Effectiveness of injectable incretin therapies on obstructive sleep apnoea outcomes in overweight or obese individuals: a systematic review

Christelle Sheppard; Srikanth Bellary; Pushpa Singh

doi:10.1530/obabs.05.P7

Aims: To assess the effectiveness of glucagon-like peptide-1 receptor agonists (GLP1) and dual GLP-1 and glucose-dependent insulinotropic polypeptide (GLP1/GIP) receptor agonists in overweight or obese patients with obstructive sleep apnoea (OSA).

Methods: Four electronic databases (Embase, Medline, Web of Science and PubMed) were searched for studies between 2000 –2025 using search terms related to GLP1RA, sleep apnoea and obesity. Randomised controlled trials and observational studies, using injectable incretins as an intervention in adults with BMI > 25 with OSA and measuring apnoea hypopnoea index (AHI), were included. Data was extracted from eligible studies and a meta-analysis performed.

Results: Of the 1099 studies identified (792 screened by title and abstract and 26 by full text); 3 studies with 4 trial arms and 858 participants were included in the analysis. Studies compared Liraglutide or Tirzepatide with placebo, CPAP or both, with study duration of 24 – 52 weeks. Improvement in AHI was reported in 3 trials while one trial reported maximum benefit in CPAP group, followed by combination (CPAP + GLP1RA), and least effect in GLP1RA group. Studies demonstrated an overall improvement in systolic BP and weight loss. Meta-analysis of the included studies showed overall improvement in AHI with incretins compared to control (Treatment effect -14.56 (95% confidence interval (CI), -17.64 to -11.48)).

Table 1. Results of Meta-Analysis
Paper	No. of participants	Intervention	Comparator	Treatment Effect AHI (95% CI)	Weight %
Blackman et al. 2016	359	Liraglutide	Placebo	-6.10 (-11.00, -1.20)	39.52
Malhotra et al. Trial 1, 2024	234	Tirzepatide	Placebo	-20.00 (-25.80, -14.20)	27.72
Malhotra et al. Trial 2, 2024	235	Tirzepatide + CPAP	Placebo + CPAP	-23.80 (-29.60, -17.90)	28.20
Donnell et al. 2023	30	Liraglutide + CPAP	CPAP only	2.00 (-12.43, 16.43)	4.56
Overall, IV (I2 = 89.8%, P <0.001, z = -9.264)	858			-14.56 (-17.64, -11.48)	100.00

Conclusions: We observed that treatment with injectable incretin therapies significantly improved sleep apnoea related and metabolic outcomes in people with OSA and overweight or obesity. There is a need for larger randomised studies reporting consistently on sleep apnoea outcomes to establish the benefits of these therapies in people with OSA.

Obesity Abstracts

P7