Evaluating the effects of hypnotics for insomnia in obstructive sleep apnea

Scientists compare the effects of various hypnotic agents and medications on sleep architecture and respiratory outcomes in obstructive sleep apnea

2026-03-12

(Press-News.org)

OSA is a common sleep disorder characterized by oxygen desaturation due to repeated airway collapse during sleep. This leads to oxygen desaturation or awakening from sleep. It is often linked to metabolic problems, cardiovascular disease, and a lower quality of life. OSA and insomnia symptoms often co-occur, a condition known as comorbid insomnia and sleep apnea or COMISA. This can complicate usual treatments like continuous positive airway pressure (CPAP) therapy, which is often recommended for moderate to severe OSA management.

Although Clinical Practice Guidelines generally recommend cognitive behavioral therapy for insomnia symptoms in individuals with OSA, medications are often preferred and prescribed in real-world settings. However, concerns remain that some of the common sedative-hypnotics could worsen respiratory parameters and lead to aggravated OSA symptoms.

Recently, researchers from Japan, led by Professor Taro Kishi from the Department of Psychiatry, Fujita Health University School of Medicine, Japan, conducted a systematic review and network meta-analysis to identify the hypnotics providing optimal sleep architecture without compromising the respiratory safety in adults with OSA. Professor Tsuyoshi Kitajima, Professor Nakao Iwata, and Dr. Kenji Sakuma, also from the Department of Psychiatry, Fujita Health University School of Medicine, were a part of the research group. The study findings were made available online on February 10, 2026, in the academic journal of the Japanese Society of Psychiatry and Neurology, Psychiatry and Clinical Neurosciences.

“The hypnotics used for insomnia in patients with OSA have varied effects on sleep quality and respiratory function. Our research aims to enable safer and more effective drug selection that considers the respiratory risks and is tailored to each patient's symptoms,” mentions Prof. Kishi while talking about the motivation underlying the study. The researchers conducted a network meta-analysis of 32 randomized controlled trials for 12 types of hypnotic medications, including brotizolam, daridorexant, eszopiclone, flurazepam, lemborexant, nitrazepam, ramelteon, temazepam, triazolam, zaleplon, zolpidem, zopiclone, and placebo. 17 distinct outcomes, categorized into sleep architecture, respiratory function, treatment acceptability, treatment tolerability, and other safety outcomes, were assessed for the study.

The hypnotics showed varied effectiveness in treating insomnia. Highlighting the importance of this finding, Prof. Kitajima mentions, “While some patients reported difficulty in falling asleep, others reported waking up in the middle of the night or early in the morning. Suggesting appropriate medication, based on the symptom of insomnia, can aid in alleviating the problem effectively.”

Additionally, “Since our network meta-analysis included both CPAP users and non-users, we have focused on the sensitivity analysis results while excluding CPAP users and titration studies,” Dr. Sakuma emphasized.

The biggest concern for OSA patients when using sleep-inducing medication is the worsening of apnea and hypopnea. Overall, the study did not find broad evidence that hypnotics uniformly worsened respiratory outcomes. Important metrics like apnea-hypopnea index did not significantly differ from placebo for most of the analyzed drugs. Conversely, temazepam, a benzodiazepine hypnotic, was found to decrease arterial oxygen saturation during sleep. Considering the limitations of this study, clinicians are advised to individualize treatment, carefully weigh potential benefits and risks, and monitor respiratory status when prescribing hypnotics to patients with OSA.

“This is the first network meta-analysis to comprehensively compare multiple hypnotics across both sleep architecture and respiratory parameters in adults with OSA. This allows us to establish the requirement of tailoring medication based on specific symptoms associated with insomnia. Clinical trials that verify the effectiveness of each sleeping medication on patients' specific insomnia symptoms can help in the formal synthesis of subjective outcomes in the future,” concludes Prof. Iwata.

***

Reference
DOI: 10.1111/pcn.70036

About Fujita Health University
Fujita Health University (FHU) is a private medical university located in Aichi, Japan. Established in 1964, it houses one of the largest university hospitals in Japan. It's 900-member faculty provides diverse learning and research opportunities to medical students worldwide. Guided by its founding philosophy of "Our creativity for the people," Fujita Health University believes that its students can shape the future through creativity and innovation. FHU has earned global recognition, ranking eighth among all universities and second among private universities in Japan in the 2020 Times Higher Education (THE) World University Rankings. The university ranked fourth worldwide in the 2024 THE University Impact Rankings for contributions to the "Good Health and Well-being" SDG (Sustainable Development Goals) of the United Nations (UN). In June 2021, the university made history as the first Japanese institution to host the THE Asia Universities Summit. In 2024, Fujita Health University was awarded the Forming Japan’s Peak Research Universities (J-PEAKS) Program by the Japanese government to establish an innovative academic drug discovery ecosystem and hub of a multi-university consortium for research and education.

Website: https://www.fujita-hu.ac.jp/

About Professor Taro Kishi from Fujita Health University
Dr. Taro Kishi is a Professor in the Department of Psychiatry at Fujita Health University School of Medicine in Toyoake, Japan. He earned his MD and PhD from Fujita Health University Graduate School. His research interests include the treatment of schizophrenia and mood disorders, alongside evidence-based medicine in schizophrenia and mood disorders, with a focus on meta-analyses. In addition, Prof. Kishi takes a keen interest in psychiatric genetics, pharmacogenetics, compliance enhancement strategies, and medical decision making. He has published over 260 academic articles to date, maintaining an h-index of 46.

Funding information
This work was supported by JSPS KAKENHI Grant Number 25K10874 (Grant-in-Aid for Scientific Research(C)).

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