Background: Obstructive sleep apnea (OSA) is strongly associated with obesity, and weight loss is a cornerstone of its management. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), are a class of medications that induce significant weight loss and have shown promise in improving OSA severity. Purpose: This meta-analysis aimed to evaluate the pooled efficacy of GLP-1 RAs on sleep-disordered breathing, body weight, and cardiovascular risk factors in patients with OSA. Methods: A systematic review and meta-analysis of four randomized controlled trials were performed, comparing GLP-1 RA therapy with placebo in adults with OSA. The primary outcomes analyzed were the mean differences in the change from baseline for the apnea-hypopnea index (AHI), body weight, and systolic and diastolic blood pressure. Results: In the pooled analysis, treatment with GLP-1 RAs was associated with a robust and statistically significant reduction in AHI (mean difference [MD]: -13.89 events/hour; p < 0.01). Therapy also resulted in substantial weight loss compared to placebo (MD: -12.46 kg; p < 0.01). For cardiovascular parameters, the use of GLP-1 RA was associated with a significant reduction in systolic blood pressure (mean difference [MD]: -4.86 mmHg; p < 0.01) and diastolic blood pressure ( p = 0.03). Conclusion: GLP-1 receptor agonists significantly reduce OSA severity, promote substantial weight loss, and lower systolic and diastolic blood pressure in patients with obstructive sleep apnea and obesity. These findings support the role of GLP-1 RAs as a multifaceted and effective therapeutic intervention for managing OSA.

Cardiac myosin activators (CMAs) have been explored as a potential therapy to enhance cardiac contractility in patients with heart failure with reduced ejection fraction (HFrEF). However, their effect on clinical outcomes, including mortality, cardiovascular (CV) events, and heart failure (HF) symptoms, remains unclear. This study aimed to evaluate the efficacy and safety of CMAs compared to placebo in patients with HFrEF through a systematic review and meta-analysis of randomized controlled trials. A systematic search of PubMed, Cochrane, Embase, and Scopus identified randomized controlled trials comparing CMAs to placebo in HFrEF patients. Meta-analyses were performed using a random-effects model, including 10,019 patients from nine trials, with 5204 receiving CMAs. CMAs had no significant effect on CV death (risk ratio [RR]: 1.01; 95 % confidence interval [CI]: 0.92-1.10; p = 0.85), HF events (RR: 0.95; 95 % CI: 0.89-1.02; p = 0.15), or all-cause mortality (RR: 1.00; 95 % CI: 0.93-1.07; p = 0.95). However, CMAs significantly reduced the composite outcome of CV death, HF hospitalization, and urgent outpatient visits for HF (hazard ratio [HR]: 0.92; 95 % CI: 0.90-0.93; p < 0.00001) and lowered stroke risk compared to placebo (p = 0.006). CMAs, particularly omecamtiv mecarbil, did not significantly impact all-cause mortality, cardiovascular death, or HF recurrence in patients with HFrEF. However, modest reductions were observed in composite outcomes and stroke. These findings should be interpreted cautiously, and further trials are needed to validate their clinical role.

Background: In patients undergoing atrioventricular node ablation (AVNA), permanent pacing is required, making lead performance and procedural durability important. His bundle pacing (HBP) and left bundle branch area pacing (LBBAP) are physiologic pacing strategies used in this setting, but comparative evidence remains limited. Methods: We searched PubMed/MEDLINE and Embase through January 31, 2026, for comparative studies of HBP versus LBBAP in adults undergoing AVNA. The primary outcome was chronic lead‐related dysfunction, defined as clinically significant chronic capture‐threshold elevation. Secondary outcomes were AVNA procedural duration and atrioventricular nodal reconduction requiring repeat ablation. Random‐effects models generated pooled risk ratios (RRs) or mean differences (MDs). Certainty was assessed using GRADE. Results: Three observational studies comprising 434 patients were included. Two studies ( n = 270) contributed to chronic lead‐related dysfunction, which occurred more often with HBP than LBBAP (RR 15.43, 95% CI 2.80–85.04); the estimate was imprecise because of sparse events. Two studies ( n = 262) contributed to procedural duration, which was longer with HBP (MD 11.33 min, 95% CI 6.64–16.02; I ² = 0%). Two studies ( n = 262) contributed to atrioventricular nodal reconduction, which was more frequent with HBP (RR 19.34, 95% CI 2.60–143.61; I ² = 0%). Certainty was low for procedural duration and very low for the other outcomes. Conclusions: Among patients undergoing AVNA, LBBAP was associated with more favorable lead‐related and procedural outcomes than HBP across available observational studies. Because evidence is limited by small cohorts, sparse events, and nonrandomized designs, these findings should be considered hypothesis‐generating. Trial Registration: This systematic review was registered in the PROSPERO database (registration number: CRD420261424072)