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Dragonieri S, Portacci A, Quaranta VN, Carratu P, Lazar Z, Carpagnano GE, Bikov A. Therapeutic Potential of Glucagon-like Peptide-1 Receptor Agonists in Obstructive Sleep Apnea Syndrome Management: A Narrative Review. Diseases 2024; 12:224. [PMID: 39329893 DOI: 10.3390/diseases12090224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 09/20/2024] [Accepted: 09/20/2024] [Indexed: 09/28/2024] Open
Abstract
Background: Obstructive Sleep Apnea (OSA) is a prevalent disorder characterized by repetitive upper airway obstructions during sleep, leading to intermittent hypoxia and sleep fragmentation. Current treatments, particularly Continuous Positive Airway Pressure (CPAP), face adherence challenges, necessitating novel therapeutic approaches. Methods: This review explores the potential of Glucagon-like Peptide-1 receptor agonists (GLP-1RA), commonly used for type 2 diabetes and obesity, in managing OSA. GLP-1RA promotes weight loss, enhances insulin sensitivity, and exhibits anti-inflammatory and neuroprotective properties, potentially addressing key pathophysiological aspects of OSA. Results: Emerging evidence suggests that these agents may reduce OSA severity by decreasing upper airway fat deposition and improving respiratory control. Clinical trials have demonstrated significant reductions in the Apnea-Hypopnea Index (AHI) and improvements in sleep quality with GLP-1 therapy. Conclusions: Future research should focus on elucidating the mechanisms underlying GLP-1 effects on OSAS, optimizing combination therapies, and identifying patient subgroups that may benefit the most. Integrating GLP-1RA into OSAS management could revolutionize treatment by addressing both the metabolic and respiratory components of the disorder, ultimately enhancing patient outcomes.
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Affiliation(s)
- Silvano Dragonieri
- Respiratory Medicine, Dipartimento di Biomedicina Traslazionale e Neuroscienze, University of Bari, 70121 Bari, Italy
| | - Andrea Portacci
- Respiratory Medicine, Dipartimento di Biomedicina Traslazionale e Neuroscienze, University of Bari, 70121 Bari, Italy
| | - Vitaliano Nicola Quaranta
- Respiratory Medicine, Dipartimento di Biomedicina Traslazionale e Neuroscienze, University of Bari, 70121 Bari, Italy
| | - Pierluigi Carratu
- Internal Medicine "A. Murri", Department DIMEPREJ, University of Bari, 70121 Bari, Italy
| | - Zsofia Lazar
- Department of Pulmonology, Semmelweis University, 1085 Budapest, Hungary
| | - Giovanna Elisiana Carpagnano
- Respiratory Medicine, Dipartimento di Biomedicina Traslazionale e Neuroscienze, University of Bari, 70121 Bari, Italy
| | - Andras Bikov
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
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Lin R, Yan W, He M, Liu B, Su X, Yi M, Zhang Y. The benefits of hypoglycemic therapy for patients with obstructive sleep apnea. Sleep Breath 2024; 28:1355-1363. [PMID: 38489146 DOI: 10.1007/s11325-024-03015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is often associated with glycemic abnormalities. This study is conducted to investigate the effects of hypoglycemic therapy on OSA-related indicators. METHOD We systematically searched Web of Science, PubMed, Embase, and the Cochrane Library for articles on OSA patients receiving any hypoglycemic drugs, published until December 25, 2022. Seven original studies were finally included. The proposal was registered with PROSPERO (CRD42022351206). RESULTS In summary, in addition to reduced glycosylated hemoglobin A1c (HbA1c), we found that hypoglycemic treatment can lower the apnea-hypopnea index (AHI) by 7.07/h (p = 0.0001). Although long-term treatment (> 12 weeks) achieved a more significant reduction in HbA1c (- 1.57% vs. - 0.30%) compared to short-term treatment (≤ 12 weeks), there was no significant difference between the two in terms of AHI (intergroup p-value = 0.27). We also found that patients using sodium glucose cotransporter 2 inhibitors (SGLT2i) experienced a greater reduction in AHI (- 11.00/h, p < 0.00001). Additionally, hypoglycemic treatment also showed certain improvements in related indicators like Epworth Sleepiness Scale, body mass index, and blood pressure. CONCLUSIONS Our results affirm the benefits of hypoglycemic treatment for OSA patients and highlight the notable effect of SGLT2i. Further researches are needed to help doctors gain a comprehensive understanding of the interaction between OSA and glycemic abnormalities.
