Psychiatry Clin Neurosci

Some sleep meds may be safer than expected in obstructive sleep apnea

March 17, 2026

This network meta-analysis of 32 randomized trials (N = 1,871; mean age, 52 years; mean apnea–hypopnea index, 23.6) compared 12 commonly used hypnotics in adults with obstructive sleep apnea (OSA). The findings were as follows:

• Lemborexant: Associated with longer total sleep time, more REM sleep, higher sleep efficiency, and lower sleep latency and wake after sleep onset; respiratory outcomes and discontinuation rates similar to placebo.
• Daridorexant: Associated with longer total sleep time and higher sleep efficiency, with less wake after sleep onset; respiratory outcomes similar to placebo.
• Zolpidem: Associated with longer total sleep time and higher sleep efficiency, with less wake after sleep onset; respiratory safety similar to placebo.
• Eszopiclone: Associated with improvements in multiple sleep and respiratory measures, though several effects were not robust in sensitivity analyses.

Clinical takeaway: In adults with OSA and comorbid insomnia, selected agents—particularly lemborexant, daridorexant, or zolpidem—may be considered to improve sleep continuity without clear respiratory harm, while individual risk assessment and cautious monitoring remain essential.

Source:

Kishi T, et al. (2026, February 10). Psychiatry Clin Neurosci. Comparative effects of hypnotic agents on sleep architecture and respiratory outcomes in obstructive sleep apnea: A systematic review and network meta-analysis. https://pubmed.ncbi.nlm.nih.gov/41665171/