Abstract
BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep disorder and has become a significant public health issue. Weight-loss diet (WLD), exercise training (ET), respiratory muscle training (RMT), and oropharyngeal muscle training (OMT) have been shown to improve OSA symptoms to some extent, offering new treatment options. OBJECTIVE: To compare the relative efficacy of WLD, ET, RMT, and OMT in patients with OSA through a systematic review and network meta-analysis, and to provide evidence-based support for clinical decision-making on lifestyle and functional training interventions in OSA management. METHODS: PubMed, EMBASE, Web of Science, and the Cochrane Library were systematically searched from inception to December 2025, with an updated search performed in January 2026. The primary outcome was the apnea-hypopnea index (AHI), while secondary outcomes included the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and body mass index (BMI). Risk of bias was assessed using RevMan 5.4, and the GRADE method was used to evaluate the quality of evidence for all outcomes. Network meta-analysis was conducted using the "network" command in STATA 17.0. RESULTS: ET exhibited the most significant efficacy in reducing the AHI (MD = -9.13, 95% CI: -12.04 to -6.21, SUCRA = 89.9%) and the PSQI (MD = -2.20, 95% CI: -3.23 to -1.16, SUCRA = 78.1%); OMT yielded the greatest reduction in the ESS score (MD = -4.00, 95% CI: -5.45 to -2.56, SUCRA = 92.2%); WLD showed the most prominent effect in reducing the BMI (MD = -2.39, 95% CI: -3.95 to -0.84, SUCRA = 96.2%). CONCLUSION: Lifestyle and functional training interventions demonstrate distinct outcome-specific effects in the management of OSA. These findings suggest that individualized intervention strategies should be selected in clinical practice based on patients' predominant symptoms and therapeutic goals. However, the effects of these interventions still require further high-quality evidence to be fully validated.