Review of Glucagon-Like Peptide 1 and Glucose-Dependent Insulinotropic Polypeptide Agonists for Treatment of Adult Obese Patients with Obstructive Sleep Apnea
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Abstract
Although there are multiple risk factors for obstructive sleep apnea, obesity is a significant actionable risk factor that is increasing worldwide. Studies have shown that weight loss whether through bariatric surgery or medications is associated with improvement in obstructive sleep apnea severity. This review summarizes the underlying mechanisms of glucagon-like peptide 1 and glucose-dependent insulinotropic polypeptide receptor agonists pertaining to weight loss and then summarizes the studies which show beneficial effects on weight loss in obese adults with or without diabetes. We then review the available studies showing a reduction in obstructive sleep apnea severity in adult patients with obesity primarily through weight reduction. Potential limitations and implications of treatment with these medications for obstructive sleep apnea will be reviewed.
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References
2. Lyons MM, Bhatt NY, Pack AI, Magalang UJ. Global burden of sleep-disordered breathing and its implications. Respirology. 2020;25(7):690-702. doi:10.1111/resp.13838
3. Caples SM, Anderson WM, Calero K, Howell M, Hashmi SD. Use of polysomnography and home sleep apnea tests for the longitudinal management of obstructive sleep apnea in adults: an American Academy of Sleep Medicine clinical guidance statement. J Clin Sleep Med. 2021;17(6):1287-1293. doi:10.5664/jcsm.9240
4. Hudgel DW, Patel SR, Ahasic AM, et al. The Role of Weight Management in the Treatment of Adult Obstructive Sleep Apnea. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2018;198(6):e70-e87. doi:10. 1164/rccm.201807-1326ST
5. Popoviciu MS, Păduraru L, Yahya G, Metwally K, Cavalu S. Emerging Role of GLP-1 Agonists in Obesity: A Comprehensive Review of Randomised Controlled Trials. Int J Mol Sci. 2023;24(13):10449. Published 2023 Jun 21. doi:10.3390/ijms241310449
6. Cao W, Xu Y, Shen Y, et al. Change of neck circumference in relation to visceral fat area: a Chinese community-based longitudinal cohort study. Int J Obes (Lond). 2022;46(9):1633-1637. doi:10.1038/s41366-022-01160-w
7. Subramanian SK, Rajendran R, Venkata Vijaya Sai A, Ramachandra S. Correlation of Neck Circumference with Body Fat Percentage by Bioelectrical Impedance Analysis. International Journal of Kinanthropometry. 2023, 3(1): 102–108.
8. Lo Mauro A, Tringali G, Codecasa F, Abbruzzese L, Sartorio A, Aliverti A. Pulmonary and chest wall function in obese adults. Sci Rep. 2023;13(1):17753 . Published 2023 Oct 18. doi:10.1038/s41598-023-44222-3
9. Dixon AE, Peters U. The effect of obesity on lung function. Expert Rev Respir Med. 2018;12(9):755-767. doi:10.1080/17476348.2018.1506331
10. Kress JP, Pohlman AS, Alverdy J, Hall JB. The impact of morbid obesity on oxygen cost of breathing (VO(2RESP)) at rest. Am J Respir Crit Care Med. 1999;160(3):883-886. doi:10.1164/ajr ccm.160.3.9902058
11. Al Oweidat K, Toubasi AA, Tawileh RBA, Tawileh HBA, Hasuneh MM. Bariatric surgery and obstructive sleep apnea: a systematic review and meta-analysis. Sleep Breath. 2023;27(6):2283-2294. doi:10.1007/s11325-023-02840-1
12. Locke BW, Gomez-Lumbreras A, Tan CJ, et al. The association of weight loss from anti-obesity medications or bariatric surgery and apnea-hypopnea index in obstructive sleep apnea. Obes Rev. 2024;25(4):e13697. doi:10.1111/obr.13697
13. Fattal D, Hester S, Wendt L. Body weight and obstructive sleep apnea: a mathematical relationship between body mass index and apnea-hypopnea index in veterans. J Clin Sleep Med. 2022;18(12):2723-2729. doi:10.5664/jcsm.10190
14. Georgoulis M, Yiannakouris N, Kechribari I, et al. Dose-response relationship between weight loss and improvements in obstructive sleep apnea severity after a diet/lifestyle interventions: secondary analyses of the "MIMOSA" randomized clinical trial. J Clin Sleep Med. 2022;18(5):1251-1261. doi:10.5664/jcsm.9834
15. Peppard PE, Young T, Palta M, Dempsey J, Skatrud J. Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA. 2000;284(23):3015-3021. doi:10.1001/jama.284.23.3015
