From the Guidelines
Weight gain is not a direct consequence of Continuous Positive Airway Pressure (CPAP) use, but rather a potential indirect effect due to improved sleep quality and subsequent changes in appetite, metabolism, and physical activity levels. According to the American College of Physicians guideline on management of obstructive sleep apnea (OSA) in adults 1, CPAP is recommended as initial therapy for patients diagnosed with OSA, with moderate-quality evidence supporting its efficacy in improving symptoms and reducing Apnea-Hypopnea Index (AHI) scores. While CPAP use may lead to weight gain in some individuals, this is not a direct side effect of the therapy itself, but rather a potential consequence of improved sleep quality and subsequent changes in lifestyle habits.
Some key factors to consider when using CPAP and managing weight include:
- Monitoring diet and physical activity levels, as improved sleep quality can increase appetite and energy levels
- Maintaining consistent sleep schedules to regulate hormones that control appetite and metabolism
- Ensuring optimal CPAP settings to minimize potential disruptions to sleep and daily activities
- Consulting with a healthcare provider or nutritionist to develop a personalized weight management plan
It is essential to note that the relationship between CPAP use and weight gain is complex, and individual results may vary. Some patients may experience weight loss with CPAP therapy as their energy levels improve, while others may gain weight due to changes in appetite and physical activity levels. As recommended by the American College of Physicians guideline 1, overweight and obese patients with OSA should be encouraged to lose weight, as intensive weight-loss interventions have been shown to reduce AHI scores and improve OSA symptoms.
From the Research
Relationship Between Weight Gain and CPAP Use
- The relationship between weight gain and Continuous Positive Airway Pressure (CPAP) use has been studied in several research papers 2, 3, 4, 5, 6.
- A study published in 2021 found that higher adherence to CPAP therapy was associated with weight gain in patients with obstructive sleep apnea syndrome (OSAS) 2.
- Another study published in 2016 found that high adherence to CPAP treatment did not prevent the continuation of weight gain in severely obese OSAS patients 3.
- A meta-analysis published in 2021 found that CPAP treatment was associated with a significant increase in body mass index (BMI) in patients with OSAS, especially in those with CPAP use of ≤5 h/night, without cardiovascular disease, and/or with dysglycemia at baseline 4.
- A study published in 2021 found that simulated CPAP treatment and positional therapy were able to compensate for the increase in the apnea-hypopnea index (AHI) caused by weight gain in OSA patients 5.
- A randomized controlled trial published in 2014 found that CPAP alone did not reduce C-reactive protein levels, insulin resistance, or serum triglyceride levels, while weight loss alone and the combined interventions of CPAP and weight loss did 6.
Factors Influencing Weight Gain with CPAP Use
- CPAP adherence: Higher adherence to CPAP therapy has been associated with weight gain in patients with OSAS 2.
- CPAP use duration: CPAP use of ≤5 h/night has been associated with a significant increase in BMI in patients with OSAS 4.
- Presence of comorbidities: Patients with cardiovascular disease or dysglycemia at baseline may have different responses to CPAP treatment in terms of weight gain 4.
- Lifestyle interventions: Weight loss interventions have been shown to reduce weight gain and improve metabolic outcomes in patients with OSAS 5, 6.