Evaluating the Efficacy of Sodium Glucose Cotransporter-2 Inhibitors in Management of Obstructive Sleep Apnea; a Systematic Review and Meta-Analysis

While Zepbound (Tirzepetide) is the only FDA-approved drug for obstructive sleep apnea (OSA), pharmacological options remain limited. Emerging data suggest sodium glucose co-transporter (SGLT-2) inhibitors may offer a novel therapeutic benefit in this population. Our meta-analysis aims to evaluate their efficacy based on current evidence. PubMed and Google Scholar were searched from inception to September 2024 for Randomised Controlled Trials (RCTs) and observational studies comparing SGLT-2 inhibitors to placebo in patients with OSA using continuous positive airway pressure (CPAP). After careful screening, 4 studies involving 686 patients were analysed using the random-effects model in RevMan 5.4.1, and mean differences (MD) were calculated. The addition of an SGLT-2 inhibitor showed a statistically significant reduction in the apnea-hypopnea index (AHI) [MD = -5.52 (95% CI: -9.72 to -1.32) (p = 0.01)], oxygen desaturation index [MD = -3.16 (95% CI: -5.33 to -0.99) (p = 0.004)], and Body Mass Index (BMI) [MD = -1.29 (95% CI: -2.20 to -0.39) (p = 0.005)]. However, they failed to show any significant improvement in daytime sleepiness [MD = -2.28 (95% CI: -4.92 to 0.37) (p = 0.90)] and Haemoglobin A1c [MD = 0.25 (95% CI: -0.32 to 0.82) (p = 0.88)]. Similarly, SGLT-2 inhibitors failed to depict any significant improvement in blood pressure or serum lipid levels. SGLT-2 inhibitors, along with significantly reducing AHI, also offer added cardiometabolic benefits in OSA patients. These findings support their role as a promising adjunct or alternative to existing therapeutic options. Further studies are warranted to define their place in OSA management.