Comment on Neeland et al. The Impact of Empagliflozin on Obstructive Sleep Apnea and Cardiovascular and Renal Outcomes: An Exploratory Analysis of the EMPA-REG OUTCOME Trial. Diabetes Care 2020;43:3007–3015
Abstract
We read with great interest the leading article by Neeland et al. (1) highlighting the beneficial effects of empagliflozin treatment on several metabolic end points among participants with type 2 diabetes and obstructive sleep apnea (OSA) in the BI 10773 (Empagliflozin) Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPAREG OUTCOME). In addition, the authors observed a lower frequency of new-onset OSA, even when adjusting for baseline BMI. The authors provided few physiological explanations for the favorable effects of empagliflozin, mainly attributing them to the diuretic and natriuretic effects of the drug. Among the latter effects were 1) reduction of intrathoracic fluid retention and rostral fluid shifts from the legs and 2) interrupted sleep cycles and decreased rapid eye movement sleep secondary to nocturia. We would like to suggest another explanation for the lower frequency of newonset OSA in patients in the empagliflozin group. In a previous work (2), we hypothesized that sodium–glucose cotransporter 2 inhibitors (SGLT2i) might be therapeutically beneficial for patients with respiratory diseases and carbon dioxide (CO2) retention (e.g., with OSA and with obesity hypoventilation syndrome [OHS]). OHS is a common pulmonary disease, defined by the presence of obesity (BMI >30 kg/m) associated with daytime hypercapnia (pCO2 >45 mmHg) in the absence of other causes of hypoventilation. Approximately 70–90% of patients with OHS also have OSA. In…
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Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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