Obstructive sleep apnea (OSA) is a type of sleep-disordered breathing in which the upper airway partially or completely collapses during sleep. This can cause episodes of shallow breathing or pauses in breathing, negatively affecting sleep quality and overall health.
Losing weight can help reduce OSA symptoms in a person who has overweight or obesity. Their doctor may recommend a combination of lifestyle changes and, in some cases, medication or surgery to support weight loss.
A person’s doctor will also prescribe positive airway pressure (PAP) therapy or other treatments to manage OSA. Healthy sleep habits are important.
Read on to learn more about weight and OSA, including strategies to manage both.
How does weight affect the risk of OSA?
A 2024 review describes body fat accumulation as an important risk factor for OSA. Research cited in the review found that each point increase in body mass index (BMI) was linked to a 14% greater likelihood of higher apnea-hypopnea index (AHI), which measures OSA severity. Each 0.1-unit increase in waist-to-hip ratio was associated with a 61% greater likelihood of higher AHI.
Scientists are still studying the exact causes of this link. Fat pads in the tongue and around the throat put pressure on the upper airway, which may cause it to collapse. Excess fat around the ribs, abdomen, and internal organs puts pressure on the lungs, reducing lung volume. This may reduce breathing control and raise the risk of disordered breathing during sleep.
Other factors may also contribute to OSA in people with and without obesity. These include the structure of a person’s upper airway. It can also be related to how their nervous system or muscles respond to changes in the airway or breathing.
What are the benefits of weight management for OSA?
Even modest weight loss may have benefits for improving OSA in people with overweight or obesity.
A 2024 review used past research to develop a statistical model that predicts the benefits of weight loss for OSA. This model predicted that lowering BMI by 10% in adults with OSA and obesity results in a 36% decrease in OSA symptoms. It predicted that lowering BMI by 20% decreases OSA symptom severity by 57%.
How can someone lose weight?
If someone has overweight or obesity, their doctor may recommend a weight loss program that includes one or more of the following:
A person can speak with their doctor to learn about the potential benefits and risks of different weight loss approaches. Their doctor may refer them to a registered dietitian, weight management counselor, or other specialist to help them make changes.
Medication for OSA in adults with obesity
A doctor may prescribe tirzepatide (Zepbound) to help treat moderate to severe OSA in adults with obesity. This is the first medication approved by the Food and Drug Administration (FDA) to manage OSA and obesity.
Tirzepatide is a dual glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist. Phase 3 clinical trials found that adults with OSA and obesity who took this medication lost more weight and experienced greater improvements in OSA, compared with adults who took a placebo.
People who use tirzepatide are also advised to increase physical activity and follow a reduced-calorie diet to support weight loss and improve OSA.
Scientists are also studying other drugs to treat OSA among adults with obesity. It’s possible that the FDA may approve those treatments in the future.
A person can talk with their doctor to learn about the latest treatment options.
A person’s doctor will likely encourage them to use a positive airway pressure (PAP) machine while they sleep to treat OSA. There are multiple types of PAP machines:
- Continuous PAP (CPAP) machine: This machine uses constant air pressure to help keep a person’s airway open and support breathing during sleep.
- Bilevel PAP (BPAP) machine: This machine uses different air pressure levels when a person inhales versus exhales to help keep their airway open and support breathing.
- Auto-adjusting PAP (APAP) machine: This machine automatically adjusts air pressure.
A person’s doctor may recommend PAP therapy in combination with weight loss or other treatments. Some people don’t want to use a PAP machine or find it difficult to tolerate. Their doctor may prescribe an oral device to help keep their airway open during sleep.
Other treatments for OSA include:
- positional therapy to help someone sleep on their side instead of their back
- orofacial therapy to strengthen muscles that control the face, mouth, and airway
- nerve or muscle stimulation to improve muscle tone in the tongue
- surgery to make the upper airway larger
Other habits that can help a person get plenty of high quality sleep include:
- limiting caffeine and alcohol
- avoiding tobacco
- regularly exercising
- maintaining a regular sleep schedule
Having overweight or obesity increases the risk of OSA and can make symptoms more severe. Losing weight helps improve OSA in adults with overweight or obesity. Even slight weight loss may have benefits.
A person can talk with their doctor to learn about different weight loss approaches. Their doctor will likely recommend lifestyle changes, including reducing calorie consumption and increasing physical activity.
Their doctor may also recommend medication or surgery to support weight loss and treat OSA. Tirzepatide is the first medication for treating moderate to severe OSA in adults with obesity. Scientists are studying other medications that may become available in the future.
PAP therapy is the gold-standard treatment for OSA. A person’s doctor may encourage them to combine PAP therapy with weight loss or other treatments. A combination of treatments may be best for meeting a person’s individual needs.