GLP-1-based drugs lowered the apnoea-hypopnoea index by about 10 events an hour

Design

Meta-analysis of 6 randomised trials

Population

1,069 adults with moderate-to-severe obstructive sleep apnoea

Primary outcome

Change in apnoea-hypopnoea index

Effect

-9.99 events/hour (95% CI -16.47 to -3.50); I2 87%

A meta-analysis pooled six randomised trials (1,069 adults with moderate-to-severe obstructive sleep apnoea), four of liraglutide and two of tirzepatide, against control.

The apnoea-hypopnoea index fell by about 10 events an hour (95% CI -16.5 to -3.5) and weight by about 9.7 kg, with small falls in blood pressure. Oxygen desaturation index and minimum saturation did not change significantly, and adverse events were not increased. Heterogeneity was very high, partly because tirzepatide produces much larger weight loss than liraglutide.

The authors are clear that these drugs are not a substitute for CPAP. For a patient with obesity and sleep apnoea, a GLP-1-based drug can be part of a plan that treats both, but CPAP remains the treatment for the apnoea while weight falls.

• Continue CPAP as first-line treatment for moderate-to-severe obstructive sleep apnoea.
• Consider weight-loss medication as an addition for patients with obesity and sleep apnoea.
• Repeat a sleep study after substantial weight loss to reassess severity.
• Expect bigger effects with tirzepatide than liraglutide.

Why it matters

Drug-induced weight loss is now large enough to change sleep apnoea severity, which may reduce the pressure needed or the need for CPAP in some patients over time.

Don't overread it

Very high heterogeneity, and oxygenation measures did not improve; the pooled size of effect is uncertain.

The statistics, in plain English

An I-squared of 87% means the trials disagreed considerably on the size of the effect, so the pooled 10 events an hour is a rough average of quite different results. The confidence interval still excludes no effect.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.