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Affiliation(s)
- Ruihan Lin
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Medical School, Central South University, Changsha, China
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wenjie Yan
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Xiangya Medical School, Central South University, Changsha, China
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Meng He
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Bin Liu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoli Su
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Minhan Yi
- School of Life Sciences, Central South University, Changsha, China.
| | - Yuan Zhang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Le KDR, Le K, Foo F. The Impact of Glucagon-like Peptide 1 Receptor Agonists on Obstructive Sleep Apnoea: A Scoping Review. PHARMACY 2024; 12:11. [PMID: 38251405 PMCID: PMC10801460 DOI: 10.3390/pharmacy12010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/04/2024] [Accepted: 01/07/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) and associated hypopnoea syndromes are chronic conditions of sleep-disordered breathing with significant sequelae if poorly managed, including hypertension, cardiovascular disease, metabolic syndrome and increased mortality. Glucagon-like peptide 1 receptor agonists (GLP-1RA) have recently garnered significant interest as a potential therapeutic, attributed to their durable effects in weight loss and glycaemic control in metabolic syndromes, such as obesity and type 2 diabetes mellitus. This has led to significant investment into companies that produce these medications and divestment from traditional gold standard methods of OSA management such as continuous positive airway pressure machines. Despite these sentiments, the impacts of these medications on OSA outcomes are poorly characterised, with no high-quality evidence at this stage to support this hypothesis. This scoping review therefore aims to address the research question of whether GLP-1RAs lead to a direct improvement in OSA and associated hypopnoea syndromes. METHODS A scoping review was performed following a computer-assisted search of Medline, Embase and Cochrane Central databases. Papers that evaluated the use of GLP-1RA medications related to sleep-disordered breathing, OSA or other sleep-related apnoeic or hypopnoeic syndromes were included. RESULTS Literature search and evaluation identified 9 articles that were eligible for inclusion. Of these, 1 was a study protocol, 1 was a case report, 1 was an abstract of a randomised controlled trial (RCT), 1 was a non-randomised clinical trial and the remaining 5 were randomised clinical trials of variable rigour. All studies evaluated the outcomes of GLP-1RAs in patients with diagnosed OSA or symptoms suggestive of this condition. CONCLUSION This scoping review identified early evidence to suggest that GLP-1RAs may improve OSA as defined by reduction in apnoea-hypopnoea index (AHI). This evidence is however conflicting due to contradicting results demonstrated from other studies. Overall, these medications were tolerated well, with minor gastrointestinal side-effects reported in some cases. Of all included studies, the quality of evidence was low, with short lengths of follow-up to identify durable effects of these medications on OSA outcomes and identify adverse events. More rigorous, RCTs with sufficient length of follow-up are required before consideration of formalising these medications into OSA treatment guidelines, frameworks and policies are warranted.
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Affiliation(s)
- Khang Duy Ricky Le
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Melbourne, VIC 3010, Australia
- Department of Surgical Oncology, The Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Geelong Clinical School, Deakin University, Geelong, VIC 3220, Australia
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Kelvin Le
- Melbourne Medical School, The University of Melbourne, Melbourne, VIC 3052, Australia;
| | - Felicia Foo
- Department of Pharmacy, The Royal Melbourne Hospital, Melbourne, VIC 3010, Australia;
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Martynowicz H, Poreba R, Wieczorek T, Domagala Z, Skomro R, Wojakowska A, Winiewska S, Macek P, Mazur G, Gac P. Sleep Architecture and Daytime Sleepiness in Patients with Erectile Dysfunction. Life (Basel) 2023; 13:1541. [PMID: 37511916 PMCID: PMC10381524 DOI: 10.3390/life13071541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Obstructive sleep apnea is considered a risk factor for erectile dysfunction. The aim of this study was to determine sleep architecture and assess daytime sleepiness in patients with erectile dysfunction. The study group included 280 patients. The 107 enrolled patients had reported erectile dysfunction. The control group consisted of 173 patients who had no history of erectile dysfunction. The Epworth sleepiness scale (ESS) was used to measure the subjects' level of daytime sleepiness. All patients underwent a standardized overnight, single-night polysomnography in sleep laboratory. In the erectile dysfunction group, we observed increased ESS total score and N1 sleep phase duration. Mean and minimal oxygen saturation and mean oxygen desaturation were decreased in comparison to the control group. In summary, subjects with erectile dysfunction have altered sleep architecture, oxygen saturation parameters and increased daytime sleepiness.
