Efficacy of incretin-based therapies in obesity-related obstructive sleep apnea: a systematic review and meta-analysis of randomized controlled trials
Anna Bardóczi, Zsombor Matics, Caner Turan, Bence Szabó, Zsolt Molnár, Péter Hegyi, Veronika Müller, Gábor Horváth
Abstract
The primary etiologic risk factor for obstructive sleep apnea (OSA) is obesity. As incretin-based therapies, specifically glucagon-like peptide 1 (GLP-1) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) agonists, have shown promising outcomes in obesity management, these medications have generated interest in OSA therapy. To investigate their efficacy in OSA, we performed a systematic literature search following PRISMA and Cochrane Handbook guidelines for studies reporting apnea-hypopnea index (AHI) and incretin-based therapy in patients with OSA. Only randomized controlled trials were eligible for inclusion. Our literature search identified 813 publications, and 5 articles met the inclusion criteria. Collectively, the studies enrolled 1024 patients, lasted ≥12 weeks with liraglutide or tirzepatide, and resulted in significant reductions in body weight and/or body mass index. Incretin-based therapies were also associated with AHI reduction, with a mean change of -14.45 events/h (95 % CI: 25.90 to -2.99, p < 0.001). By pooling data of 5 RCTs in a pairwise meta-analysis, incretin-based therapies showed a greater effect on AHI than usual care, with a mean difference of -11.61 events/h (95 % CI: 22.91 to -0.31, p = 0.046). Our analysis demonstrates that weight reduction through incretin-based therapies improves AHI in OSA. Incretin-based therapies have the potential to treat sleep-disordered breathing in OSA patients with excess weight.