Possible Preventative/Rehabilitative Role of Gliflozins in OSA and T2DM. A Systematic Literature Review-Based Hypothesis

Abstract

Obstructive sleep apnoea (OSA) is characterized by frequent apnoea episodes during sleep due to upper airway obstruction. The present review summarizes current knowledge on inter-relationships between OSA and type 2 diabetes mellitus (T2DM) and suggests the former as a possible target for sodium-glucose co-transporter-2 inhibitors (SGLT-2i). Based on pathophysiological mechanisms underlying OSA onset and renal SGLT-2 effects, we suggest that SGLT-2i indications might expand beyond current ones, including glucose, lipids, uric acid, blood pressure, and body weight control as well as chronic heart failure and kidney disease prevention.

Heart Failure with Preserved Ejection Fraction and Obstructive Sleep Apnea: A Novel Paradigm for Additional Cardiovascular Benefit of SGLT2 Inhibitors in Subjects With or Without Type 2 Diabetes

“…All the above further supports the hypothesis of cardiovascular and neurological (polysomnographic parameters) SGLT2i benefits in OSA independently of diabetes [32].…”

“…On the basis of pathophysiological mechanisms underlying OSA onset-related and renal SGLT2 effects, we already suggested SGLT2is as promising for prevention, rehabilitation, and treatment of patients with OSA regardless of coexisting diabetes. This approach would expand their indications beyond current ones, including glucose, lipids, uric acid, blood pressure, body weight control, and chronic HF, and kidney disease prevention [ 32 ]. This hypothesis finds further support in the previously mentioned EMPEROR-Preserved trial because of the close association between OSA and HFpEF [ 7 , 33 ].…”