基于胰高血糖素样肽-1受体激动作用的疗法治疗阻塞性睡眠呼吸暂停的疗效与安全性：一项系统评价与荟萃分析
Efficacy and Safety of Glucagon Like Peptide-1 Receptor Agonism Based Therapies in Obstructive Sleep Apnoea: A Systematic Review and Meta-Analysis.
作者信息
Dutta Deep, Jindal Radhika, Raizada Nishant, Nagendra Lakshmi, Kamrul Hasan Abm, Sharma Meha
机构信息
Department of Endocrinology, CEDAR Superspeciality Healthcare, Dwarka, New Delhi, India.
Department of Endocrinology, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
出版信息
Indian J Endocrinol Metab. 2025 Jan-Feb;29(1):4-12. doi: 10.4103/ijem.ijem_365_24. Epub 2025 Feb 28.
INTRODUCTION
The exponential increase in obesity is responsible for the increased prevalence of obstructive sleep apnoea (OSA). Weight loss is critical to improvement in OSA. Glucagon-like peptide-1 receptor (GLP1R) agonism-based therapies (GLP1RA-BT) have been associated with significant weight loss. Several randomized controlled trials have been published evaluating the use of GLP1RA-BT on OSA. However, the literature review revealed that no systematic review and meta-analysis (SRM) has been published evaluating the efficacy and safety of GLP1RA-BT in OSA.
METHODS
Electronic databases were searched for studies documenting the use of GLP1RA-BT in OSA. The primary outcome was to evaluate the impact on the apnea-hypopnea index (AHI). Secondary outcomes were to evaluate the impact on percent change in AHI, Epworth Sleepiness Score, body weight, blood pressure, and side-effect profile.
RESULTS
From initially screened 59 articles, data from 4 articles having 5 different randomized cohorts (937 patients) were analysed in this SRM. Use of GLP1RA-BT was associated with a significant reduction in AHI [MD-12.50 events/ hour (95% CI:-17.33 - -7.67); < 0.001; I=95%], percent-reduction in AHI [MD-52.17% (95% CI: -64.49 - -39.85); < 0.001; I = 0%], percent-reduction in body-weight [MD-12.46% (95% CI:-22.54 - -2.39); < 0.001; I = 99%] and systolic blood-pressure [MD -4.59 mm of Hg (95% CI:-6.61 - -2.58); P < 0.001; I = 67%]. The considerable heterogeneity was because of greater improvement in outcomes withtirzepatide compared to liraglutide. The occurrence of nausea [RR4.23 (95% CI: 2.73-6.55); < 0.001; I = 0%], vomiting [RR4.22 (95% CI: 2.12-8.41); < 0.001; I = 0%], diarrhoea [RR2.81 (95% CI: 1.84-4.31); < 0.001; I = 0%], and constipation [RR4.51 (95% CI: 2.47-8.26); < 0.001; I = 0%] were significantly higher with GLP1RA-BT compared to placebo.
CONCLUSION
This SRM provides encouraging data on the use of GLP1RA-BT in improving different respiratory aspects of OSA and reducing body weight and blood pressure.
引言
肥胖人数呈指数增长，导致阻塞性睡眠呼吸暂停（OSA）的患病率上升。体重减轻对于改善OSA至关重要。基于胰高血糖素样肽-1受体（GLP1R）激动剂的疗法（GLP1RA-BT）与显著的体重减轻相关。已经发表了几项随机对照试验，评估了GLP1RA-BT对OSA的治疗效果。然而，文献综述显示，尚未发表系统评价和荟萃分析（SRM）来评估GLP1RA-BT在OSA中的疗效和安全性。
方法
检索电子数据库，查找记录GLP1RA-BT在OSA中应用的研究。主要结局是评估对呼吸暂停低通气指数（AHI）的影响。次要结局是评估对AHI变化百分比、爱泼华嗜睡量表、体重、血压和副作用的影响。
结果
在本SRM中，从最初筛选的59篇文章中，分析了4篇文章中5个不同随机队列（937例患者）的数据。使用GLP1RA-BT与AHI显著降低相关[MD -12.50次/小时（95%CI：-17.33至-7.67）；P<0.001；I²=95%]，AHI降低百分比[MD -52.17%（95%CI：-64.49至-39.85）；P<0.001；I²=0%]，体重降低百分比[MD -12.46%（95%CI：-22.54至-2.39）；P<0.001；I²=99%]和收缩压[MD -4.59 mmHg（95%CI：-6.61至-2.58）；P<0.001；I²=67%]。相当大的异质性是由于替尔泊肽与利拉鲁肽相比，结局改善更大。与安慰剂相比，GLP1RA-BT组恶心[RR 4.23（95%CI：2.73 - 6.55）；P<0.001；I²=0%]、呕吐[RR 4.22（95%CI：2.12 - 8.41）；P<0.001；I²=0%]、腹泻[RR 2.81（95%CI：1.84 - 4.31）；P<0.001；I²=0%]和便秘[RR 4.51（95%CI：2.47 - 8.26）；P<0.001；I²=0%]的发生率显著更高。
结论
本SRM提供了关于使用GLP1RA-BT改善OSA不同呼吸方面以及减轻体重和血压的令人鼓舞的数据。
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