16. Ayas N.T. Circadian Rhythm Sleep Disorders. In: Encyclopedia of Sleep.2013: 212-14.
17. Malhotra A, Heilmann CR, Banerjee KK, Dunn JP, Bunck MC, Bednarik J. Weight reduction and the impact on apnea-hypopnea index: A systematic meta-analysis. Sleep Med. 2024;121:26 -31. doi:10.1016/j.sleep.2024.06.014
18. Tsaban G, Bilitzky-Kopit A, Yaskolka Meir A, et al. The Effect of Weight-Loss Interventions on Cervical and Chin Subcutaneous Fat Depots; the CENTRAL Randomized Controlled Trial. Nutrients. 2021;13(11):3827. Published 2021 Oct 27. doi:10. 3390/nu13113827
19. López-Padrós C, Salord N, Alves C, et al. Effectiveness of an intensive weight-loss program for severe OSA in patients undergoing CPAP treatment: a randomized controlled trial. J Clin Sleep Med. 2020;16(4):503-514. doi:10.5664/jcsm.8252
20. Look AHEAD Research Group, Wadden TA, West DS, et al. The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it [published correction appears in Obesity (Silver Spring). 2007 May;15(5):1339. Wadden, Thomas A [added]; West, Delia Smith [added]; Delahanty, Linda [added]; Jakicic, John [added]; Rejeski, Jack [added]; Williamson, Don [added]; Berkowitz, Robert I [added]; Kelley, David E [added]; Tomchee, Christine [added]; Hill, James O [added]; K]. Obesity (Silver Spring). 2006;14(5):737-752. doi:10.1038/oby.2006.84
21. Kuna ST, Reboussin DM, Strotmeyer ES, et al. Effects of Weight Loss on Obstructive Sleep Apnea Severity. Ten-Year Results of the Sleep AHEAD Study. Am J Respir Crit Care Med. 2021;203(2):221 -229. doi:10.1164/rccm.201912-2511OC
22. Kuna ST, Reboussin DM, Borradaile KE, et al. Sleep AHEAD Research Group of the Look AHEAD Research Group. Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes. Sleep. 2013 May 1;36(5):641-649A.
23. Kuna ST, Reboussin DM, Strotmeyer ES, et al. Sleep AHEAD Research Subgroup of the Look AHEAD Research Group. Effects of Weight Loss on Obstructive Sleep Apnea Severity. Ten-Year Results of the Sleep AHEAD Study. Am J Respir Crit Care Med. 2021 Jan 15;203(2):221-229.
24. Drucker DJ. Mechanisms of Action and Therapeutic Application of Glucagon-like Peptide-1. Cell Metab. 2018;27(4):740-756. doi:10.1016/j. cmet.2018.03.001
25. Smith NK, Hackett TA, Galli A, Flynn CR. GLP-1: Molecular mechanisms and outcomes of a complex signaling system. Neurochem Int. 2019;1 28:94-105. doi:10.1016/j.neuint.2019.04.010
26. Patti ME, Goldfine AB. Hypoglycemia after gastric bypass: the dark side of GLP-1. Gastroenterology. 2014;146(3):605-608. doi:10.10 53/j.gastro.2014.01.038
27. Salehi M, Prigeon RL, D'Alessio DA. Gastric bypass surgery enhances glucagon-like peptide 1-stimulated postprandial insulin secretion in humans. Diabetes. 2011;60(9):2308-2314. doi:10. 2337/db11-0203
28. Reis RL, Gavin KM. Brown adipocytes in Encyclopedia of Tissue Engineering and Regenerative Medicine Vol 2, Elsevier Academic Press. 2019, 299-312.
29. Wang JY, Wang QW, Yang XY, et al. GLP-1 receptor agonists for the treatment of obesity: Role as a promising approach. Front Endocrinol (Lausanne). 2023;14:1085799. Published 2023 Feb 1. doi:10.3389/fendo.2023.1085799
30. Gutierrez AD, Gao Z, Hamidi V, et al. Anti-diabetic effects of GLP1 analogs are mediated by thermogenic interleukin-6 signaling in adipocytes. Cell Rep Med. 2022;3(11):100813. doi:10.1016/j. xcrm.2022.100813
31. Gupta K, Raja A. Physiology, Gastric Inhibitory Peptide. In: StatPearls. Treasure Island (FL): StatPearls Publishing; September 26, 2022.