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Affiliation(s)
- Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Rafal Poreba
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Tomasz Wieczorek
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10, 50-367 Wroclaw, Poland
| | - Zygmunt Domagala
- Department of Anatomy, Wroclaw Medical University, Chałubińskiego 6a, 50-368 Wroclaw, Poland
| | - Robert Skomro
- Division of Respiratory Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Anna Wojakowska
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Sylwia Winiewska
- Department of Experimental Dentistry, Wroclaw Medical University, Krakowska 26, 50-425 Wroclaw, Poland
| | - Piotr Macek
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Paweł Gac
- Division of Environmental Health and Occupational Medicine, Department of Population Health, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-368 Wroclaw, Poland
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Fang J, Miller P, Grigson PS. Sleep is increased by liraglutide, a glucagon-like peptide-1 receptor agonist, in rats. Brain Res Bull 2023; 192:142-155. [PMID: 36410565 DOI: 10.1016/j.brainresbull.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Sleep disturbances are prominent in drug use disorders, including those involving opioids in both humans and animals. Recent studies have shown that administration of liraglutide, a glucagon-like peptide-1 agonist, significantly reduces heroin taking and seeking in rats. In an effort to further understand the action of this substance on physiological functions and to evaluate safety issues for its potential clinical use, the aim of the present study was to determine whether the dose of liraglutide found effective in reducing responding for an opioid also could improve sleep in drug-naïve rats. METHODS Using a within-subjects design, adult male rats chronically implanted with EEG and EMG electrodes received subcutaneous injection of saline or 0.06, 0.10, 0.30 or 0.60 mg/kg liraglutide. The 0.10 and 0.30 mg/kg doses are known to be most effective in reducing responding for heroin in rats at light or dark onset during a 12:12 h light-dark cycle (0.10 mg/kg for taking and seeking, 0.30 mg/kg for seeking). EEG and EMG were recorded across the 24 h period following each injection. RESULTS After both dark and light onset injections, liraglutide dose-dependently decreased wakefulness and increased non-rapid eye movement (NREM) sleep except at the lowest dose. The bout length of wakefulness and NREM sleep were decreased and increased, respectively. Whether administered at light or dark onset, the above alterations occurred primarily during the dark period (i.e., during the active period). The animals' body weight was decreased after liraglutide treatments as expected since it is clinically used for the treatment of obesity. CONCLUSION These data indicate that liraglutide, at doses known to reduce responding for heroin and fentanyl, also increases NREM sleep, suggesting that the increase in sleep may contribute to the protective effects of liraglutide and may promote overall general health.
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Affiliation(s)
- Jidong Fang
- The Pennsylvania State University College of Medicine, Department of Psychiatry, USA.
| | - Patti Miller
- The Pennsylvania State University College of Medicine, Department of Psychiatry, USA.
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Abstract
Obstructive sleep apnea (OSA) is characterized by upper airway collapse during sleep. Chronic intermittent hypoxia, sleep fragmentation, and inflammatory activation are the main pathophysiological mechanisms of OSA. OSA is highly prevalent in obese patients and may contribute to cardiometabolic risk by exerting detrimental effects on adipose tissue metabolism and potentiating the adipose tissue dysfunction typically found in obesity. This chapter will provide an update on: (a) the epidemiological studies linking obesity and OSA; (b) the studies exploring the effects of intermittent hypoxia and sleep fragmentation on the adipose tissue; (c) the effects of OSA treatment with continuous positive airway pressure (CPAP) on metabolic derangements; and (d) current research on new anti-diabetic drugs that could be useful in the treatment of obese OSA patients.
