Introduction

Obstructive sleep apnea (OSA) is a complex disorder that can be exacerbated by underlying conditions such as obesity. Treating these underlying conditions can help manage sleep apnea, thus resulting in a better night's rest. 

In recent times, many researchers have established a bidirectional relationship between obesity and sleep apnea. It is well known that excess weight contributes to the severity of OSA, but what is lesser known is that OSA itself can promote further weight gain. In this article, we’ll examine the relationship between OSA and obesity, how weight loss can impact OSA, and how a person can utilize weight loss to manage symptoms of OSA. 

Relation between Obesity and Sleep Apnea

Many studies have found that people with a higher body mass index (BMI) are at an increased risk of developing sleep apnea. With every point increase in BMI, the likelihood of a higher apnea-hypopnea index (AHI) is 14% greater.1 Moreso, a 10% gain in weight correlates with a predicted 32% increase in AHI. This is because the fat can deposit around the upper airway as we accumulate more weight. In turn, the airway lumen becomes narrower and is more likely to collapse during sleep resulting in a higher AHI. Additionally, if fat deposits surround the thorax, chest compliance (how well the chest wall can expand while breathing) and functional residual capacity (FRC, which is the remaining volume of air in the lungs after a normal exhalation) can become reduced. This reduction results in an increased demand for oxygen. 

However, as previously mentioned, sleep apnea itself can result in obesity. Sleep apnea causes a disruption in the balance of the hormones that regulate appetite, causing increased hunger and thus, weight gain.2 Specifically, sleep apnea can increase the production of the hormone leptin, which allows the body to know when it is full. The body then builds an increased resistance to the hormone leading to it feeling less satisfied from eating.3 

Relationship between Weight Loss and Sleep Apnea

Weight loss has been found to be an effective method of managing sleep apnea. With every 10% decrease in weight, AHI is predicted to decrease 26%.1 Losing excess weight can remove fat deposits around the neck and throat, preventing the airway from becoming obstructed. Similarly, weight loss can reduce fat around the chest wall, further reducing the chance of the airway becoming obstructed and helping to increase FRC. 

However, weight loss itself can be quite difficult without a proper night's rest. Those with sleep apnea often have lower energy levels due to their disrupted sleep, which can make exercising during the day difficult. Thus, treatment for sleep apnea and weight loss should go hand in hand. Patients with sleep apnea can utilize other treatment options (such as CPAP, oral appliances, positional therapy, etc.).  

What are Some Ways to Reduce Weight? 

Now that we have looked at the relationship between sleep apnea and obesity/weight loss, what are some ways in which a person may be able to reduce their weight? 

  1. Zepbound (tirzepatide) became the first FDA-approved medication specifically designed for the treatment of OSA and obesity after passing two phase 3 trials in December 2024. This drug works by activating receptors for glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP).4 This helps to reduce a person’s appetite and food intake, thereby reducing weight and helping to manage symptoms of OSA. The main study behind tirzepatide found the drug to help in reducing AHI and body weight, as well as hypoxic burden (the cumulative duration and severity of oxygen desaturation) among other measures.5
  2. Surgical interventions and procedures for weight loss have been practiced since the 1950s6 and are still a common method for weight loss in the modern day. There are several different types of weight loss surgeries available and those interested should contact a bariatric surgeon. The most common surgery for weight loss is a Roux-en-Y gastric bypass, where the stomach is reduced in size and the small intestine is rerouted to reconnect to the smaller stomach pouch.7 Another common surgery is a sleeve gastrectomy, where the stomach is reduced to about two-thirds of its size, and a narrow, banana-shaped stomach is left. This procedure also results in hormonal changes that create a feeling of being full for longer.8 Lastly, an endoscopic intragastric balloon is another procedure that can be done to aid with weight loss. This procedure involves inserting a balloon into the stomach that fills up about half of the organ to increase the feeling of fullness. 
  3. Prescription weight loss pills are another method of weight loss that is becoming more popular among adults with obesity. These pills work in several ways, primarily by decreasing appetite and increasing the feeling of fullness. Additionally, some of these pills can interfere with fat absorption. These pills are primarily designed for long-term use and are meant to be taken in addition to regular exercise and healthy eating habits, not as a replacement for them. 
  4. Diet changes and exercise have long been the primary recommendations by health care providers and other wellness professionals for those who are seeking to lose weight. Diet changes do not necessarily mean eating less, but more so monitoring what it is that a person eats. Eating a healthy, balanced diet is one of the most important factors when it comes to losing weight. However, staying in a caloric deficit can also be beneficial. Additionally, exercising for at least 30 minutes per day in addition to diet changes can aid in a person losing weight. 9 

Can you cure Sleep Apnea with Weight Loss?

