Title

The use of GLP-1 agonists in Obstructive Sleep Apnea: a meta-analysis of randomized controlled trials

Authors

Paula Rocha, M.D. , Milene Sobral, Clara Pontual, Claudio Lucca.

Introduction

Glucagon-like Peptide-1 (GLP-1) agonists stand out as promising alternatives or adjunctive treatments to Continuous Positive Airway Pressure (CPAP) in treating Obstructive Sleep Apnea (OSA). However, the efficacy and safety of GLP-1 agonists in OSA remains unclear.

Methods

We systematically searched PubMed, Embase, and Cochrane for randomized clinical trials (RCTs) comparing GLP-1 agonists and placebo in patients with OSA. Statistical analyses were performed using R Studio 4.3.2. Mean difference (MD) and risk ratio (RR) with 95% confidence intervals (CI) were pooled across trials. Efficacy outcomes of interest were: apnea-hypopnea index (AHI, events/hour), systolic blood pressure (SBP) and diastolic blood pressure (DBP). Safety outcomes of interest were gastrointestinal adverse effects.

Results

This meta-analysis included four RCTs reporting data on 917 patients (458 GLP1s and 459 placebo). Mean age was 49.8 years. The combined analysis showed that GLP-1 agonists significantly reduced AHI (MD -15.19; 95% CI -22.31 to -8.08; p < 0.01; I2 = 91%), SBP (MD -4.88; 95% CI -6.82 to -2.95; p < 0.01; I2 = 46%) and DBP (MD -1.35; 95% CI -2.47 to -0.23; p = 0.02; I2 = 12%). The incidence of adverse events related to gastrointestinal upset was higher in the intervention group for nausea (RR 3.35; 95% CI 2.28 to 4.93; p < 0.001; I2 = 0%), diarrhea (RR 2.19; 95% CI 1.54 to 3.11; p < 0.001; I2 = 0%), constipation (RR 3.97; 95% CI 2.25 to 7.03; p < 0.001; I2 = 0%), dyspepsia (RR 5.60; 95% CI 2.15 to 14.58; p < 0.001; I2 = 0%) and gastroesophageal reflux disease (RR 10.21; 95% CI 2.80 to 37.18; p < 0.001; I2 = 0%).

Conclusion

In patients with OSA, GLP-1 agonists reduced AHI by minus 15.19 points, which translates to an average reduction of up to 15 episodes of hypopnea and apnea per hour of sleep, a statistical and clinical significant difference.

References

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