up are required before consideration of formalising these medications into OSA treatment guidelines, frameworks and policies are warranted.

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“…As fat deposits around the neck and thorax may make upper airway collapsibility worse, losing weight may have a positive impact on airway collapse and AHI. Indeed, the diuretic action of SGLT2i may prevent nocturnal rostral fluid shift and lessen airway collapse while also reducing the severity of SA [38][39][40]. This is of particular interest, because whereas diuretics can reduce the severity of OSA in obese and hypertensive patients by acting through fluid reduction and redistribution, this is not obvious in diabetic patients where resistance to diuretics is often observed [41].…”

Section: Discussionmentioning

confidence: 99%

Effect of SGLT2-Inhibitors on Polygraphic Parameters in Elderly Patients Affected by Heart Failure, Type 2 Diabetes Mellitus, and Sleep Apnea

Armentaro,

Pelaia,

Condoleo

et al. 2024

Biomedicines

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Obstructive sleep apneas (OSAs) and central sleep apneas (CSAs) are the most common comorbidities in Heart Failure (HF) that are strongly associated with all-cause mortality. Several therapeutic approaches have been used to treat CSA and OSA, but none have been shown to significantly improve HF prognosis. Our study evaluated the effects of a 3-months treatment with sodium-glucose cotransporter type 2 inhibitor (SGLT2i) on polygraphic parameters in patients with sleep apnea (SA) and HF, across the spectrum of ejection fraction, not treated with continuous positive air pressure (CPAP). A group of 514 consecutive elderly outpatients with HF, type 2 diabetes mellitus (T2DM) and SA, eligible for treatment with SGLT2i, were included in the investigation before starting any CPAP therapy. The two groups were compared with the t-test and Mann–Whitney test for unpaired data when appropriate. Then, a simple logistic regression model was built using 50% reduction in AHI as the dependent variable and other variables as covariates. A multivariate stepwise logistic regression model was constructed using the variables that linked with the dependent variable to calculate the odds ratio (OR) for the independent predictors associated with the reduction of 50% in AHI. The treated group experienced significant improvements in polygraphic parameters between baseline values and follow-up with reduction in AHI (28.4 ± 12.9 e/h vs. 15.2 ± 6.5 e/h; p < 0.0001), ODI (15.4 ± 3.3 e/h vs. 11.1 ± 2.6 e/h; p < 0.0001), and TC90 (14.1 ± 4.2% vs. 8.2 ± 2.0%; p < 0.0001), while mean SpO2 improved (91. 3 ± 2.3 vs. 93.8 ± 2.5); p < 0.0001. These benefits were not seen in the untreated population. The use of SGLT2i in patients suffering from HF and mixed-type SA not on CPAP therapy significantly contributes to improving polygraphic parameters.

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GLP-1 receptor agonists, SGLT-2 inhibitors, and obstructive sleep apnoea: can new allies face an old enemy?

Cited by 13 publications

References 122 publications

The association of weight loss from anti‐obesity medications or bariatric surgery and apnea‐hypopnea index in obstructive sleep apnea

The association of weight loss from anti‐obesity medications or bariatric surgery and apnea‐hypopnea index in obstructive sleep apnea

The Impact of Glucagon-like Peptide 1 Receptor Agonists on Obstructive Sleep Apnoea: A Scoping Review

Effect of SGLT2-Inhibitors on Polygraphic Parameters in Elderly Patients Affected by Heart Failure, Type 2 Diabetes Mellitus, and Sleep Apnea

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