32. Seino Y, Fukushima M, Yabe D. GIP and GLP-1, the two incretin hormones: Similarities and differences. J Diabetes Investig. 2010;1(1-2):8-23. doi:10.1111/j.2040-1124.2010.00022.x
33. Kim SJ, Nian C, McIntosh CH. GIP increases human adipocyte LPL expression through CREB and TORC2-mediated trans-activation of the LPL gene. J Lipid Res. 2010;51(11):3145-3157. doi:10. 1194/jlr.M006841
34. Lupi R, Del Guerra S, D'Aleo V, Boggi U, Filipponi F, Marchetti P. The direct effects of GLP-1 and GIP, alone or in combination, on human pancreatic islets. Regul Pept. 2010;165(2-3):129-132. doi:10.1016/j.regpep.2010.04.009
35. Regmi A, Aihara E, Christe ME, et al. Tirzepatide modulates the regulation of adipocyte nutrient metabolism through long-acting activation of the GIP receptor. Cell Metab. 2024;36(8):1898-1899. doi:10.1016/j.cmet.2024.06.012
36. Zaffina I, Pelle MC, Armentaro G, et al. Effect of dual glucose-dependent insulinotropic peptide /glucagon-like peptide-1 receptor agonist on weight loss in subjects with obesity. Front Endocrinol (Lausanne). 2023;14:1095753. Published 2023 Feb 22. doi:10.3389/fendo.2023.109575
37. Ansari HUH, Qazi SU, Sajid F, et al. Efficacy and Safety of Glucagon-Like Peptide-1 Receptor Agonists on Body Weight and Cardiometabolic Parameters in Individuals With Obesity and Without Diabetes: A Systematic Review and Meta-Analysis. Endocr Pract. 2024;30(2):160-171. doi:10. 1016/j.eprac.2023.11.007
38. Jensterle M, Rizzo M, Haluzík M, Janež A. Efficacy of GLP-1 RA Approved for Weight Management in Patients With or Without Diabetes: A Narrative Review. Adv Ther. 2022;39(6):2452-2467. doi:10.1007/s12325-022-02153-x
39. Haase CL, Serratore Achenbach MG, Lucrezi G, Jeswani N, Maurer S, Egermann U. Use of Liraglutide 3.0 mg for Weight Management in a Real-World Setting in Switzerland. Obes Facts. 2021;14(5):568-576. doi:10.1159/000518325
40. Singh G, Krauthamer M, Bjalme-Evans M. Wegovy (semaglutide): a new weight loss drug for chronic weight management. J Investig Med. 2022;70(1):5-13. doi:10.1136/jim-2021-001952
41. Xie Z, Yang S, Deng W, Li J, Chen J. Efficacy and Safety of Liraglutide and Semaglutide on Weight Loss in People with Obesity or Overweight: A Systematic Review. Clin Epidemiol. 2022;14:146 3-1476. Published 2022 Dec 6. doi:10.2147/CLEP .S391819
42. Willard FS, Douros JD, Gabe MB, et al. Tirzepatide is an imbalanced and biased dual GIP and GLP-1 receptor agonist. JCI Insight. 2020;5(17) :e140532. Published 2020 Sep 3. doi:10.1172/ jci.insight.140532
43. Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022;387(3):205-216. doi:10.1056/NEJMoa2206038
44. Wharton S, Blevins T, Connery L, et al. Daily Oral GLP-1 Receptor Agonist Orforglipron for Adults with Obesity. N Engl J Med. 2023;389(10) :877-888. doi:10.1056/NEJMoa2302392
45. Jastreboff AM, Kaplan LM, Frías JP, et al. Triple-Hormone-Receptor Agonist Retatrutide for Obesity - A Phase 2 Trial. N Engl J Med. 2023;389 (6):514-526. doi:10.1056/NEJMoa2301972
46. Sodhi M, Rezaeianzadeh R, Kezouh A, Etminan M. Risk of Gastrointestinal Adverse Events Associated With Glucagon-Like Peptide-1 Receptor Agonists for Weight Loss. JAMA. 2023;3 30(18):1795-1797. doi:10.1001/jama.2023.19574
47. Smits MM, Van Raalte DH. Corrigendum: Safety of Semaglutide. Front Endocrinol (Lausanne). 2021;12:786732. Published 2021 Nov 10. doi:10.3389/fendo.2021.786732
48. Gragnano F, De Sio V, Calabrò P. FLOW trial stopped early due to evidence of renal protection with semaglutide. Eur Heart J Cardiovasc Pharmacother. 2024;10(1):7-9. doi:10.1093/ehjcvp/pvad080
49. Collins L, Costello RA. Glucagon-Like Peptide-1 Receptor Agonists. In: StatPearls. Treasure Island (FL): StatPearls Publishing; February 29, 2024.