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Affiliation(s)
- Maria R Bonsignore
- Sleep Disordered Breathing and Chronic Respiratory Failure Clinic, PROMISE Department, University of Palermo, Palermo, Italy.
- Institute for Biomedical Research and Innovation (IRIB), National Research Council (CNR), Palermo, Italy.
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Maski K, Trotti LM, Kotagal S, Robert Auger R, Swick TJ, Rowley JA, Hashmi SD, Watson NF. Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med 2021; 17:1895-1945. [PMID: 34743790 DOI: 10.5664/jcsm.9326] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION This systematic review provides supporting evidence for the accompanying clinical practice guideline on the treatment of central disorders of hypersomnolence in adults and children. The review focuses on prescription medications with U.S. Food & Drug Administration approval and nonpharmacologic interventions studied for the treatment of symptoms caused by central disorders of hypersomnolence. METHODS The American Academy of Sleep Medicine commissioned a task force of experts in sleep medicine to perform a systematic review. Randomized controlled trials and observational studies addressing pharmacological and nonpharmacological interventions for central disorders of hypersomnolence were identified. Statistical analyses were performed to determine the clinical significance of all outcomes. Finally, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process was used to assess the evidence for the purpose of making specific treatment recommendations. RESULTS The literature search identified 678 studies; 144 met the inclusion criteria and 108 provided data suitable for statistical analyses. Evidence for the following interventions is presented: armodafinil, clarithromycin, clomipramine, dextroamphetamine, flumazenil, intravenous immune globulin (IVIG), light therapy, lithium, l-carnitine, liraglutide, methylphenidate, methylprednisolone, modafinil, naps, pitolisant, selegiline, sodium oxybate, solriamfetol, and triazolam. The task force provided a detailed summary of the evidence along with the quality of evidence, the balance of benefits and harms, patient values and preferences, and resource use considerations. CITATION Maski K, Trotti LM, Kotagal S, et al. Treatment of central disorders of hypersomnolence: an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment. J Clin Sleep Med. 2021;17(9):1895-1945.
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Affiliation(s)
- Kiran Maski
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Lynn Marie Trotti
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Suresh Kotagal
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - R Robert Auger
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Todd J Swick
- Neuroscience's Clinical Division, Takeda Pharmaceuticals
| | - James A Rowley
- Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan
| | | | - Nathaniel F Watson
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington
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Sprung VS, Kemp GJ, Wilding JP, Adams V, Murphy K, Burgess M, Emegbo S, Thomas M, Needham AJ, Weimken A, Schwab RJ, Manuel A, Craig SE, Cuthbertson DJ. 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:e038856. [PMID: 32699168 PMCID: PMC7380950 DOI: 10.1136/bmjopen-2020-038856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnoea (OSA) and type 2 diabetes mellitus (T2DM) often occur concurrently, and untreated OSA may potentially amplify the high risk of cardiovascular disease in T2DM. Compliance with continuous positive airway pressure (CPAP), the conventional treatment for OSA, can be poor and considering weight loss is the most effective treatment for OSA. This trial examines whether the glucagon-like peptide-1 receptor agonist liraglutide, a glucose-lowering therapy associated with significant weight loss used in T2DM, can improve the severity and symptoms of OSA. METHODS AND ANALYSIS This is an outpatient, single-centred, open-labelled, prospective, phase IV randomised controlled trial in a two-by-two factorial design. One hundred and thirty-two patients with newly diagnosed OSA (apnoea-hypopnoea index (AHI) ≥15 events/hour), and existing obesity and T2DM (glycated haemoglobin (HbA1c) ≥47 mmol/mol), will be recruited from diabetes and sleep medicine outpatient clinics in primary and secondary care settings across Liverpool. Patients will be allocated equally, using computer-generated random, permuted blocks of unequal sizes, to each of the four treatment arms for 26 weeks: (i) liraglutide (1.8 mg once per day) alone, (ii) liraglutide 1.8 mg once per day with CPAP, (iii) CPAP alone (conventional care) or (iv) no treatment (control). The primary outcome measure is change in OSA severity, determined by AHI. Secondary outcome measures include effects on glycaemic control (glycated haemoglobin (HbA1c)), body weight and quality of life measures. Exploratory measures include measures of physical activity, MRI-derived measures of regional body composition including fat mass (abdominal subcutaneous, visceral, neck and liver fat) and skeletal muscle mass (cross-sectional analysis of thigh), indices of cardiac function (using transthoracic echocardiography) and endothelial function. ETHICAL APPROVAL The study has been approved by the North West Liverpool Central Research Ethics Committee (14/NW/1019) and it is being conducted in accordance with the Declaration of Helsinki and Good Clinical Practice. TRIAL REGISTRATION NUMBERS ISRCTN16250774. EUDRACT No. 2014-000988-41. UTN U1111-1139-0677.
