Efficacy and Safety of Glucagon Like Peptide-1 Receptor Agonism Based Therapies in Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis.

INTRODUCTION: The exponential increase in obesity is responsible for the increased prevalence of obstructive sleep apnoea (OSA). Weight loss is critical to improvement in OSA. Glucagon-like peptide-1 receptor (GLP1R) agonism-based therapies (GLP1RA-BT) have been associated with significant weight loss. Several randomized controlled trials have been published evaluating the use of GLP1RA-BT on OSA. However, the literature review revealed that no systematic review and meta-analysis (SRM) has been published evaluating the efficacy and safety of GLP1RA-BT in OSA. METHODS: Electronic databases were searched for studies documenting the use of GLP1RA-BT in OSA. The primary outcome was to evaluate the impact on the apnea-hypopnea index (AHI). Secondary outcomes were to evaluate the impact on percent change in AHI, Epworth Sleepiness Score, body weight, blood pressure, and side-effect profile. RESULTS: From initially screened 59 articles, data from 4 articles having 5 different randomized cohorts (937 patients) were analysed in this SRM. Use of GLP1RA-BT was associated with a significant reduction in AHI [MD-12.50 events/ hour (95% CI:-17.33 - -7.67);< 0.001; I=95%], percent-reduction in AHI [MD-52.17% (95% CI: -64.49 - -39.85);< 0.001; I= 0%], percent-reduction in body-weight [MD-12.46% (95% CI:-22.54 - -2.39);< 0.001; I= 99%] and systolic blood-pressure [MD -4.59 mm of Hg (95% CI:-6.61 - -2.58); P < 0.001; I= 67%]. The considerable heterogeneity was because of greater improvement in outcomes withtirzepatide compared to liraglutide. The occurrence of nausea [RR4.23 (95% CI: 2.73-6.55);< 0.001; I= 0%], vomiting [RR4.22 (95% CI: 2.12-8.41);< 0.001; I= 0%], diarrhoea [RR2.81 (95% CI: 1.84-4.31);< 0.001; I= 0%], and constipation [RR4.51 (95% CI: 2.47-8.26);< 0.001; I= 0%] were significantly higher with GLP1RA-BT compared to placebo. CONCLUSION: This SRM provides encouraging data on the use of GLP1RA-BT in improving different respiratory aspects of OSA and reducing body weight and blood pressure.