Sleep Apnea

New Guideline: Patients With Sleep Apnea May Not Realize They Are Obese

A new American Thoracic Society clinical practice guideline1 on weight management for the treatment of adult obstructive sleep apnea (OSA) offers specific evidence-based recommendations for weight loss and discusses the evidence for each recommendation.

“In addition to these scientifically derived recommendations, the guideline reviews and discusses successful methods for practitioners to discuss weight issues and ways to interact with patients who are overweight or obese,” said lead author David W. Hudgel, MD, a specialist and investigator in sleep-disordered breathing who chairs the 20-member panel that formulated the clinical recommendations.2

The document, which was published online September 15, notes that overweight or obesity is a common but reversible risk factor for OSA severity, and it makes the following recommendations and suggestions:

  • For patients with OSA with a body mass index (BMI) of 25 kg/m2 or more the panel recommended participation in a comprehensive lifestyle intervention program that includes a reduced-calorie diet, increased physical activity, and behavioral counseling, and suggested that in the absence of such a comprehensive program, participation in a diet and exercise program is recommended, together or individually.
  • For patients with OSA with a BMI of 27 kg/m2 or more and whose weight has not improved despite a comprehensive program, and who have no contraindications to pharmacotherapy (such as cardiovascular disease), the panel suggested an evaluation for anti-obesity pharmacotherapy.
  • For patients with OSA with a BMI of 35 kg/m2 or more and whose weight has not improved despite a comprehensive program, and who have no contraindications, the panel suggested referral for bariatric surgery evaluation.

The panel reviewed studies that found patients are often unaware that they are overweight or obese, and that clinicians are often reluctant to give patients a diagnosis of obesity, according to the ATS. Even when the need for weight loss is discussed, the panel said, an effective weight loss program often is not initiated.

“Weight-loss interventions, especially comprehensive lifestyle interventions, are associated with improvements in OSA severity, cardiometabolic comorbidities, and quality of life. The American Thoracic Society recommends that clinicians regularly assess weight and incorporate weight management strategies that are tailored to individual patient preferences into the routine treatment of adult patients with OSA who are overweight or obese,” the guidelines conclude.

—Michael Gerchufsky

References:

  1. Hudgel DW, Patel SR, Ahasic AM, et al; American Thoracic Society Assembly on Sleep and Respiratory Neurobiology. The role of weight management in the treatment of adult obstructive sleep apnea: an official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2018;198(6):e70-e87. https://doi.org/10.1164/rccm.201807-1326ST.
  2. New guideline recommends weight loss strategies for sleep apnea patients [press release]. New York, NY: American Thoracic Society; September 17, 2018.