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Affiliation(s)
- Victoria S Sprung
- Research Institute for Sport & Exercise Sciences, Liverpool John Moores University, Liverpool, UK
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Graham J Kemp
- Department of Musculoskeletal & Ageing Science, University of Liverpool, Liverpool, Merseyside, UK
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC), University of Liverpool, Liverpool, UK
| | - John Ph Wilding
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Valerie Adams
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC), University of Liverpool, Liverpool, UK
| | - Kieran Murphy
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC), University of Liverpool, Liverpool, UK
| | - Malcolm Burgess
- Department of Cardiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Stephen Emegbo
- Liverpool Sleep & Ventilation Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Matthew Thomas
- Liverpool Sleep & Ventilation Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Andrew Weimken
- Center for Sleep & Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Richard J Schwab
- Center for Sleep & Circadian Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ari Manuel
- Liverpool Sleep & Ventilation Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sonya E Craig
- Liverpool Sleep & Ventilation Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
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Simonds SE, Pryor JT, Koegler FH, Buch-Rasmussen AS, Kelly LE, Grove KL, Cowley MA. Determining the Effects of Combined Liraglutide and Phentermine on Metabolic Parameters, Blood Pressure, and Heart Rate in Lean and Obese Male Mice. Diabetes 2019; 68:683-695. [PMID: 30674622 DOI: 10.2337/db18-1149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/17/2019] [Indexed: 01/08/2023]
Abstract
Liraglutide, a glucagon-like peptide 1 (GLP-1) receptor agonist, and phentermine, a psychostimulant structurally related to amphetamine, are drugs approved for the treatment of obesity and hyperphagia. There is significant interest in combination use of liraglutide and phentermine for weight loss; however, both drugs have been reported to induce systemic hemodynamic changes, and as such the therapeutic window for this drug combination needs to be determined. To understand their impact on metabolic and cardiovascular physiology, we tested the effects of these drugs alone and in combination for 21 days in lean and obese male mice. The combination of liraglutide and phentermine, at 100 μg/kg/day and 10 mg/kg/day, respectively, produced the largest reduction in body weight in both lean and diet-induced obese (DIO) mice, when compared with both vehicle and monotherapy-treated mice. In lean mice, combination treatment at the aforementioned doses significantly increased heart rate and reduced blood pressure, whereas in DIO mice, combination therapy induced a transient increase in heart rate and decreased blood pressure. These studies demonstrate that in obese mice, the combination of liraglutide and phentermine may reduce body weight but only induce modest improvements in cardiovascular functions. Conversely, in lean mice, the additional weight loss from combination therapy does not improve cardiovascular parameters.
