SGLT2 inhibitors and sleep apnea; how helpful are the medications: A meta-analysis

Abstract Background Sleep disordered breathing (SDB) has a close association with diabetes, especially in obese patients. The use of sodium-glucose co-transporter-2 (SGLT2) inhibitors in patients with diabetes with SDB is a debate with conflicting evidence. We aim to study the effect of SGLT2 inhibitors on SDB in diabetes patients. Methods A literature search was done to identify articles comparing the outcomes of SGLT2 inhibitors in diabetes patients with SDB. The primary endpoint was apnea hypopnea index (AHI) and improvement in saturation. Secondary outcomes were improvement in HBA1C, systolic blood pressure, BMI. An unadjusted odds ratio (OR) with a 95% confidence interval (CI) were calculated using Review Manager (RevMan) 5.3. Results 3 studies consisting of 65 patients were included with average age of 58.29±9.56 years (males 52.31%). Our study revealed comparable results for body mass index (BMI), systolic blood pressure with SGLT2 use; p=0.56 and p=0.10 respectively. The study revealed better HBA1C results with the use of SGLT2 inhibitors after subgroup analysis and correction of heterogeneity, p=0.03. The overall results for SPO2 and AHI were comparable pre and post-SGLT2 use. The heterogeneity among the outcomes of the studies was low to moderate after subgroup analysis and the methodological quality of the studies was moderate. Conclusion SGLT2 inhibitors had a significant effect in modifying HBA1C; However, the use of SGLT2 inhibitors did not statistically improve the SDB.