50. Malhotra A, Grunstein RR, Fietze I, et al. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. N Engl J Med. Published online June 21, 2024. doi:10.1056/NEJMoa2404881
51. Mehta A, Marso SP, Neeland IJ. Liraglutide for weight management: a critical review of the evidence. Obes Sci Pract. 2017;3(1):3-14. doi:10. 1002/osp4.84
52. Blackman A, Foster GD, Zammit G, et al. Effect of liraglutide 3.0 mg in individuals with obesity and moderate or severe obstructive sleep apnea: the SCALE Sleep Apnea randomized clinical trial. Int J Obes (Lond). 2016;40(8):1310-1319. doi:10.1038/ ijo.2016.52
53. Jiang W, Li W, Cheng J, Li W, Cheng F. Efficacy and safety of liraglutide in patients with type 2 diabetes mellitus and severe obstructive sleep apnea. Sleep Breath. 2023;27(5):1687-1694. doi:10.1007/s11325-022-02768-y
54. Amin RS, Simakajornboon N, Szczesniak RV. C30 New Insights in Pathogenesis of Sleep Disordered Breathing: Treatment of obstructive sleep apnea with glucagon like peptide-1 receptor agonist. American Thoracic Society; San Diego, CA, USA: 2015.; p. A4144-A.
55. O'Donnell C, Crilly S, O'Mahony A, et al. Continuous Positive Airway Pressure but Not GLP1-mediated Weight Loss Improves Early Cardiovascular Disease in Obstructive Sleep Apnea: A Randomized Proof-of-Concept Study. Ann Am Thorac Soc. 2024;21(3):464-473. doi:10 .1513/AnnalsATS.202309-821OC
56. Le KDR, Le K, Foo F. The Impact of Glucagon-like Peptide 1 Receptor Agonists on Obstructive Sleep Apnoea: A Scoping Review. Pharmacy (Basel). 2024;12(1):11. Published 2024 Jan 8. doi:10.3390/pharmacy12010011
57. Sprung VS, Kemp GJ, Wilding JP, et al. Randomised, cOntrolled Multicentre trial of 26 weeks subcutaneous liraglutide (a glucagon-like peptide-1 receptor Agonist), with or without contiNuous positive airway pressure (CPAP), in patients with type 2 diabetes mellitus (T2DM) and obstructive sleep apnoEa (OSA) (ROMANCE): study protocol assessing the effects of weight loss on the apnea-hypnoea index (AHI). BMJ Open. 2020;10(7):e038856. Published 2020 Jul 22. doi:10.1136/bmjopen-2020-038856
58. Rubino D, Abrahamsson N, Davies M, et al. Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial. JAMA. 2021;325(14):1414-1425. doi:10.1001/jama .2021.3224
59. Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553 -1564. doi:10.1111/dom.14725
60. Aronne LJ, Sattar N, Horn DB, et al. Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial. JAMA. 2024;331(1):38-48. doi:10.1001/jama.2023.24945
61. Ard J, Fitch A, Fruh S, Herman L. Weight Loss and Maintenance Related to the Mechanism of Action of Glucagon-Like Peptide 1 Receptor Agonists. Adv Ther. 2021;38(6):2821-2839. doi:10. 1007/s12325-021-01710-0
62. Iepsen EW, Lundgren J, Dirksen C, et al. Treatment with a GLP-1 receptor agonist diminishes the decrease in free plasma leptin during maintenance of weight loss. Int J Obes (Lond). 2015;39(5):834-841. doi:10.1038/ijo.2014.177
63. Umapathysivam MM, Lee MY, Jones KL, et al. Comparative effects of prolonged and intermittent stimulation of the glucagon-like peptide 1 receptor on gastric emptying and glycemia. Diabetes. 2014;63(2):785-790. doi:10.2337/db13-0893
