From the Guidelines
Weight loss is consistently associated with improvement in obstructive sleep apnea (OSA) severity, and should be a goal of all clinicians who take care of overweight or obese patients with OSA. According to the American Thoracic Society clinical practice guideline 1, weight loss can lead to improvement or resolution of OSA, as well as other benefits such as improved quality of life, decreased blood pressure, and prevention of type 2 diabetes mellitus. The key factors to consider when approaching weight loss in patients with OSA include:
- Behavioral approaches to weight loss, which have essentially no risk
- Pharmacological and surgical therapies, which have mild to moderate risks
- Aiming for gradual, sustainable weight loss through a combination of calorie reduction and increased physical activity Some important points to note are:
- Even modest weight loss can reduce the severity of sleep apnea by 50% or more in some patients
- Excess fat around the neck and throat can compress the airway during sleep, contributing to airway collapse and breathing interruptions
- Weight loss should be pursued alongside other prescribed treatments like CPAP therapy, as completely stopping treatment before achieving significant improvement could be dangerous
- Sleep specialists typically recommend reassessment after substantial weight loss to determine if therapy adjustments are needed, as noted in the guideline 1.
From the Research
Correlation Between Weight Loss and Sleep Apnea
- Weight loss can be an effective treatment for obstructive sleep apnea syndrome (OSAS) as it is often caused by obesity 2.
- Effective treatment of sleep apnea may also facilitate weight loss in obese patients 2.
- A study found that positive airway pressure (PAP) therapy is associated with weight loss in obese patients with OSAS, with a significant decrease in body mass index (BMI) in patients compliant with PAP therapy 2.
- Another study found that a weight-loss program can produce clinically relevant weight loss and significant improvement in both obstructive sleep apnea (OSA) and subjective daytime sleepiness 3.
- The Sleep AHEAD study found that intensive lifestyle intervention (ILI) for weight loss can reduce OSA severity, with improvements in apnea-hypopnea index (AHI) and OSA remission at 10 years 4.
Dose-Response Relationship Between Weight Loss and OSA Severity
- A study found a dose-response relationship between weight loss and improvements in OSA severity, with greater weight loss resulting in greater improvements in AHI and OSA symptoms 5.
- The study found that even a small amount of weight loss (<5%) can reduce respiratory events, but a greater weight loss (≥10%) is necessary for reducing the prevalence of severe OSA 5.
- Another study found that CPAP treatment can promote weight gain in patients with OSA, especially in those with CPAP use of ≤5 hours/night, without cardiovascular disease, and/or with dysglycemia at baseline 6.
Key Findings
- Weight loss is correlated with improvements in OSA severity and symptoms 2, 3, 4, 5.
- PAP therapy can facilitate weight loss in obese patients with OSAS 2.
- CPAP treatment can promote weight gain in some patients with OSA, depending on adherence and comorbid disorders 6.
- A dose-response relationship exists between weight loss and improvements in OSA severity, with greater weight loss resulting in greater improvements 5.