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Affiliation(s)
- Stephanie E Simonds
- Metabolic Disease and Obesity Program, Monash Biomedicine Discovery Institute, and Department of Physiology, Monash University, Melbourne, Victoria, Australia
| | - Jack T Pryor
- Metabolic Disease and Obesity Program, Monash Biomedicine Discovery Institute, and Department of Physiology, Monash University, Melbourne, Victoria, Australia
- Woodrudge LTD, London, U.K
| | | | - Alberte S Buch-Rasmussen
- Metabolic Disease and Obesity Program, Monash Biomedicine Discovery Institute, and Department of Physiology, Monash University, Melbourne, Victoria, Australia
| | - Lauren E Kelly
- Metabolic Disease and Obesity Program, Monash Biomedicine Discovery Institute, and Department of Physiology, Monash University, Melbourne, Victoria, Australia
| | | | - Michael A Cowley
- Metabolic Disease and Obesity Program, Monash Biomedicine Discovery Institute, and Department of Physiology, Monash University, Melbourne, Victoria, Australia
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Alonso-Troncoso I, Carollo-Limeres C, Rios-Prego M, Guler I, Cadarso-Suárez C, F-Mariño A. Liraglutide in a real-world setting: Joint modeling of metabolic response, prediction of efficacy, and cardiovascular risk. ACTA ACUST UNITED AC 2018; 66:376-384. [PMID: 30528642 DOI: 10.1016/j.endinu.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES The worldwide prevalence of type 2 diabetes mellitus increases in parallel to that of obesity. Liraglutide (LRG), a glucagon-like peptide-1 receptor agonist, can reduce body weight. This study assessed the metabolic efficacy of LRG in real-world clinical practice. METHODS An observational, retrospective cohort study including patients treated with LRG for at least one year (187 patients). Anthropometric and metabolic variables, a composite endpoint, factors predicting response to LRG, and cardiovascular risk over time were assessed. A linear mixed-effects model with a bivariate structure was constructed to investigate the time-dependent relationship between weight and HbA1c values. RESULTS HbA1c levels and weight significantly decreased in the first 12 weeks, and the decrease persisted at 12 and 24 months in all subgroups studied. Mean weight and HbA1c decreases after 24 months were 8.5kg and 1.7% respectively. HbA1c values <7% were achieved by 42% of patients at 12 months and by 40% at 24 months. Treatment with LRG allowed for reduction in insulin dose. No serious adverse events were noted. Cardiovascular risk decreased from high to moderate-low. CONCLUSIONS Under standard clinical practice conditions, LRG achieved a better metabolic response than seen in clinical trials. Efficacy at 12 weeks of treatment is a good predictor of response. LRG allows for delaying or reducing insulin dose by improving both weight and glucose control. Cardiovascular risk improved.
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Affiliation(s)
| | - Carmen Carollo-Limeres
- Unidad de Bioestadística, Facultad de Medicina, Universidad Santiago de Compostela, Santiago de Compostela, Spain
| | - Mónica Rios-Prego
- Servicio Medicina Interna, Complejo Hospitalario Universitario de Pontevedra, Spain
| | - Ipek Guler
- Unidad de Bioestadística, Facultad de Medicina, Universidad Santiago de Compostela, Santiago de Compostela, Spain
| | - Carmen Cadarso-Suárez
- Unidad de Bioestadística, Facultad de Medicina, Universidad Santiago de Compostela, Santiago de Compostela, Spain
| | - Alexis F-Mariño
- Servicio Endocrinología, Complejo Hospitalario Universitario de Vigo, Spain
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Xanthopoulos MS, Berkowitz RI, Tapia IE. Effects of obesity therapies on sleep disorders. Metabolism 2018; 84:109-117. [PMID: 29409812 DOI: 10.1016/j.metabol.2018.01.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/18/2018] [Accepted: 01/26/2018] [Indexed: 12/21/2022]
Abstract
Obesity is a significant risk factor for obstructive sleep apnea syndrome (OSAS), and has also been linked to reductions in sleep quality and quantity. Weight loss has been shown to be an effective treatment for improving OSAS; however, there is a high degree of variability in improvements of OSAS in response to weight loss. There are three modalities of obesity therapies: 1) lifestyle modification, which includes changes in dietary intake and physical activity, along with behavioral interventions; 2) pharmacologic agents; and 3) bariatric surgery. Individuals have a highly variable response to the various obesity interventions, and maintenance of weight loss can be especially challenging. These factors influence the effect of weight loss on sleep disorders. There is still a need for large, well-controlled studies examining short- and long-term efficacy of weight loss modalities and their impact on long-term treatment of OSAS and other sleep parameters, particularly in youth. Nonetheless, given our current knowledge, weight reduction should always be encouraged for people coping with obesity, OSAS, and/or sleep disruptions and resources identified to assist patients in choosing a weight loss approach that will benefit them the most.
