A network meta-analysis of various pharmacotherapeutics for obstructive sleep apnea

Abstract

Background: Obstructive sleep apnea (OSA) management modalities face challenges of non-compliance. Different pharmacotherapies have been introduced as a solution, but their comparative efficacies are unknown. Objective: To compare various pharmacotherapies efficacy in adults with OSA. Methods: An electronic literature search of four databases was done till January 2025 Results: The analysis included 21 trials involving 1,852 patients. Morning fluoxetine 10 mg + evening ondansetron 24 mg yielded the best reductions in Apnea-Hypopnea Index (AHI)3% (surface under the cumulative ranking curves [SUCRAs] 89%; mean difference [MD] = -15.33; 95% confidence interval [CI] -27.46, -3.20). For AHI4%, tirzepatide 10 or 15 mg demonstrated the best reductions (SUCRAs 91%; MD= -20; 95% CI -25.8, -14.2). Lemborexant 10 mg resulted in the largest increases in total sleep time (TST) and sleep efficiency compared to most interventions. However, remifentanil 0.075 mg/kg led to the greatest reductions in TST and sleep efficiency. Interestingly, remifentanil 0.075 mg/kg produced the most significant increases in non-rapid eye movement (NREM) TST and the largest decreases in REM TST. Conclusion: Morning fluoxetine 10 mg + evening ondansetron 24 mg and tirzepatide 10 or 15 mg are the most promising drugs for reducing OSA severity. Lemborexant 10 mg improved sleep efficiency and architecture the most, whereas remifentanil 0.075 mg/kg disrupted them the most. erj;66/suppl_69/PA3565/F1 F1 F1