Comparative effectiveness and safety of novel antidiabetic agents in the management of obstructive sleep apnea: a systematic review, meta-analysis, and network meta-analysis.

BACKGROUND

Obstructive sleep apnea (OSA) is a prevalent but frequently underdiagnosed type of sleep-disordered breathing. Excessive obesity is a primary reversible risk factor for OSA. A range of novel antidiabetic agents has recently demonstrated promising potential for improving OSA severity through weight loss and metabolic regulation.

OBJECTIVE

This study aimed to examine the effectiveness and safety of novel antidiabetic agents for people with OSA.

METHODS

We searched PubMed, Web of Science, Cochrane Library, and Embase database from inception to May 18, 2025. Pairwise meta-analysis and Bayesian network meta-analysis (NMA) were conducted to compare relative efficacy.

RESULTS

A total of 8 RCTs and 2 non-RCTs involving 1280 OSA participants were enrolled. Compared with the control group, SGLT-2i (MD = -7.73 events/h, 95 % CI [-9.83, -5.64]), GLP-1 RAs (MD = -5.19 events/h, 95 % CI [-6.87, -3.51]), and tirzepatide (-21.89 events/h, 95 % CI [-26.01, -17.77]) could significantly decrease AHI. The NMA results suggested that tirzepatide ranking highest of producing the greatest AHI reduction (MD = -21.85 events/h, 95 % CI [-27.52, -16.34]), along with the most substantial decreases in body weight (MD = -19.41 kg, 95 % CI [-21.00, -17.82]) and blood pressure (MDSBP = -5.86 mmHg, 95 % CI [-7.97, -3.74]; MDDBP = -1.96 mmHg, 95 % CI [-3.45, -0.46]).

CONCLUSION

Based on indirect evidence, tirzepatide was associated with the largest estimated magnitude of AHI reduction, presumably mediated by its weight-loss effects. For obesity-related OSA patients intolerant to continuous positive airway pressure therapy, tirzepatide may represent a potential adjunctive or alternative pharmacological option. High-quality studies are still needed to validate these findings further.

PROSPERO REGISTRATION NUMBER: CRD420251165267.