Key Points
➤ Overweight/obesity is a common, reversible risk factor for obstructive sleep
apnea (OSA) severity.
➤ Behavioral, pharmacological, and surgical treatments promote weight
loss and can reduce OSA severity, reverse common cardiometabolic
comorbidities, and improve quality of life.
Treatment
➤ For patients with OSA who are overweight or obese (i.e., body mass index
[BMI] ≥25 kg/m
2
):
• The ATS recommends participation in a comprehensive lifestyle intervention program
that includes a reduced-calorie diet, exercise/increased physical activity, and behavioral
counseling rather than no program (strong recommendation, very low certainty in the
estimated effects).
• The ATS suggests participation in a comprehensive lifestyle intervention program that
includes a reduced-calorie diet, exercise/increased physical activity, and behavioral
counseling rather than a program that includes only a reduced-calorie diet, with or
without exercise/increased physical activity (conditional recommendation, very low
certainty in the estimated effects).
• The ATS suggests participation in a reduced-calorie diet (with or without exercise/
increased physical activity) rather than no diet (conditional recommendation, very low
certainty in the estimated effects).
• The ATS suggests exercise/increased physical activity rather than no exercise or increased
physical activity (conditional recommendation, very low certainty in the estimated
effects).
➤ For patients with OSA with a BMI ≥27 kg/m
2
, whose weight has not improved
despite participating in a comprehensive weight loss lifestyle program, and
who have no contraindications including no active cardiovascular disease,
the ATS suggests an evaluation for antiobesity pharmacotherapy (conditional
recommendation, very low certainty in the estimated effects).
➤ For patients with OSA with a BMI ≥35 kg/m
2
, whose weight has not improved
despite participating in a comprehensive weight-loss lifestyle intervention
program, and who have no contraindications, the ATS suggests referral for
bariatric surgery evaluation (conditional recommendation, very low certainty
in the estimated effects).
