The primary objective of this study is to determine whether ertugliflozin 15 mg once daily compared with placebo reduces the apnea hypopnea index (AHI) in adults with overweight or obesity with moderate to severe OSA.~The secondary objectives of this study are to determine whether ertugliflozin 15 mg once daily compared with placebo (a look-alike substance that contains no active drug):~reduces visceral and neck fat and upper airway soft tissue structure volumes and increases airway caliber~reduces Critical closing pressure~reduces rostral to caudal fluid shifts (measured by neck circumference)~improves clinical measures of OSA severity and sleep deficiency~This is a 2-center clinical trial of overweight or obese adults (BMI 25-40 kg/m2) diagnosed with moderate to severe OSA, recruited from University Hospitals Cleveland Medical Center (UH) and Yale New Haven Health (YNHH). Participants will be randomized to ertugliflozin 15 mg once daily or matching placebo in addition to standard routine clinical care for both groups for 6 months. At baseline and at study end, participants will undergo measurements of anatomic traits using MRI imaging, critical closing pressure, blood-based biomarkers of dysfunctional adiposity, non-anatomic physiologic trait polysomnographic phenotyping, morning neck circumference, clinical measures of sleep apnea severity (apnea hypopnea index (AHI), oxygen desaturation index (ODI), % time with O2sat < 90% (T90)), sleep arousal index (AI)), and measures of sleep deficiency, to evaluate the effects of SGLT2i on the measured phenotypes.
The goal of this clinical trial is to test if ertugliflozin lowers the sleep apnea severity in adults who are overweight or obese with moderate to severe obstructive sleep apnea (OSA) compared with a placebo (look-alike substance that contains no active drug).~The main question it aims to answer is:~If SGLT2i will reduce anatomic and physiologic traits, clinical measures of OSA and sleep deficiency in participants~If improvement in clinical measures are because of improvement in the anatomic and physiologic traits.~Participants will be placed on either drug or placebo and get routine normal care for 6 months. At the start and end of the study, participants will undergo different clinical measurements to see if the drug makes the sleep apnea better.