AJRCCM

David W. Hudgel ,  Sanjay R. Patel , Amy M. Ahasic ,  Susan J. Bartlett , Daniel H. Bessesen , Melisa A. Coaker , P. Michelle Fiander ,  Ronald R. Grunstein , Indira Gurubhagavatula ,  Vishesh K. Kapur ,  Christopher J. Lettieri ,  Matthew T. Naughton ,  Robert L. Owens , Jean-Louis D. Pepin , Henri Tuomilehto , and  Kevin C. Wilson

Am J Respir Crit Care Med. 2018 Sep 15;198(6):e70-e87

Background: Overweight/obesity is a common, reversible risk factor for obstructive sleep apnea severity (OSA). The purpose of this guideline is to provide evidence-based recommendations for the management of overweight/obesity in patients with OSA.

Methods: The Grading of Recommendations, Assessment, Development and Evaluation approach was used to evaluate the literature. Clinical recommendations were formulated by a panel of pulmonary, sleep medicine, weight management, and behavioral science specialists.

Results: Behavioral, pharmacological, and surgical treatments promote weight loss and can reduce OSA severity, reverse common comorbidities, and improve quality of life, although published studies have methodological limitations. After considering the quality of evidence, feasibility, and acceptability of these interventions, the panel made a strong recommendation that patients with OSA who are overweight or obese be treated with comprehensive lifestyle intervention consisting of 1) a reduced-calorie diet, 2) exercise or increased physical activity, and 3) behavioral guidance. Conditional recommendations were made regarding reduced-calorie diet and exercise/increased physical activity as separate management tools. Pharmacological therapy and bariatric surgery are appropriate for selected patients who require further assistance with weight loss.

Conclusions: 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.

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