Weight-loss treatment for OSA: medical and surgical options

The public health impact of obstructive sleep apnoea (OSA) is increasingly recognised and will rise in conjunction with the obesity epidemic.

Current clinical management of OSA focuses on device-based interventions, which do not correct underlying obesity. Various approaches to weight loss have been tested, including diet and behavioural modification programmes, pharmacological interventions and bariatric surgery.

Emergent clinical trials demonstrate that intensive diet and behavioural interventions can reduce weight, and this will substantively reduce OSA severity. However, there is little long-term or subgroup data.

Pharmacological interventions alone provide minimal weight loss and potentially unacceptable side-effect profiles as highlighted by the recent withdrawal of sibutramine. Bariatric surgery can markedly reduce obesity and is an effective OSA treatment but there is little good-quality long-term outcome data specific to OSA. The relative effectiveness and safety profiles of various bariatric surgeries, pharmacotherapies or behavioural/diet interventions either in combination or in comparison are unstudied.

The multi-comorbidity of OSA lends itself to a multidisciplinary approach incorporating dieticians, physiotherapists, psychologists, exercise physiologists, sleep physicians and surgeons.