By: Said Mostafavi, MD, FCCP, FAASM

Like most sleep physicians, treating sleep-disordered breathing constitutes a large percentage of my practice. When it comes to treating obstructive sleep apnea, we thankfully have various treatment options available, some evidence-based and others not as much. While some treatments I’m able to prescribe, including positive airway pressure therapy, and other treatments require me to refer out, such as to ENTs and dentists, there is one treatment that can help countless people with OSA achieve better outcomes which often falls between the cracks. Weight reduction is a well-known treatment that, when applicable, can achieve multiple beneficial outcomes that extend far beyond the treatment of sleep-disordered breathing. With that said, evidence shows that even a 5% total body weight loss can significantly reduce the apnea hypopnea index in patients with obesity, and may even result in reversal or “cure” of OSA in certain cases.

Clearly, no one would argue the benefits of weight loss when it comes to overall health, but the question now becomes what is the role of the sleep physician in treating overweight/obesity? More specifically, in between my prescriptions for CPAP devices and referrals to dentists, what specifically comprises my clinical armamentarium for helping patients lose weight? Sure, I can make various recommendations, including some evidence-based diets, but how can I treat patients in the most comprehensive with regard to their OSA if I can’t treat overweight or obesity? As more and more non-surgical treatment options for weight loss become available, the role of physicians in treating overweight/obesity draws more attention, as bariatric medicine specialists are not widely available nor are their services always covered by insurance, leaving patients few options for weight loss outside of bariatric surgery. Should sleep physicians however be treating weight loss, or should this be left to our primary care providers? Who knows, but perhaps a sleep physician who could prescribe CPAP and an evidence-based regimen to achieve a target goal of weight loss, maybe treating OSA can be more…exciting?