SLEEP 2026 | Integrating obesity medicine into OSA management: a more holistic approach

Obesity, as you mentioned, is one of the strongest risk factors for sleep apnea. And I think we’ve known for decades that weight loss can help reduce sleep apnea severity. So that’s going back to studies from decades ago, showing that even a 10% weight loss can significantly reduce AHI by 26%. I think what’s really changed over the past few years is that now we actually have highly effective medications for obesity. So our audience might be familiar with SURMOUNT-OSA, where tirzepatide actually became approved for adults with obesity and moderate to severe sleep apnea, and the results were pretty impressive. They showed a substantial reduction in AHI leading up to 29.3 events per hour. But not just that, they also showed improvement in hypoxic burden, CRP or inflammatory markers, solid blood pressure, which are all outcomes that we care about. I think one thing to keep in mind is the secondary analysis showed that improvements in both body weight and sleep apnea metrics independently actually contribute to improvement in cardiometabolic risk. So the way that I think about this is we should be really addressing both obstructive sleep apnea and obesity. In regards to how this is changing our field, I think we’re looking at different models for how this should be incorporated. I don’t think there’s a single model that works for every practice. For instance, some sleep physicians are directly incorporating obesity medicine into sleep medicine. So I myself am board-certified in both obesity and sleep. So I try to address both conditions simultaneously. Other sleep practices co-manage or have referral pathways to weight management specialists or primary care doctors. So I think the models of how we’re incorporating this might differ a little bit, but I think the principle is the same, which is obesity really should be addressed in conjunction with addressing sleep apnea. How do we do this holistically? I think the first part is how we discuss it with patients. So bringing it up with a patient, these conversations really need to be non-stigmatizing, having the patient be at the center of those conversations, explaining how obesity and sleep apnea interact. So explaining the excess weight contributes to upper airway collapse, but also how untreated sleep apnea can worsen metabolic outcomes through increases in hunger hormones like ghrelin and impaired insulin sensitivity. So really helping the patients understand that cycle can help increase engagement and motivation. And from our perspective too, it’s important to discuss and understand that obesity is really a chronic heterogeneous disease requiring sustained comprehensive treatment. It’s important that we discuss with the patient that it’s a medical condition, that has safe, effective treatments that go just beyond lifestyle modifications alone. And when bringing up the conversation with the patients, what we really care about is health outcomes. So I try to make sure that we’re not focusing on a number on the scale or their BMI, but really in regards to their cardiometabolic health and their overall health. And we can’t really do it holistically without incorporating lifestyle modifications. So making sure that we’re helping patients build sustainable nutrition, physical activity habits, addressing behavioral, emotional factors that influence eating, stress. So really ideally, if you can do it with a multidisciplinary team, that would be best. But again, making sure that you’re incorporating nutrition, exercise, stress management, so all the aspects of a healthful life is important. And I think one thing I also want to mention is I think sleep physicians were actually well positioned to be doing this because we already do a lot of lifestyle counseling when it comes to a lot of other sleep disorders. So things like circadian rhythm disorders, insomnia, we already counsel on meal timing, importance of exercise, importance of stress management. So I think we’re already well positioned to be doing a lot of this counseling. So I guess obesity really should complement, not replace our traditional sleep apnea therapies. And this is even based on the trial results, which again, were pretty impressive, but still showed that 50% of the patients still needed to be on other forms of treatment. So I think integrating both weight management and sleep apnea is really the best option to optimize long-term outcomes.

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