Sleep apnea tends to be a lifelong condition; however, some people are able to resolve their OSA completely through weight loss. The Mayo Clinic and Cleveland Clinic have both found that reducing weight and returning to a healthy weight are both effective in resolving OSA entirely. 10,11 However, if a person were to return to their previous weight, it is likely that their OSA would return. Studies have also found that losing 10-15% of weight can result in significant improvement of OSA symptoms.12 This in and of itself can be an effective method of managing sleep apnea. It is important to note, however, that sleep apnea may not be entirely cured. In these cases, combining weight loss with other treatments (such as CPAP) can help a person successfully manage their OSA and obtain a good night’s rest, just as if they did not have OSA. 

The Bottom Line

The bidirectional relationship between OSA and obesity is complex in that either condition can exacerbate the other. To effectively treat one condition, the other must also be addressed. Managing obesity can aid in reducing the severity of OSA and treating OSA can result in higher energy levels and better hormonal balance that can help a person manage their weight. Combined, losing weight and treating OSA can result in a person having a higher quality of sleep every night, increased daytime productivity, and a better overall quality of life. 

References: 

  1. Commissioner, Office of the. “FDA Approves First Medication for Obstructive Sleep Apnea.” U.S. Food and Drug Administration, FDA, 20 Dec. 2024, www.fda.gov/news-events/press-announcements/fda-approves-first-medication-obstructive-sleep-apnea.
  2. Edward R. Laskowski, M.D. “How Much Exercise Do You Really Need?” Mayo Clinic, Mayo Foundation for Medical Education and Research, 26 July 2023, www.mayoclinic.org/healthy-lifestyle/fitness/expert-answers/exercise/faq-20057916.
  3. Edwards, Martinique. “Obesity & Sleep Apnea.” Edited by Howard Hoffman, SleepApnea.Org, 26 Dec. 2024, www.sleepapnea.org/sleep-health/obesity-and-sleep-apnea/?srsltid=AfmBOoqF1PAdjxSQQ0X5YqmMik_xQvCmoz5hPzLxHQKuUIy9q0cqj3SM.
  4. “Gastric Bypass Surgery.” UCLA Health, UCLA, www.uclahealth.org/medical-services/surgery/bariatrics/obesity-treatments/gastric-bypass-surgery. Accessed 21 Mar. 2025.
  5. Malhotra, Atul, et al. “Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity.” New England Journal of Medicine, vol. 391, no. 13, 21 June 2024, pp. 1193–1205, https://doi.org/10.1056/nejmoa2404881.
  6. Mayo Clinic Staff. “Sleep Apnea.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 6 Apr. 2023, www.mayoclinic.org/diseases-conditions/sleep-apnea/diagnosis-treatment/drc-20377636.
  7. Messineo, Ludovico, et al. “Obstructive Sleep Apnea and Obesity: A Review of Epidemiology, Pathophysiology and the Effect of Weight-Loss Treatments.” Sleep Medicine Reviews, ScienceDirect, 30 Aug. 2024, www.sciencedirect.com/science/article/pii/S108707922400100X#:~:text=Body%20fat%20accumulation%20is%20an,levels%20%5B14%2C15%5D.
  8. People@marionrelationshipmarketing.com. “Find out How Much Weight to Lose to Get off CPAP.” Sleep Cycle Centers, 19 Nov. 2024, sleepcyclecenters.com/blog/how-much-weight-to-lose-to-get-off-cpap/.
  9. Romero-Corral, Abel, et al. “Interactions between Obesity and Obstructive Sleep Apnea: Implications for Treatment.” Chest Postgraduate Education Corner, U.S. National Library of Medicine, Mar. 2010, pmc.ncbi.nlm.nih.gov/articles/PMC3021364/#:~:text=It%20is%20possible%20that%20obesity,upper%20airway%2C%20predisposing%20to%20apnea.
  10. “Sleep Apnea: What Is It?” Cleveland Clinic, 7 Mar. 2025, my.clevelandclinic.org/health/diseases/8718-sleep-apnea.
  11. “Story of Obesity Surgery.” American Society for Metabolic and Bariatric Surgery, 20 Nov. 2023, asmbs.org/resources/story-of-obesity-surgery/#:~:text=The%20first%20operations%20designed%20solely,bacteria%20in%20the%20bypassed%20intestine.
  12. Thomas, Dr. Sany. “Roux En Y Gastric Bypass vs Sleeve Gastrectomy.” Denver Health, 1 June 2023, www.denverhealth.org/blog/2023/06/roux-en-y-gastric-bypass-vs-sleeve-gastrectomy. 
  13. Humpherys, Dr. C. “Image Depicting OSA vs. Normal Unobstructed Breathing While Sleeping,” Medicine Specifics, Oct. 2024, medicinespecifics.com/wp-content/uploads/2024/10/obesity-upper-airway-osa.png. Accessed 24 Mar. 2025. This image is intended to be used for educational purposes. This image is not being monetized. All rights belong to the original owner(s).

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