Anyone can develop obstructive sleep apnea (OSA), but there are certain risk factors that can make some people more susceptible to the condition than others.

“Obesity, by far, is the main risk factor,” says Vsevolod (Seva) Polotsky, MD, PhD, director of the Polotsky Lab at The George Washington University School of Medicine & Health Sciences, in Washington, DC, which conducts research on sleep disorders and obesity.

OSA does more than make you feel groggy in the morning. It’s associated with an elevated risk of serious health problems, including strokes, heart failure, coronary artery disease, and atrial fibrillation. Here’s what you should know about the link between OSA and obesity, including what to do about it.

• Obesity narrows your airway. During sleep, it’s normal for your airway to narrow, especially if you’re sleeping on your back, because gravity pulls the soft tissues in your throat toward the airway. But if you have obesity, there’s more fat tissue around the airway, which makes it more likely to collapse when you fall asleep, says Dr. Polotsky. As a result, oxygen levels drop, disturbing your sleep. In addition, excess fat around the chest and abdomen can push up your diaphragm, crowding your lungs and making it harder to breathe. Plus, “People with obesity tend to have small lung volumes. So when the airway is closed, they just don’t have enough oxygen in the lungs to keep oxygen going through the body,” says Polotsky.
• Obesity affects nerves around your tongue. During deep sleep, your tongue falls back, but the nerve reflexes in your tongue muscles are supposed to prevent it from blocking your airway. Problem is, “People with obesity, especially men, have decreased reflexes, which prevent this from happening. And it’s not entirely known why,” says Polotsky. One theory is that over time, people with obesity develop a resistance to leptin, an appetite-suppressing hormone produced in fat tissue. Research conducted on mice suggests that alterations in leptin signaling affect nerve activity in the tongue.

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Treating obesity can also help treat sleep apnea, so it’s a good idea to consult your doctor about a weight loss plan that feels doable.

“Weight loss may completely cure mild apnea and may significantly improve moderate-to-severe apnea,” says Polotsky. If you have obesity, losing 10 percent of your body weight is enough to improve the symptoms of OSA, he says.

Even if you don’t see a huge drop on the scale, you could still be “losing small amounts of weight in an area of your throat ... [which] could be meaningful,” says Bolong Xu, MD, who studies sleep apnea and is an internal medicine resident at the Icahn School of Medicine at Mount Sinai, in New York City.

Here are some strategies your doctor may recommend:

• Shore up your diet and exercise regimen. Lowering your calorie intake and moving more has been shown to improve OSA. One study conducted in people with OSA found that those who followed a reduced-calorie diet and physical activity plan were more likely to have fewer breathing disruptions at night than those who didn’t take part in the weight loss program. Plus, more than one third of the participants were OSA free at a 10-year follow-up.

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• Consider weight loss surgery. A study of people with OSA who had bariatric surgery found that 55 percent were cured of OSA five years later.

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  And even those who still had OSA experienced improvements in symptoms, such as better sleep, less discomfort, and more vitality. On average, the number of breathing disruptions at night decreased from nearly 28 per hour before surgery to 9 per hour five years later.
• Try a GIP/GLP-1 agonist medication. Glucagon-like peptide-1s (GLP-1s) are popular weight loss drugs. And a dual gastric inhibitory polypeptide (GIP)/GLP-1 agonist, tirzepatide (Zepbound), was recently approved by the U.S. Food and Drug Administration for treating obesity with moderate-to-severe OSA specifically.

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  Research shows that tirzepatide reduced participants’ nighttime breathing disruptions by about 25 to 29 events per hour, compared with a placebo.

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