Extract

Obesity is widely recognized as one of the leading risk factors for obstructive sleep apnea (OSA). Analyses from the Wisconsin Sleep Cohort Study suggest that 41% of all OSA cases, including 58% of moderate-to-severe cases, can be attributed to the presence of a body mass index (BMI) of 25 kg/m2 or greater.1 Importantly, obesity is the only major OSA risk factor that is reversible; however, longitudinal data from the Sleep Heart Health Study demonstrate that the impact of weight loss on the apnea-hypopnea index (AHI) is not simply the opposite of weight gain.2 Thus, although a wide range of both longitudinal and interventional studies have established that the relationship between obesity and OSA is causative, the extent to which OSA improves with weight loss is unclear. The most recent American Academy of Sleep Medicine (AASM) guidelines for the management of OSA state that weight loss should be recommended for all overweight patients alongside a primary treatment. The AASM Task Force noted, however, that this recommendation was “a strategy that reflects uncertain clinical use,”3 and the guidelines do not specifically address the use of intensive behavioral weight loss programs as opposed to general weight loss education.

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