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Affiliation(s)
- Melissa S Xanthopoulos
- Sleep Center in the Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Robert I Berkowitz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ignacio E Tapia
- Sleep Center in the Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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12
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Reutrakul S, Sumritsopak R, Saetung S, Chanprasertyothin S, Anothaisintawee T. The relationship between sleep and glucagon-like peptide 1 in patients with abnormal glucose tolerance. J Sleep Res 2017; 26:756-763. [DOI: 10.1111/jsr.12552] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 03/28/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Sirimon Reutrakul
- Division of Endocrinology and Metabolism; Department of Medicine; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Rungtip Sumritsopak
- Division of Endocrinology and Metabolism; Department of Medicine; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Sunee Saetung
- Division of Endocrinology and Metabolism; Department of Medicine; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Suwannee Chanprasertyothin
- Research Center; Department of Medicine; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Thunyarat Anothaisintawee
- Department of Family Medicine; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
- Section for Clinical Epidemiology and Biostatistics; Faculty of Medicine Ramathibodi Hospital; Mahidol University; Bangkok Thailand
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13
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Ng WL, Stevenson CE, Wong E, Tanamas S, Boelsen-Robinson T, Shaw JE, Naughton MT, Dixon J, Peeters A. Does intentional weight loss improve daytime sleepiness? A systematic review and meta-analysis. Obes Rev 2017; 18:460-475. [PMID: 28117952 DOI: 10.1111/obr.12498] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/24/2016] [Accepted: 12/02/2016] [Indexed: 12/11/2022]
Abstract
Obesity is associated with excessive daytime sleepiness, but its causality remains unclear. We aimed to assess the extent to which intentional weight loss affects daytime sleepiness. Electronic databases were searched through 24 October 2016. Studies involving overweight or obese adults, a weight loss intervention and repeated valid measures of daytime sleepiness were included in the review. Two independent reviewers extracted data on study characteristics, main outcome (change in daytime sleepiness score standardized by standard deviation of baseline sleepiness scores), potential mediators (e.g. amount of weight loss and change in apnoea-hypopnoea index) and other co-factors (e.g. baseline demographics). Forty-two studies were included in the review. Fifteen before-and-after studies on surgical weight loss interventions showed large improvements in daytime sleepiness, with a standardized effect size of -0.97 (95% confidence interval [CI] -1.21 to -0.72). Twenty-seven studies on non-surgical weight loss interventions showed small-to-moderate improvement in daytime sleepiness, with a standardized effect size of -0.40 (95%CI -0.52 to -0.27), with no difference between controlled and before-and-after studies. We found a nonlinear association between amount of weight loss and change in daytime sleepiness. This review suggests that weight loss interventions improve daytime sleepiness, with a clear dose-response relationship. This supports the previously hypothesized causal effect of obesity on daytime sleepiness. It is important to assess and manage daytime sleepiness in obese patients.
