GLP-1受体激动剂预防2型糖尿病患者阻塞性睡眠呼吸暂停的有效性：活性对照、新使用者队列研究
Effectiveness of GLP-1 receptor agonists to prevent obstructive sleep apnea in patients with type 2 diabetes: active comparator, new user cohort study.
文献信息
| PMID | 42745463 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Charles Khouri |
| 作者单位 | Univ. Grenoble Alpes, Pharmacovigilance unit, Grenoble Alpes University Hospital, Grenoble, France. |
| 期刊 | American journal of respiratory and critical care medicine |
| SCI 分区 | Q1 |
| IF | 21.2 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
理由： 阻塞性睡眠呼吸暂停（OSA）在2型糖尿病（T2D）中高度流行，二者共享代谢危险因素，尤其是肥胖，并可增加心血管结局。胰高血糖素样肽-1受体激动剂（GLP-1RA）已在临床试验中被证明可减轻OSA严重程度，但其在预防T2D患者新发OSA中的作用仍不明确。
目的： 评估在T2D患者中，与体重中性对照药二肽基肽酶-4抑制剂（DPP-4i）相比，使用GLP-1RA是否与新发OSA风险降低相关。
方法： 我们使用英国CPRD（2007-2023）数据库开展了一项基于人群的队列研究，采用活性对照、新使用者设计。纳入开始使用GLP-1RA或DPP-4i且BMI ≥30 kg/m²的T2D成人，排除既往有睡眠呼吸暂停的个体。在BMI分层内使用倾向评分精细分层加权。主要结局为新发OSA的临床诊断。采用Cox比例风险模型，以治疗中分析方式估计风险比（HR）及95%置信区间（CI），随访时间最长3年。
结果： 队列包括47,315名GLP-1RA使用者和159,066名DPP-4i使用者，加权后基线特征均衡良好。随访期间，GLP-1RA使用者和DPP-4i使用者中分别发生612例和1,197例新发OSA，发病率分别为每1000人年5.8例和5.4例。与使用DPP-4i相比，使用GLP-1RA的新发OSA HR为1.07（95% CI 0.93-1.23）。结果在不同BMI分层、性别、药物类型及多项敏感性分析中一致。
结论： 在常规临床诊疗中，与DPP-4i相比，GLP-1RA与无OSA病史的T2D患者OSA发生率降低无关。
英文摘要
RATIONALE: Obstructive sleep apnea (OSA) is highly prevalent in type 2 diabetes (T2D), sharing metabolic risk factors, notably obesity, and increased cardiovascular outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been shown to reduce OSA severity in clinical trials but their role in preventing incident OSA in T2D remains unclear.
OBJECTIVE: To assess whether GLP-1RA use is associated with a reduced risk of incident OSA compared with dipeptidyl peptidase-4 inhibitors (DPP-4i), a weight-neutral comparator, in patients with T2D.
METHODS: We conducted a population-based cohort study using the UK CPRD (2007-2023) database with an active-comparator, new-user design. Adults with T2D and BMI ≥30 kg/m² initiating a GLP-1RA or DPP-4i were included, excluding individuals with prior sleep apnea. Propensity scores with fine-stratification weighting were used within BMI strata. The primary outcome was incident clinical diagnosis of OSA. Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs) using an as-treated approach, with up to 3 years of follow-up.
RESULTS: The cohort included 47,315 GLP-1RAs and 159,066 DPP-4i initiators with baseline characteristics well balanced after weighting. During follow-up, 612 and 1,197 incident OSA cases occurred among GLP-1RAs and DPP-4i users, yielding incidence rates of 5.8 and 5.4 per 1000 person-years, respectively. The HR of incident OSA with GLP-1RA use compared with DPP-4i use was 1.07 (95% CI 0.93-1.23). Results were consistent across BMI strata, sex, drug type, and multiple sensitivity analyses.
CONCLUSIONS: In routine clinical care, GLP-1RAs were not associated with a decreased incidence of OSA in patients with T2D and no history of OSA, when compared with DPP-4i.