A Pilot Study of the Effects on Sleep Disordered Breathing (SDB) When Using the Drug Liraglutide for 4 Weeks
Condition: Sleep Apnea; Sleep Disordered Breathing
MeSH terms: Sleep Apnea Syndromes; Respiratory Aspiration
Study type: Interventional
Phase: Phase 1/Phase 2

Summary: 
      This is an open label, controlled study.

      The investigators are studying if the FDA approved diabetes medicine liraglutide (Victoza®)
      can improve sleep apnea in adults. This study is testing liraglutide in 20 adults without
      diabetes that are diagnosed with sleep apnea.The treatment group will be compared to a
      control group of 10 adults without diabetes who have sleep apnea but will not use
      liraglutide. Both groups will continue receiving standard of care for their sleep apnea as
      prescribed by their managing sleep physician throughout their study participation.

      Everyone in the study will have two study visits and one overnight sleep study for research.
      Subjects who have not had a recent sleep study but otherwise qualify for the study, will have
      an additional research sleep study to determine the baseline severity of their sleep apnea.
      The study visits include fasting blood samples and breathing tests (pulmonary function test
      and hypercapnic challenge). There will be weekly phone visits that include a questionnaire on
      sleepiness. The group that takes liraglutide will check their blood sugar two times a day
      while on the medicine.
    

Detailed description: 
      This is a pilot study aimed at measuring the change in obstructive apnea/hypopnea index in
      non-diabetic patients being treated for the first time with the glucagon-like peptide-1
      (GLP-1) agonist, Liraglutide. Sleep disordered breathing (SDB) consists of nocturnal alveolar
      hypoventilation and / or obstructive sleep apnea which result from abnormalities in upper
      airway tone and ventilation during sleep. The development of a new pharmacological treatment
      for sleep disordered breathing (SDB) could bring a breakthrough discovery that will impact a
      rapidly growing population of children and adults with this disorder. The investigators
      hypothesize that GLP-1 plays a central role in the improvement of SDB and that the
      administration of GLP-1 receptor agonist to patients with OSA will correct or improve SDB.

        -  Hypothesis 1: Administration of Liraglutide to patients with severe OSA defined as apnea
           hypopnea index ≥ 8 /hr. will result in a mean reduction in the index by a minimum of 50%
           after 4 weeks.

        -  Hypothesis 2: Administration of Liraglutide will result in significant increase in
           Orexin level, decrease in leptin, decrease in Epworth Sleepiness Scale (ESS) score and
           increase in carbon dioxide (CO2) chemosensitivity.

      This is an open label, non-randomized, controlled pilot study. Subjects are heavy to obese
      non-diabetic adults that are diagnosed with sleep apnea. 20 subjects will be treated with
      liraglutide for 4 weeks and compared to 10 untreated controls.

      Study time points are baseline and 4 weeks post treatment. Study procedures include pre and
      post treatment: fasting blood for glucose, hemoglobin A1C (HbA1C), Orexin and leptin; ESS
      questionnaire; pulmonary function test and hypercapnic challenge. The procedures also include
      a post treatment overnight research sleep study to measure change in apnea index from
      diagnostic sleep study done previous to study enrollment or if needed, the baseline research
      sleep study.
    

Intervention name(s): liraglutide
Intervention type(s): Drug
Intervention description(s): daily use of drug. Titrated up from 0.6mg/day to 1.8mg/day or highest tolerated dose
Other intervention name(s): Other name- Victoza
Intervention MeSH terms: Liraglutide
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Sleep Apnea; Sleep Disordered Breathing; liraglutide; glucagon-like peptide-1 agonist; Orexin; leptin,