The Case for Early Use of Glucagon-like Peptide-1 Receptor Agonists in Obstructive Sleep Apnea Patients with Comorbid Diabetes and Metabolic Syndrome

Abstract

Patients with obstructive sleep apnea (OSA) have high rates of co-occurring type 2 diabetes, hypertension, obesity, stroke, congestive heart failure, and accelerated atherosclerotic cardiovascular diseases. These conditions frequently require multiple medications, raising the risk of polypharmacy, adverse drug–drug and drug–disease interactions, decreased quality of life, and increased healthcare cost in these patients. The current review of extant literature presents evidence supporting glucagon-like peptide-1 receptor agonists (GLP-1RA) as one pharmacologic intervention that provides a “one-stop shop” for OSA patients because of the multiple effects GLP-1RA has on comorbidities (e.g., hypertension, diabetes, obesity, metabolic syndrome, and atherosclerotic cardiovascular diseases) that commonly co-occur with OSA. Examples of glucagon-like peptide-1 receptor agonists approved by the FDA for diabetes (some of which are also approved for obesity) are liraglutide, exenatide, lixisenatide, dulaglutide, semaglutide, and albiglutide. Prescribing of GLP-1RAs to address these multiple co-occurring conditions has enormous potential to reduce polypharmacy, cost, and adverse drug events, and to improve quality of life for patients living with OSA and diabetes. We thus strongly advocate for increased and early use of GLP-1RA in OSA patients with co-occurring diabetes and other cardiometabolic conditions common in OSA.

The role of glucagon‐like peptide 1 receptor agonists for weight control in individuals with acquired hypothalamic obesity—A systematic review

“…GLP-1RA is beneficial also in exogenous obesity and its various metabolic complications. 31 We believe that earlier initiation of GLP-1RA may help disrupt this vicious cycle of progressive weight gain which is especially profound in HO and would be an important consideration in future trials using newer GLP-1RA.…”

“…As such, the timing of initiation of GLP‐1RA is an important strategy in curbing the exponential increase in weight in HO, particularly since fat mass may perpetuate further weight gain. Moreover, early initiation of GLP‐1RA is beneficial also in exogenous obesity and its various metabolic complications 31 . We believe that earlier initiation of GLP‐1RA may help disrupt this vicious cycle of progressive weight gain which is especially profound in HO and would be an important consideration in future trials using newer GLP‐1RA.…”

Diabetes-Related Mechanisms of Action Involved in the Therapeutic Effect of Croton Species: A Systematic Review

“…Hence, the application of incretin therapy results in a sustained improvement not only in glycemic levels but also in body weight. In addition, incretin treatment has a positive impact on inflammation, cardiovascular and liver health, and the central nervous system, especially improving sleep apnea [ 73 , 74 , 75 ]. According to the literature search, only the triterpene 3β-hydroxyhop-22(29)ene ( Figure 1 c), isolated from C. heterodoxus , increased insulin secretion through GLP-1, which was associated with the antihyperglycemic effect exhibited in the OGTTs in vivo.…”

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

“…Obstructive sleep apnoea (OSA) is a chronic condition of sleep-disordered breathing with important health outcomes including hypertension, atherosclerotic cardiovascular disease, metabolic syndrome, reduced quality of life and premature mortality [ 1 ]. OSA is characterised by evidence of complete or partial upper airway closure associated with temporarily reduced or complete cessation of breathing; termed hypopnoea or apnoea respectively [ 2 ].…”