Liraglutide-Based Weight Loss versus CPAP Therapy in improving Sleep Quality and Quality of Life of Patients with Obstructive Sleep Apnoea - an Explorative, Proof of Concept Study

Abstract

Obstructive sleep apnoea (OSA) is associated with reductions in sleep quality and quality of life indices. Continuous positive airway pressure (CPAP) therapy improves quality of life, but adherence to treatment is often poor. In this study we evaluated the effect of CPAP vs. a glucagon-like peptide (GLP)-1 (Liraglutide)-mediated weight loss strategy (LWR) on sleep quality and quality of life scores. These are data from a randomized proof-of-concept study (clinicaltrials.gov: NCT04186494). 30 patients with moderate to severe OSA without diabetes were randomised to CPAP, LWR alone or both in combination for 24 weeks. All patients underwent full polysomnography before and after treatment, along with evaluation of subjective quality of life using the Sleep Apnoea Quality of Life Index (SAQLI), Epworth sleepiness scale (ESS) and the 36 Item Short Form Survey (SF-36). 30 subjects (50±7 years, 75% males, apnoea-hypopnoea index (AHI) 50±19/hr, body mass index (BMI) 34.8 ±3 kg/m2) completed the study. In the per protocol analysis, CPAP resulted in greater reduction in AHI vs LWR ( -43±20 vs. -12±18, p = 0.004) and greater improvements in quality of life indices (p = 0.016 for differences in SAQLI outcomes). However, LWR resulted in longer total sleep time (+20±46 vs -35±49 minutes for LWR vs CPAP, p[SR1] =0.051). and greater  sleep efficiency[SR2] [SR3] ) (+6±16% vs -9±9% for LWR vs CPAP, p[SR4] =0.034). Both treatments led to improvements in ESS (-3.9 vs -1.7 for CPAP vs LWR, p[SR5] =0.59). The group on combination treatment had similar improvements in AHI and quality of life to the CPAP group. CPAP was associated with greater improvement of quality of life, while LWR resulted in improved sleep duration and efficiency.