Efficacy of incretin-based therapies in obesity-related obstructive sleep apnea : a systematic review and meta-analysis of randomized controlled trials

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.