Safety and efficacy of glucagon-like peptide-1 receptor agonists in patients with obstructive sleep apnea: a systematic review and meta-analysis of randomized controlled trials

Mar 27, 2025European clinical respiratory journal

Safety and effectiveness of diabetes drugs in people with sleep apnea: a review of clinical trials

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Abstract

A meta-analysis involving 828 patients indicated that GLP-1 agonists improved the by 16.57 events per hour.

GLP-1 agonists are associated with a reduction in weight by an average of 12.71%.
decreased by an average of 4.93 mmHg with GLP-1 agonist treatment.
Tirzepatide specifically reduced high-sensitivity C-reactive protein levels by 0.89 mg/dl.
The sleep apnea-specific hypoxic burden was reduced by 66.21% per minute with tirzepatide.
No significant serious adverse events were reported, though gastrointestinal issues were more common.

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BACKGROUND: Obstructive sleep apnea (OSA) is a common condition affecting around one billion people worldwide. Emerging evidence from recent studies suggests that Glucagon-like peptide 1 receptor (GLP-1) agonists may reduce OSA severity. Hence, this meta-analysis aims to evaluate the efficacy and safety of GLP-1 agonists in patients with OSA.

METHODS: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched four electronic databases (PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science) to identify eligible studies reported up to 24 June 2024. Using Review Manager software, we reported outcomes as risk ratios (RRs) or mean difference (MD) and confidence intervals (CIs). The protocol for this review has been registered and published in PROSPERO with the ID (CRD42024562853).

RESULTS: The meta-analysis included three randomized controlled trials with 828 patients. Pooled analysis of patients administered GLP-1 agonists or tirzepatide showed improvement in (MD -16.57 events per hour, 95% CI [-27.41, -5.73], = 0.003), weight reduction (MD -12.71%, 95% CI [-21.38, -4.03], = 0.004), and (MD -4.93 mmHg,95% CI [-7.67, -2.19], = 0.0004). Tirzepatide showed a reduction in high-sensitivity C-reactive protein (MD -0.89 mg/dl, 95% CI [-1.25, -0.54], < 0.0001) and sleep apnea-specific hypoxic burden (MD -66.21%/min, 95% CI [-81.75, -50.67], < 0.0001). Despite the heterogeneity observed in the AHI and weight, it was resolved, and the results were consistent. GLP-1 agonists/tirzepatide showed comparable outcomes concerning diastolic blood pressure (MD -1.34 mmHg, 95% CI [-2.80, 0.12], = 0.07). No significant serious adverse events were observed for GLP-1 agonists/tirzepatide, but it was associated with a higher incidence of gastrointestinal adverse events. p p p p p p

CONCLUSION: GLP-1 agonists, including tirzepatide, improved Apnea/Hypopnea Index, weight, and systolic blood pressure in adults with moderate-to-severe OSA. However, the evidence remains limited to two published studies comprising three randomized controlled trials using different pharmacological agents. Consequently, further research is needed before firm conclusions can be drawn.

Key numbers

-16.57 events per hour

Reduction in

Mean difference in for GLP-1 agonists vs. placebo

-12.71%

Weight Reduction

Mean percentage change in body weight for GLP-1 agonists vs. placebo

-4.93 mmHg

Reduction

Mean difference in for GLP-1 agonists vs. placebo

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Safety and efficacy of glucagon-like peptide-1 receptor agonists in patients with obstructive sleep apnea: a systematic review and meta-analysis of randomized controlled trials

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