By Jordan Stern, MD
About the author: Jordan Stern, MD, Founder and CEO of BlueSleep, is a Head and Neck surgeon, a subspecialty of Ear, Nose and Throat (ENT or Otolaryngology), who has treated over 10,000 sleep apnoea patients and published multiple studies on the diagnosis and treatment of Sleep Apnoa. He is also the author of The New York Times bestselling book, Dropping Acid, about reducing acid reflux through a better diet.
Ozempic, Wegovy, and Zepbound are not Miracle Drugs for Sleep Apnoea
In the same year as Jenny Craig couldn’t trim the corporate fat and filed for bankruptcy, weight loss drugs, Ozempic and Wegovy, have had a meteoric rise, causing a flurry of questions about their effects on Sleep Apnoea. The bottom line is that weight loss reduces the risk and severity of Sleep Apnoea, but the drugs are not the holy grail to eliminating this debilitating and dangerous disease.
What We Learned from Bariatric Surgery
Obstructive sleep apnoea (OSA) is strongly correlated with obesity which affects 40% of the population. The incidence and severity of OSA rise with increase in body mass index (BMI). For decades patients have turned to traditional weight loss diets and exercise programs and resorted to a more invasive approach to reducing weight fast-–bariatric surgery. Luckily, researchers have lots of data to understand the effects of weight loss on Obstructive Sleep Apnoea.
The results showed that Bariatric Surgery resulted in a significant improvement in both subjective and objective parameters of OSA. In essence, weight loss, in roughly 55% of cases, contributed to the decrease of the severity of Sleep Apnoea, but many patients had no change at all. In fact, 36% of the newly thin patients still suffered from severe sleep apnoea. The conclusion–Bariatric Surgery does not cure Sleep Apnoea or eliminate the need for a CPAP or a Mandibular Advancement Device (MAD).
Thin People Have Sleep Apnoea Too
While Obesity has a high correlation with Snoring and Sleep Apnoea, due to the restriction of the airway caused by excessive fatty tissue in the tongue and throat, not all overweight people snore or have sleep apnoea. In fact, a majority (60%) do not suffer from Sleep Apnoea. But, obese people have severe sleep apnoea at twice the rate of normal-weight individuals. It’s imperative that they seek treatment to reduce their chances of hypertension, diabetes, heart disease, fatigue and sexual dysfunction.
Conversely, people with a normal body weight also snore and have sleep apnoea. In fact, a substantial proportion of patients with OSA are not obese. Many suffer from Moderate or Mild Sleep Apnoea which make up over 80% of the population suffering from Sleep Apnoea. Many of these OSA sufferers don’t acknowledge their problem; fail to seek treatment; and discontinue treatment. Untreated Sleep Apnoea can decrease life expectancy. We recommend they consult a Sleep Specialist who can prescribe a Home Sleep Test and a treatment that works for their individual needs.
Weight Loss Drugs are Costly and have Side Effects
The manufacturer of Wegovy and Ozempic, Novo Nordisk, will earn about $15 billion in 2023, accounting for almost all of Denmark’s economic growth. These drugs are not cheap. Patients pay around $1,000 a month for treatment, and insurers are reluctant to pay. In fact, Medicare is prevented by law from covering weight-loss drugs. Ironically, if you suffer from Diabetes then Ozempic is covered, but if you’re Diabetes-free, then you most likely pay out-of-pocket for Wegovy, a higher dose of Ozempic, that was FDA-approved for weight loss in 2021. But, with high interest rates and a tight economy, patients are likely to forego Wegovy and Ozempic, save $12,000 a year, and wait till more competitors, like Zepbound by Eli Lilly, enter the market.
As with a majority of drugs, there are also adverse side effects to these weight-loss drugs, namely nausea, diarrhea, vomiting, constipation, among others. And, the drug is self-administered with an injection which will deter many patients who fear needles.
Given the low cost of non-invasive Sleep Apnoea treatments like CPAP and Mandibular Advancement Devices and their minor side effects, patients will still gravitate towards the drug-free approach.
Weight Loss Drugs Are Not the Cure-All for Sleep Apnoea
There are over 54 million Americans who suffer from Sleep Apnoea. Only about 20% seek diagnosis and treatment, mainly because front line healthcare professionals don’t diagnose OSA. They are simply unaware that non-specific symptoms such as fatigue, daytime sleepiness, hypertension and irritability are associated with Sleep Apnoea.
Weight loss drugs will have a positive effect on reducing the severity of Sleep Apnoea in overweight and obese Americans, but, there are still 43 million Americans who are undiagnosed and untreated for Sleep Apnoea.
And, a majority of those on weight loss drugs will still need OSA treatment. In a recent study on bariatric surgery patients with OSA, less than 1% of patients were cured. The remaining patients, some of whom had no change and others who had a decrease in severity, still need to be treated for Sleep Apnoea.
Get an Action Plan for Sleep Apnoea
If you’re overweight or normal weight and suffering from daytime sleepiness, snoring, and chronic fatigue, then we recommend the following:
- Make an appointment with a Sleep Specialist.
- Take a Home Sleep Test to measure Sleep Apnoea.
- Get a Mandibular Advancement Device or CPAP to reduce snoring and prevent Sleep Apnoea.
- Take another Home Sleep Test three months after the MAD treatment.
- If you’re overweight, first consider a diet and exercise program.
- Ask your primary care doctor about Ozempic, if you have Type 2 Diabetes, or Wegovy or Mounjaro, for weight loss.
References
PMD Pub Med Central
Impact of bariatric surgery on obstructive sleep apnoea–hypopnea syndrome in morbidly obese patients
OSA was present in a significant proportion of patients undergoing bariatric surgery. Bariatric surgery resulted in significant improvement in both subjective and objective parameters of OSA. Significant change in the trend of severity of OSA was seen after surgery as depicted in Figure 1. Amongst fourteen patients with severe OSA, one was cured, four downgraded to mild OSA, another four downgraded to moderate OSA and five patients persisted to have severe OSA.
National Library of Medicine
Despite the beneficial effects of weight reduction on sleep breathing disorders confirmed by a number of studies, there is still significant uncertainty whether bariatric surgery eliminates OSA and allows CPAP therapy discontinuation. This study suggests that bariatric surgery does not sufficiently reduce obstructive sleep apnoea and warrants mandatory postoperative sleep test in order to precisely re-evaluate at least all severe OSA patients regardless of the postoperative weight loss or patient-reported resolution of symptoms.
BMC Research
The impact of bariatric surgery on the resolution of obstructive sleep apnoea
The research demonstrated that 55.3% of patients had resolution or improvement in OSA following bariatric surgery. However, there was a high rate of non-attendance of follow-up appointments. Future efforts will involve analysis of the reasons for this to ensure more robust monitoring.
Journal of Clinical Sleep Medicine
A substantial proportion of patients with OSA are not obese. These patients are challenging to treat with existing therapies as they are less adherent and compliant with CPAP therapy. Nonanatomical contributors to OSA, such a low threshold for arousal, are likely to be particularly important in OSA pathogenesis in nonobese patients with OSA.
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