Ahmed Magdy Ahmed
Ministry of Health, Egypt
Abstract Title: Efficacy of Incretin-Based Therapies in Obesity-Related Obstructive Sleep Apnea
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Research Interests:
Abstract
Background: Obesity is the principal modifiable risk factor for obstructive sleep apnea (OSA). Incretin-based therapies, including glucagon-like peptide-1 (GLP-1) receptor agonists and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) agonists, produce substantial weight reduction and may improve sleep-disordered breathing. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate their efficacy in patients with obesity-related OSA.
Methods: Following PRISMA guidelines and Cochrane Handbook recommendations, we searched major databases from inception to January 2026 for RCTs assessing incretin-based therapies in adults with OSA. The primary outcome was change in apnea–hypopnea index (AHI). Secondary outcomes included body weight, body mass index (BMI), oxygen desaturation index (ODI), and daytime sleepiness. Random-effects pairwise meta-analysis was performed using mean differences (MD) with 95% confidence intervals (CI).
Results: The search yielded 947 records, of which 7 RCTs met inclusion criteria, enrolling 1,286 participants with follow-up durations ranging from 12 to 52 weeks. Interventions included liraglutide, semaglutide, and tirzepatide. Incretin-based therapies resulted in significant reductions in body weight (pooled MD −8.7 kg, 95% CI −11.9 to −5.5) and BMI (MD −3.1 kg/m², 95% CI −4.4 to −1.8). These therapies were associated with improvement in OSA severity, with a pooled within-group AHI reduction of −12.8 events/h (95% CI −19.6 to −6.0). Compared with usual care or placebo, incretin-based therapy demonstrated a greater reduction in AHI (MD −9.4 events/h, 95% CI −17.8 to −1.0, p = 0.028). Improvements were also observed in ODI and Epworth Sleepiness Scale scores, with moderate heterogeneity across studies. Sensitivity analyses confirmed robustness of findings, and meta-regression suggested that magnitude of weight loss was significantly associated with AHI improvement.
Conclusions: Incretin-based therapies significantly reduce OSA severity in patients with excess weight, likely mediated by meaningful weight loss and possible direct effects on upper airway physiology. These agents may represent an effective adjunctive strategy for obesity-related OSA, particularly in patients intolerant of conventional therapies. Larger, long-term RCTs evaluating cardiometabolic outcomes and combination strategies with CPAP are warranted.
