by Dr. Maria Paula Guzman
Maria Paula Guzman, MD, is a triple board-certified internal medicine, sleep medicine, and obesity medicine physician. She is a member of the American Academy of Sleep Medicine (AASM) and the Obesity Medicine Association (OMA). Dr. Guzman is also the CEO of DreamLife Medicine & Wellness, a Florida-based practice.
Exploring the Link Between Sleep Apnea and Obesity
Imagine waking up in the morning feeling groggy or tired despite getting a full night of sleep. On top of that, you have a nagging headache, your throat feels dry, and your bed partner is complaining about how loud you were snoring the night before. You’re not alone—millions of people experience these symptoms of obstructive sleep apnea (OSA) every day. In fact, it is estimated that nearly 1 billion adults around the world and over 54 million adults in the U.S. may have at least mild OSA.[1]
What is Obstructive Sleep Apnea (OSA)?
OSA occurs when the muscles around the throat relax excessively during sleep, causing the airway to collapse. This leads to interrupted breathing and reduced oxygen levels, disrupting restful sleep. Repeated episodes of airway obstruction place significant strain on the body, contributing to fatigue, cardiovascular issues, and metabolic disturbances.
How Obesity Increases the Risk of OSA
It is estimated that only about 40% of individuals with OSA have obesity (BMI ≥30 kg/m²), meaning that most cases are due to other genetic, anatomic, or physiologic factors. However, individuals with obesity have a much higher likelihood of developing OSA. Studies show that around 70% of individuals with obesity have some degree of OSA, underscoring the strong connection between these conditions and the importance of addressing both when they are present.
Excess body weight, particularly around the neck and upper airway, is a major risk factor for OSA. Fat deposits in these areas can narrow the airway, making it more susceptible to collapse during sleep. Beyond physical changes, obesity is associated with metabolic and hormonal shifts that can worsen OSA. For instance, insulin resistance, systemic inflammation, and increased levels of leptin (an appetite-regulating hormone) can contribute to the physiology of OSA.
Obesity Worsens the Severity of OSA
The link between OSA and obesity is especially pronounced in patients with moderate to severe sleep apnea. A large population study revealed that 85–90% of individuals with moderate to severe sleep apnea had excess body weight, classified as either overweight (BMI 25–29.9 kg/m²) or obesity (BMI ≥30 kg/m²). While the classification of overweight in this study differs from our current BMI classification for overweight (BMI 27–30 kg/m²), these findings emphasize that excess body weight plays a significant role in the development of more severe cases of sleep apnea.[2]
Why Addressing Both Conditions is Essential
OSA and obesity form a vicious cycle. Sleep deprivation caused by OSA can lead to hormonal imbalances, such as increased ghrelin (hunger hormone) and reduced leptin (satiety hormone), promoting weight gain. Simultaneously, excess weight worsens OSA symptoms. This interplay underscores the importance of treating both conditions together to achieve meaningful health improvements.
Treatment Approaches for OSA and Obesity
Weight reduction is often recommended as first-line treatment for patients with OSA and excess body weight. Even modest weight loss—5-10% of total body weight—can significantly reduce OSA severity. Lifestyle changes, including healthful nutrition and increased physical activity, are essential first steps. CPAP (continuous positive airway pressure) is usually prescribed simultaneously as the gold-standard treatment. While CPAP significantly improves symptoms and quality of life, some patients find it challenging to adhere to therapy. Similarly, achieving and maintaining weight loss through lifestyle modifications alone can be difficult due to several genetic, hormonal, and behavioral factors.
For patients with class II obesity (BMI ≥35 kg/m2) who cannot tolerate CPAP, bariatric surgery is recommended as another effective treatment option. This surgical approach not only reduces the severity of OSA, improving symptoms, but also addresses related conditions like diabetes, high blood pressure, and acid reflux while reducing the risk of stroke, heart disease, and overall mortality. Unfortunately, despite its benefits, less than 1% of eligible patients pursue bariatric surgery.[3]
Most recently, a new medication, tirzepatide (also known as Zepbound®), a dual GLP-1/GIP receptor agonist, was approved for the treatment of moderate to severe OSA in adults with obesity. This groundbreaking treatment not only reduces the severity of sleep apnea but also promotes significant weight loss and improves sleep quality. However, it is important to follow up with a sleep physician following weight loss to check the severity of OSA. Patients should not assume that weight loss equals to curing OSA. Speaking to a sleep physician may help manage if any residual OSA symptoms persist after weight loss.
Building a personalized care plan for individuals with sleep apnea and obesity is key to long-term success. This plan starts with a full evaluation of the patient’s sleep patterns, metabolic health, weight history, and related medical conditions. By involving specialists like sleep doctors, dietitians, and behavioral therapists, tailored interventions can be developed. Gradual changes to lifestyle, realistic weight-loss goals, and ongoing support for treatments like CPAP or medications help ensure a comprehensive approach that addresses both conditions effectively.
Conclusion
The link between OSA and obesity is clear and impactful, with each condition making the other worse. The good news? Taking steps to address your weight can not only ease the symptoms of OSA but also lead to better overall health and well-being.
Your Next Steps
If you’ve noticed loud snoring, gasping for air during sleep, waking up unrefreshed, or feeling tired throughout the day, it’s time to take action. These could be signs of undiagnosed sleep apnea. Start by talking to your doctor about your symptoms, and consider a sleep study, which can often be done conveniently at home.
Don’t wait—untreated sleep apnea increases the risk of serious health problems like high blood pressure, heart disease, type 2 diabetes, and stroke. With early diagnosis, personalized care plans, and innovative treatments, you have the tools to take control of your health and regain your vitality. The first step starts with you!
References
[1] Benjafield, Adam V., et al. "Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis." The Lancet Respiratory Medicine 7.8 (2019): 687-698.
[2] Messineo, Ludovico, et al. "Obstructive sleep apnea and obesity: A review of epidemiology, pathophysiology and the effect of weight-loss treatments." Sleep Medicine Reviews 78 (2024): 101996.
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