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Affiliation(s)
- W L Ng
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Obesity and Population Health Unit, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
- Obesity and Population Health Unit, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - C E Stevenson
- Obesity and Population Health Unit, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - E Wong
- Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Obesity and Population Health Unit, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
- Obesity and Population Health Unit, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - S Tanamas
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA
| | - T Boelsen-Robinson
- Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Obesity and Population Health Unit, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
- Obesity and Population Health Unit, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - J E Shaw
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - M T Naughton
- General Respiratory and Sleep Medicine, Department of Allergy, Immunology, and Respiratory Medicine, The Alfred, Melbourne, Australia
- Department of Medicine, Monash University, The Alfred Hospital, Melbourne, Australia
| | - J Dixon
- Clinical Obesity Research, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - A Peeters
- Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Obesity and Population Health Unit, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
- Obesity and Population Health Unit, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Martynowicz H, Skomro R, Gać P, Mazur G, Porębska I, Bryłka A, Nowak W, Zieliński M, Wojakowska A, Poręba R. The influence of hypertension on daytime sleepiness in obstructive sleep apnea. ACTA ACUST UNITED AC 2017; 11:295-302. [PMID: 28412276 DOI: 10.1016/j.jash.2017.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/06/2017] [Accepted: 03/14/2017] [Indexed: 12/22/2022]
Abstract
Daytime sleepiness is a common symptom among hypertensive patients. The aim of this study was to determine subjective sleepiness assessed by Epworth Sleepiness Scale (ESS) and to asses sleep architecture in 304 patients with arterial hypertension. All patients underwent a standardized diagnostic overnight, polysomnography. The control group consisted of 67 normotensives. The hypertensive patients had a decreased sleep efficiency, mean and minimum oxygen saturation levels, and increased apnea/hypopnea index and oxygen desaturation index compared with normotensive patients. The lower ratio of N3 sleep, higher of N2 sleep, and decreased sleep efficiency was observed in hypertensives without obstructive sleep apnea (OSA). In the moderate to severe OSA groups, the total ESS score was significantly lower in hypertensives compared with normotensives. The ESS scores decreased with age in hypertensives, but not in normotensives. The study showed that ESS total score is lower in hypertensives than in normotensives with OSA, making the OSA more difficult to suspect. Thus, the low ESS score in hypertensives should not discourage further evaluation.
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Affiliation(s)
- Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland
| | - Robert Skomro
- Division of Respiratory Critical Care and Sleep Medicine, Department of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Paweł Gać
- Department of Hygiene, Wroclaw Medical University, Wrocław, Poland.
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland
| | - Irena Porębska
- Department of Pulmonology and Lung Cancers, Wroclaw Medical University, Wroclaw, Poland
| | - Agnieszka Bryłka
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland
| | - Wojciech Nowak
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland
| | - Michał Zieliński
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Wojakowska
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Wroclaw, Poland
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Ostawal A, Mocevic E, Kragh N, Xu W. Clinical Effectiveness of Liraglutide in Type 2 Diabetes Treatment in the Real-World Setting: A Systematic Literature Review. Diabetes Ther 2016; 7:411-38. [PMID: 27350545 PMCID: PMC5014786 DOI: 10.1007/s13300-016-0180-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION In clinical trials, liraglutide has proven to be an effective drug for the treatment of type 2 diabetes mellitus (T2DM). The real-world effectiveness of liraglutide has been investigated in numerous studies. The aim of this systematic literature review is to collate evidence on the real-world clinical effectiveness of liraglutide. METHODS A review of publications from Medline, EMBASE, the Cochrane Library, and conference proceedings was conducted to identify observational studies that assessed the clinical effectiveness of liraglutide in real-world clinical practice. This review was conducted according to the National Institute of Health and Care Excellence (NICE) guidance. No language or time limits were applied, except to the conference proceedings (2013-2015). Endpoints for data extraction were decided a priori. Study quality appraisal was done for full-text journal articles. RESULTS Of 124 publications included in the review, 43 were full-text articles. Liraglutide significantly reduces glycated hemoglobin (HbA1c) within 6 months of initiating treatment (mean change in HbA1c from baseline: -0.9% to -2.2%; HbA1c <7.0%: 29.5-65.0%). The NICE composite endpoint (HbA1c reduction ≥1% and weight reduction ≥3%) was met in 16.9-47.0% of patients with liraglutide treatment. Liraglutide therapy led to a mean change in absolute weight from baseline of -1.3 to -8.65 kg. Liraglutide treatment was well tolerated in patients with T2DM. The rate of occurrence of hypoglycemia with liraglutide monotherapy was ≤0.8%. Hypoglycemia was more common in patients taking antidiabetic medications (0.0-15.2%) together with liraglutide. The beneficial glycemic and weight effect of liraglutide therapy in patients with T2DM was maintained for at least 12 months. CONCLUSION Evidence from observational studies reflecting real-world clinical practice demonstrates that liraglutide therapy improves glycemic control with a low risk of hypoglycemia, and is associated with significant weight loss in patients with T2DM. These observations are consistent with clinical trial findings. FUNDING Novo Nordisk A/S, Søborg, Denmark.
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Affiliation(s)
| | | | | | - Weiwei Xu
- Pharmerit International, Rotterdam, The Netherlands.
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