Efecto sobre la apnea obstructiva del sueño de los fármacos para la pérdida de peso. Revisión sistemática
Resumen
Introducción y objetivo: La apnea obstructiva del sueño (AOS) coexiste con la obesidad en hasta el 70 % de los casos, y su gravedad se correlaciona con el exceso ponderal. Se ha planteado que los fármacos aprobados para la pérdida de peso podrían reducir la carga respiratoria nocturna. El objetivo de esta revisión sistemática fue sintetizar la evidencia sobre el efecto de orlistat, fentermina-topiramato, naltrexona-bupropión, liraglutida, semaglutida y tirzepatida sobre el índice de apneas-hipopneas (IAH) y otros desenlaces respiratorios en adultos con sobrepeso u obesidad y AOS. Método: Se realizó una revisión sistemática conforme a las directrices PRISMA, incluyendo ensayos clínicos aleatorizados que evaluaran alguno de los fármacos seleccionados en pacientes adultos con AOS. Resultados: De 126 registros, se incluyeron 6 estudios. No se identificaron ensayos sobre orlistat ni naltrexona-bupropión. Fentermina-topiramato redujo el IAH en 30 eventos/hora y el peso en 10,8 kg tras 28 semanas. Liraglutida (3 mg) redujo el IAH en 12,2 eventos/hora y logró una reducción ≥50 % del IAH en el 31 % de los pacientes. Tirzepatida (10–15 mg/semana) mostró las mayores reducciones del IAH (−25,3 y −29,3 eventos/hora en 52 semanas), además de pérdida de peso (−20 kg), mejora de la carga hipóxica y reducción de la presión arterial. No se encontraron estudios específicos con semaglutida. Discusión: Los resultados muestran que ciertos fármacos para la obesidad pueden generar mejoras respiratorias significativas en pacientes con AOS, lo que refuerza su valor terapéutico más allá de la pérdida de peso. Conclusiones: Liraglutida y, especialmente, tirzepatida emergen como opciones terapéuticas complementarias en el abordaje integral de la AOS asociada a la obesidad.
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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 (Basel). 2024 Jan 8;12(1):11. https://doi.org/10.3390/pharmacy12010011
Papaetis GS. GLP-1 receptor agonists, SGLT-2 inhibitors, and obstructive sleep apnoea: can new allies face an old enemy? Arch Med Sci Atheroscler Dis. 2023;8:e19-e34. Published 2023 Feb 28. https://doi.org/10.5114/amsad/161170
Nobre ML, Sarmento ACA, de Oliveira PF, Wanderley FF, Diniz Júnior J, Gonçalves AK. Pharmacological treatment for obstructive sleep apnea: A systematic review and meta-analysis. Clinics (Sao Paulo). 2024;79:e100330. https://doi.org/10.1016/j.clinsp.2024.100330
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 Mar 15. https://doi.org/10.1007/s11325-024-03015-2
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(9):224. https://doi.org/10.3390/diseases12090224.
El-Solh AA, Gould E, Aibangbee K, Jimerson T, Hartling R. Current perspectives on the use of GLP-1 receptor agonists in obesity-related obstructive sleep apnea: a narrative review. Expert Opin Pharmacother. Published online December 6, 2024. https://doi.org/10.1080/14656566.2024.2437525
Sevencan B, Steenackers N, van Laar ADE, Lucio SP, Buyse B, Kalkanis A, Testelmans D, Van der Schueren B. Evaluating the potential of metabolic drugs in obstructive sleep apnea and obesity: a narrative review. J Clin Sleep Med. 2025 Mar 21. https://doi.org/10.5664/jcsm.11682
Mediano O, Masa JF. Impact of Glucagon-Like Peptide-1 Analogues in the Treatment of Obstructive Sleep Apnoea: A Pro/Con Debate. Arch Bronconeumol. 2025:S0300-2896(25)00088-2
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71). https://doi.org/10.1136/bmj.n71
Winslow DH, Bowden CH, DiDonato KP, McCullough PA. A randomized, double-blind, placebo-controlled study of an oral, extended-release formulation of phentermine/topiramate for the treatment of obstructive sleep apnea in obese adults. Sleep. 2012;35(11):1529–1539. https://doi.org/10.5665/sleep.2204
Blackman A, Foster GD, Zammit G, et al. Effect of liraglutide 3.0 mg in individuals with obesity and moderate or severe obstructive sleep apnea: the SCALE Sleep Apnea randomized clinical trial. Int J Obes (Lond). 2016;40(8):1310–1319. https://doi.org/10.1038/ijo.2016.52
Jiang W, Li W, Cheng J, et al. Efficacy and safety of liraglutide in patients with type 2 diabetes mellitus and severe obstructive sleep apnea. Sleep Breath. 2023;27(4):1687–1694. https://doi.org/10.1007/s11325-022-02768-y
O’Donnell C, Crilly S, O’Mahony A, O’Riordan B, Traynor M, Gitau R, McDonald K, Ledwidge M, O’Shea D, Murphy DJ, Dodd JD, Ryan S. CPAP but Not GLP1-mediated Weight Loss Improves Early Cardiovascular Disease in Obstructive Sleep Apnea: A Randomized Proof-of-Concept Study. Ann Am Thorac Soc. 2023 Dec 14. https://doi.org/10.1513/AnnalsATS.202309-821OC
Rubino D, Abrahamsson N, Davies M, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial. JAMA. 2021;325(14):1414–1425. https://doi.org/10.1001/jama.2021.3224
Malhotra A, Grunstein RR, Fietze I, et al. Tirzepatide for the treatment of obstructive sleep apnea and obesity. N Engl J Med. 2024;391(13):1193–1205. https://doi.org/10.1056/NEJMoa2404881
Beccuti G, Bioletto F, Parasiliti-Caprino M, et al. Estimating cardiovascular benefits of tirzepatide in sleep apnea and obesity: insight from the SURMOUNT-OSA trials. Curr Obes Rep. 2024;13:739–742. https://doi.org/10.1007/s13679-024-00592-x
Azarbarzin A, Sands SA, Stone KL, et al. The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study. Eur Heart J. 2019;40(14):1149–1157.
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