Benefits of GLP-1 therapy for sleep apnea

[madman]

SURMOUNT-OSA Results: 'Impressive' in Improving Sleep Apnea​

Drs Akshay Jain and James Kim discuss the benefits of GLP-1 therapy for sleep apnea, as reported from the SURMOUNT-OSA trial.

Key Insights from the Surmount OSA Study: Implications for Primary Care and Endocrinology​

Introduction​

Dr. Aay Jane, an endocrinologist from Vancouver, Canada, and Dr. James Kim, a primary care physician from Calgary, Canada, discussed highlights from the recent American Diabetes Association (ADA) Annual Conference in Orlando. The conversation focused on clinically relevant studies, particularly the Surmount OSA trial, which examined the intersection of obesity and obstructive sleep apnea (OSA).

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The Surmount OSA Study​

This randomized controlled trial investigated the effects of tirzepatide (branded as Mounjaro) compared to a placebo in individuals with obesity and OSA.

Key Study Features:​

• Participants included those using CPAP (Continuous Positive Airway Pressure) machines and those who were not.
• Baseline Apnea-Hypopnea Index (AHI): >50.
• Outcomes measured:
  • Reduction in AHI.
  • Weight loss and symptom improvement.

Results:​

1. AHI Reduction:
   • Tirzepatide group: >60% reduction in AHI.
   • Placebo group: ~6% reduction.
2. Weight Loss:
   • Tirzepatide group: ~20% weight loss.
   • Placebo group: No significant weight loss.

These findings highlight a strong correlation between weight loss and improvement in OSA severity.

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Primary Care Perspective​

Dr. Kim emphasized the clinical importance of addressing OSA in primary care:

• OSA is a highly underdiagnosed conditionand a significant risk factor for:
  • Hypertension, dyslipidemia, poor glycemic control (higher A1C and fasting glucose levels).
  • Cardiovascular diseases, including myocardial infarction, arrhythmias, stroke, and cardiovascular mortality.
• Bidirectional Relationship:
  • Type 2 diabetes (T2D) increases OSA risk, while OSA exacerbates diabetes complications.
  • Weight plays a central role in this interaction.

Clinical Implications:​

• Weight Loss Benefits:
  • Improves OSA, blood pressure, cholesterol levels, glycemic control, and insulin sensitivity.
  • Up to 50% of patients in the trial experienced such significant improvement in OSA that they may no longer require CPAP therapy.
• Symptom Management:
  • Improvements in daytime fatigue and energy levels, which are often major concerns for patients and their families.

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Endocrinology Perspective​

Dr. Jane highlighted the endocrine benefits of effective OSA management:

• Improvement in insulin resistance and reduced medication needs for diabetes.
• Positive effects on:
  • Male hypogonadism.
  • Polycystic Ovary Syndrome (PCOS).
  • Hypertension.

Comparison to Previous Studies:​

• Similar trends had been observed with other GLP-1 receptor agonists, but the extent of improvement with tirzepatide was unprecedented, signaling a breakthrough in medical management for OSA and obesity.

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Study Limitations and Future Directions​

Dr. Kim noted one limitation: the exclusion of patients with mild OSA who were symptomatic.

• Data on this population remain conflicting.
• Future studies should explore this subgroup to expand the applicability of findings.

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Conclusion​

The Surmount OSA trial provides compelling evidence linking weight loss with significant improvements in OSA severity and related symptoms.

• For Primary Care: A critical tool for managing a common yet underdiagnosed condition.
• For Endocrinology: A promising option for addressing metabolic and endocrine complications associated with OSA.

Both Dr. Jane and Dr. Kim underscored the importance of these findings in transforming care for patients with obesity and OSA.