Potential Use of SGLT-2 Inhibitors in Obstructive Sleep Apnea: A new treatment on the horizon

Tanrıöver, Cem; Ucku, Duygu; Akyol, Merve Aliye; Cevik, Enes; Kanbay, Asiye; Sridhar, Vikas S.; Cherney, David Z.I.; Kanbay, Mehmet

doi:10.1007/s11325-022-02606-1

Cited by 12 publications

(7 citation statements)

References 67 publications

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“…According to multiple studies using animal models receiving empagliflozin after myocardial infarction, SGLT2i may also work by inhibiting sympathetic nervous system activation [43]. Through this mechanism, SGLT2i may theoretically lessen circadian sympathetic overactivity and associated symptoms in OSA patients, including nocturnal hypertension, the non-dipping phenomena [44]. Dapagliflozin only significantly improves moderate-to-severe sleep disordered breathing (SDB), not mild SDB, according to Furukawa et al [32].…”

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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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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“…SGLT2i have been found to reduce apnea-hypopnea index in patients with T2DM with OSAS in small studies, though their beneficial effects on OSA or sleep-disordered breathing have not been substantiated by other studies or meta-analyses[ 47 - 49 ]. Apart from weight reduction, other postulated beneficial mechanisms could include rostral nasal fluid shift due to diuresis and reduction of circadian sympathetic nerve activity, nocturnal hypertension, and oxidative stress by which SGLT2i might reduce the incidence or the CV effects of OSA[ 50 , 51 ]. Further studies are required to elucidate the benefits of SGLT2i in this regard.…”

Section: Effects Of Sglt2i On Different CV Risk Factorsmentioning

confidence: 99%

Sodium glucose cotransporter-2 inhibitors and heart disease: Current perspectives

Mondal,

Pramanik,

Khare

et al. 2024

World J Cardiol

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Sodium glucose cotransporter-2 inhibitors (SGLT-2i) are antidiabetic medications with remarkable cardiovascular (CV) benefits proven by multiple randomised controlled trials and real-world data. These drugs are also useful in the prevention of CV disease (CVD) in patients with diabetes mellitus (DM). Although DM as such is a huge risk factor for CVD, the CV benefits of SGLT-2i are not just because of antidiabetic effects. These molecules have proven beneficial roles in prevention and management of nondiabetic CVD and renal disease as well. There are various molecular mechanisms for the organ protective effects of SGLT-2i which are still being elucidated. Proper understanding of the role of SGLT-2i in prevention and management of CVD is important not only for the cardiologists but also for other specialists caring for various illnesses which can directly or indirectly impact care of heart diseases. This clinical review compiles the current evidence on the rational use of SGLT-2i in clinical practice.

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“…In this way, SGLT2 inhibitors may decrease rostral-to-caudal fluid shifts in the recumbent sleep position, cardiac preload, and intrathoracic fluid retention; (iii) due to the modest increase in urinary frequency, manifested usually as nocturia, SGLT2 inhibitors could promote interrupted sleep cycles and suppress the duration of REM sleep (a higher risk period for OSA events); (iv) SGLT2 inhibitors can suppress circadian sympathetic nervous system activation and its related conditions (such as non-dipping pattern of hypertension, cardiac autonomic neuropathy, and stroke); (v) forced glucosuria after their administration can reduce the availability of glucose as an energy fuel. In this way other substrates are utilized, and less endogenous CO 2 production is expected, with less CO 2 to be removed by the respiratory tract; and (vi) modulation of arousal threshold, muscle compensation, and loop gain [78,[93][94][95][96][97][98].…”

Section: Pathophysiological Conceptsmentioning

confidence: 99%

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

Papaetis¹

2023

Arch Med Sci Atheroscler Dis

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Obstructive sleep apnoea (OSA) is the most common form of abnormal sleep pattern (ASP). It is characterized by narrowing of the upper airways (complete or partial) during sleep. Although continuous positive airway pressure is recognized as the gold standard treatment of OSA, unfortunately treatment adherence is often suboptimal and does not address the pathophysiological mechanisms governing its pathogenesis. Weight gain is an important risk factor for the development and worsening of OSA both in adults and in children. Meaningful and sustained weight reduction using lifestyle modifications alone remains difficult and challenging. Novel therapeutic strategies are vital because currently there are no approved pharmacological therapies. This paper explores thoroughly both preclinical and clinical studies that investigated the possible role of GLP-1 receptor agonists and SGLT-2 inhibitors in individuals with ASP and especially OSA. It also discusses their future role in order to ameliorate the global burden of OSA.

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Potential Use of SGLT-2 Inhibitors in Obstructive Sleep Apnea: A new treatment on the horizon

Cited by 12 publications

References 67 publications

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

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

Sodium glucose cotransporter-2 inhibitors and heart disease: Current perspectives

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

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