64. Garvey WT, Batterham RL, Bhatta M, et al. Two-year effects of semaglutide in adults with overweight or obesity: the STEP 5 trial. Nat Med. 2022;28(10):2083-2091. doi:10.1038/s41591-022-02026-4
65. Ryan DH, Lingvay I, Deanfield J, et al. Long-term weight loss effects of semaglutide in obesity without diabetes in the SELECT trial. Nat Med. 2024;30(7):2049-2057. doi:10.1038/s41591-024-02996-7
66. Wadden TA, Hollander P, Klein S, et al. Weight maintenance and additional weight loss with liraglutide after low-calorie-diet-induced weight loss: the SCALE Maintenance randomized study [published correction appears in Int J Obes (Lond). 2013 Nov;37(11):1514] [published correction appears in Int J Obes (Lond). 2015 Jan;39(1):187. doi: 10.1038/ijo.2014.88]. Int J Obes (Lond). 2013;37(11):1443-1451. doi:10.1038/ijo.2013.120
67. Klein HE. Most insured adults still have to pay at least part of the cost of GLP-1 Drugs. AJMC. May 16, 2024. Accessed August 14, 2024. https://www.ajmc.com/view/most-insured-adults-still-have-to-pay-at-least-part-of-the-cost-of-glp-1-drugs .
68. Cubanski J, Neuman T. Medicare spending on Ozempic and other glp-1s is skyrocketing. KFF. March 22, 2024. Accessed August 14, 2024. https://www.kff.org/policy-watch/medicare-spending-on-ozempic-and-other-glp-1s-is-skyrocketing/#:~:text=But%20the%20annual%20cost%20of%20these%20drugs,net%20prices%20may%20be%20lower%20with%20rebates .
69. Girouard A. How much does a CPAP machine cost? NCOA Adviser. May 3, 2024. Accessed August 14, 2024. https://www.ncoa.org/adviser/sleep/cpap-machine-cost/#:~:text=The%20average%20cost%20of%20a,varies%20but%20averages%20%24649%E2%80%93%24989 .
70. Sarver A. How long does a CPAP machine last? SleepApnea.org. May 23, 2023. Accessed August 14, 2024. https://www.sleepapnea.org/cpap/how-long-does-a-cpap-machine-last/#:~:text=Most%20CPAP%20machines%20should%20function,specialist%20for%20help%20with%20troubleshooting .
71. Fulas K. How often should CPAP parts be cleaned or replaced? Americare CPAP. February 15, 2021. Accessed August 14, 2024. https://www.americarecpap.com/2015/07/08/how-often-should-cpap-parts-be-cleaned-or-replaced/#:~:text=Head%20strap%20and%20chin%20strap,replace%20every%202%2D3%20months .
72. Vgontzas AN, Tan TL, Bixler EO, Martin LF, Shubert D, Kales A. Sleep apnea and sleep disruption in obese patients. Arch Intern Med. 1994;154(15):1705-1711.
73. Wolk R, Shamsuzzaman AS, Somers VK. Obesity, sleep apnea, and hypertension. Hypertension. 2003;42(6):1067-1074. doi:10.1161 /01.HYP.0000101686.98973.A3
74. Gray EL, McKenzie DK, Eckert DJ. Obstructive Sleep Apnea without Obesity Is Common and Difficult to Treat: Evidence for a Distinct Pathophysiological Phenotype. J Clin Sleep Med. 2017;13(1):81-88. Published 2017 Jan 15. doi:10 .5664/jcsm.6394
75. Antonaglia C, Passuti G. Obstructive sleep apnea syndrome in non-obese patients. Sleep Breath. 2022;26(2):513-518. doi:10.1007/s11325-021-02412-1
76. Sultana R, Sissoho F, Kaushik VP, Raji MA. The Case for Early Use of Glucagon-like Peptide-1 Receptor Agonists in Obstructive Sleep Apnea Patients with Comorbid Diabetes and Metabolic Syndrome. Life (Basel). 2022;12(8):1222. Published 2022 Aug 12. doi:10.3390/life12081222