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Obstructive Sleep Apnoea

Treatment Options - Weight Reduction

Treatment options depend on the severity of OSA.

The level of evidence for treatment is based on GRADE ratings.

Treatment options should be considered, depending on the apnoea-hypopnoea index (AHI), body mass index (BMI), symptoms, comorbidities, possible pathophysiological background and preference of the patient.

Weight loss, including that from bariatric surgery, may decrease the apnoea-hypopnoea index (AHI), reduce blood pressure, improve quality of life, and decrease daytime sleepiness.1, 2 Improvement in AHI in patients with mild to moderate OSA achieved through weight loss can persist for several years despite (up to 50%) weight regain.3, 4 Exercise may slightly improve apnoea hypopnoea index (AHI) even in the absence of weight loss.5 Daily singing exercises may improve the tone and strength of pharyngeal muscles and reduce the severity of snoring and improve symptoms of mild to moderate OSA.6, 7

Long term body weight reduction consists of two phases: initial weight loss and weight maintenance. Behavioural strategies to reach weight reduction include a combination of reduced caloric intake, by altering eating habits, and increased physical activity. Dietary energy restriction is the critical component of weight reduction which influences the rate of weight loss. Physical activity is important in achieving long-term body weight control including mechanisms of changes in behaviour and body composition. Family support is an additional important component in achieving long-term reduction in body weight.8

Table. Lifestyle changes approach to weight reduction

● Use self-monitoring of dietary intake and physical activity to develop a sense of accountability, e.g. by keeping a food diary (record what, how much, when, where, and the context (what else they were doing at the time, what they were feeling, and who else was there) the food was consumed, and a daily physical activities dairy

● Restructuring the environment that promotes overeating and underactivity, including include the availability of foods such as fruits, vegetables, nonfat dairy products, and other foods of low energy density and high nutritional value; prepare meals at home and carry bag lunches; learn to estimate portion sizes

● Identify triggers that stimulate appetite and food intake including what and when consumed

● Shop only from a list, and shop on a full stomach

● Change eating patterns including using smaller plates, eat more slowly, buy healthy snacks i.e. fruit, nuts and vegetables, try to avoid alcohol, sugar-sweetened beverages (sodas and fruit drinks), and sweets (candy, cakes, cookies)

● Eat only regularly scheduled meals, do nothing else while eating, consume meals in a dedicated place (dining room) and leave the table after eating

● Identify specific triggers for overeating, deal with negative attitudes towards overweight and obesity in society, and realize that a minor dietary infraction does not mean failure

●Develop relapse prevention and learn to anticipate high-risk situations and devise plans to reduce the damages

●Develop stress management techniques, exercise, relaxation, and social support can help to reduce stress and assist to avoid overeating in response to stress

●Develop problem solving skills, learn to identify and anticipate problems that threaten to undermine success, craft strategies that will resolve problems as they emerge

● Set goals and use rewards e.g. related to changing your habits and positive thinking

● Use positive reinforcement e.g. participate in a particularly enjoyable activity

● Decrease sedentary activities, and promote an active lifestyle

● Increase physical activity gradually to 30 min daily or more, e.g. by using 10 min bouts to increase compliance, and using a combination of strength training or resistance exercise with aerobic activity


AHI - Apnoea-Hypopnoea Index
BBTi - Brief Behavioural Therapy for Insomnia
BMI - Body Mass Index (kg/m2)
BQ - Berlin Questionnaire
CBTi - Cognitive Behavioural Therapy for Insomnia
CELL - Coblation Endoscopic Lingual Lightening
COPD - Chronic Obstructive Pulmonary Disease
CVA - Cerebrovascular Accident
CPAP - Continuous Positive Airway Pressure
CSA - Central Sleep Apnoea
DASS - Depression Anxiety Stress Scale
DBAS - Dysfunctional Beliefs and Attitudes about Sleep
DBP - Diastolic Blood Pressure
DIMS - Difficulties Initiating and/or Maintaining Sleep
DISE - Drug-Induced Sleep Endoscopy
DISS - Daytime Insomnia Symptom Scale
ENT - Ear Nose and Throat
ESS - Epworth Sleepiness Scale
FOSQ - Functional Outcomes of Sleep Questionnaire
FSH - Follicle-Stimulating Hormone
FTP - Friedman Tong Position
GP - General Practitioner
HANDI - RACGP Handbook of Non-Drug Interventions
HGNS - Hypoglossal Herve Htimulation
ISI - Insomnia Severity Index
K10 - Kessler Psychological Distress Scale
MAD - Mandibular Advancement Device
MAS - Mandibular Advancement Rplint
MBS - Medicare Benefits Schedule
MMA - Maxillomandibular Advancement Surgery
MRA - Mandibular Repositioning Appliance
ODI - Oxygenation Desaturation Index
OSA - Obstructive Sleep Apnoea
PLMD - Periodic Limb Movement Disorder
PT - Positional Therapy
PTSD - Post-Traumatic Stress Disorder
PSG - Polysomnography
QSQ - Quebec Sleep Questionnaire
REM - Rapid Eye Movement
RFTB - Radiofrequency Thermotherapy of the Tongue Base
SBP - Systolic Blood Pressure
SCI - Sleep Condition Indicator
SE - Sleep Efficiency
SF36 - Short-Form (36) Health Survey
SMILE - Submucosal Minimally Invasive Lingual Excision
SNRIs - Serotonin-Norepinephrine Reuptake Inhibitors
SOL - Sleep Onset Latency
SSRI - Selective Serotonin Reuptake Inhibitors
TFTs - Thyroid Function Tests
TIB - Time In Bed
TORS - Transoral Robotic Surgery
TST - Total Sleep Time
UPPP - Uvulopalatopharyngoplasty
WASO - Wake After Sleep Onset

Quick links


  1. Jonas DE, et al. Screening for Obstructive Sleep Apnea in Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2017;317:415
  2. Chirinos JA, et al. CPAP, weight loss, or both for obstructive sleep apnea. N Engl J Med 2014; 370:2265
  3. Kuna ST, et al. Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes. Sleep 2013;36:641
  4. Johansson K, et al. Longer term effects of very low energy diet on obstructive sleep apnoea in cohort derived from randomised controlled trial: prospective observational follow-up study. BMJ 2011; 342:d3017
  5. Iftikhar IH, et al. Effects of exercise training on sleep apnea: a meta-analysis. Lung 2014;192:175
  6. Hilton M, et al. Singing Exercises Improve Sleepiness and Frequency of Snoring among Snorers—A Randomised Controlled Trial. International Journal of Otolaryngology and Head & Neck Surgery 2013;2:97-102
  7. Guimarães K, et al. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. American journal of respiratory and critical care medicine 2009;179(10):962-6
  8. Weight Management. Chaptor 4 Weight Loss and Weight Maintenance Strategies. Institute of Medicine of the National Academies. 2004 The National Academies Press, Washington D.C.