SLEEP 2026 | Guidance for managing weight loss and OSA simultaneously

Of course, I like to think about this sort of thing in four practical ways. So one is setting the expectations, optimizing the sleep apnea treatment while they’re losing weight, and then supporting healthy weight loss and the maintenance stage. So the first part is when patients are going on their weight loss journey is to discuss expectations and what happens with sleep apnea. So based on the trial from SURMOUNT, as I mentioned, only about half of the patients got to mild sleep apnea with no symptoms or no sleep apnea. So mentioning to the patients that still a good amount of patients still need to be on some other treatment for sleep apnea. So saying that we’ll start obesity management, but it’s really important to reevaluate their sleep apnea severity after the weight loss, because we know there are a lot of other mechanisms to sleep apnea. So making sure that the patients are aware that the weight loss should help their health in a lot of different ways and should reduce their sleep apnea severity. But sometimes they’ll still need to continue their CPAP or oral appliance or the other interventions for sleep apnea. The other thing that we have to be mindful of is making sure that the patients are still continuing to tolerate their treatment for sleep apnea as they’re losing weight. So for instance, when it comes to using PAP therapy, sometimes as patients lose weight, if they’re on a fixed CPAP, they might start having difficulty with the air pressure or like aerophagia or pressure intolerance. So trying to transition patients to what we call auto-adjusting PAP therapy to improve the tolerance. And if they are having a lot of difficulty, trying to figure out where their sleep apnea is at. So repeating sleep testing is really important, which we usually would do at around 10% reduction in body weight or more. And if their sleep apnea is improved, we can discuss alternative options if they don’t want to use a sleep app. So oral appliance, positional therapy. So really making sure that their sleep apnea continues to be treated and that they’re not discontinuing other therapies before we reassess, because as I mentioned, they might still have residual untreated sleep apnea. Supporting healthy weight loss is important. So I myself, I do obesity management. So I manage their pharmacotherapy in addition to treating their sleep apnea. So for instance, that looks like frequent follow-ups to make sure that they’re tolerating the medication or adjusting it appropriately. They are having side effects to sort of get ahead of them and try to manage them soon so they have a good experience. Of course, a sleep physician counseling on sufficient sleep is really important as they lose weight because we know that sleep deprivation actually can increase ghrelin levels or hunger hormones, worsen insulin resistance, so making sure that they’re getting their sufficient sleep. I focus a lot on nutrition exercise while I manage these medications. So making sure that patients are getting their 80 to 120 grams of protein, fiber to mitigate side effects, adequate hydration, small frequent meals. So really building those sustainable, healthy nutrition habits. And then, of course, I counsel on exercise. So the 150 to 300 minutes of moderate-intensity aerobic activity. And of course, resistance training two or three times a week to make sure that they’re maintaining their muscle mass and their strength. And then follow-up is really important. So like I said, it’s a dynamic process with weight loss. So some patients might be able to come off of their traditional therapy like CPAP. Other patients will need other treatments, but really just supporting the patients through their weight loss journey and making sure their sleep is also optimized and that they have sustainable habits and have all the support that they need to maintain their weight loss.

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