Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep MedicineDec 17, 2021

How weight loss relates to improvements in sleep apnea after diet and lifestyle changes

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Mar 31, 2026

Abstract

The median percent change in the apnea-hypopnea index was -49.3% for participants with ≥ 10% weight loss.

Weight loss is associated with improvements in respiratory events and oxygen levels during sleep.
Participants categorized in the ≥ 10% weight-loss group had a significantly lower relative risk of severe obstructive sleep apnea compared to those who lost less weight.
A decrease in insomnia and daytime sleepiness symptoms was noted in participants with a weight loss of ≥ 5%.
Even a weight loss of less than 5% can lead to some reduction in respiratory events.

Simplified

STUDY OBJECTIVES: Lifestyle-induced weight loss is a complementary therapeutic approach for obstructive sleep apnea (OSA). We aimed at identifying the dose-response relationship between weight loss and OSA severity improvement.

METHODS: This is a secondary analysis of a 6-month clinical trial in 180 adult, overweight/obese moderate-to-severe OSA patients. Participants were randomized to a standard care, a Mediterranean diet, or a Mediterranean lifestyle arm. All patients were prescribed with continuous positive airway pressure (CPAP), while intervention arms additionally participated in a weight-loss dietary/lifestyle intervention. Based on percent change in weight at 6 months, participants were categorized into a weight-stable/gain (WS/GG) group or 3 weight-loss groups (WLG): < 5%WLG, 5%-10%WLG, and ≥ 10%WLG. Polysomnographic data and OSA symptoms were evaluated preintervention and postintervention.

RESULTS: Respiratory events and oximetry indices improved only in patients who lost weight and improvements were proportional to the degree of weight loss. Median percent change in apnea-hypopnea index (AHI) was -11.7%, - 37.9%, and - 49.3% in the < 5%WLG, 5%-10%WLG, and ≥ 10%WLG, respectively (< .001). Compared to the WS/GG, the age-, sex-, baseline-, and CPAP use-adjusted relative risk (95% confidence interval) of severe OSA (AHI ≥ 30 events/h) was 0.45 (0.23-0.87) in the 5%-10%WLG and 0.32 (0.17-0.64) in the ≥ 10%WLG; the risk was also lower in the ≥ 10%WLG vs the < 5%WLG (0.42 [0.22-0.82]). Insomnia and daytime sleepiness also improved more in participants exhibiting ≥ 5% weight loss. P

CONCLUSIONS: Even a < 5% weight loss can reduce respiratory events, but a ≥ 5% and ideally ≥ 10% weight loss is necessary for reducing the prevalence of severe OSA.

CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: Mediterranean Diet/Lifestyle Intervention in Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT02515357; Identifier: NCT02515357.

CITATION: Georgoulis M, Yiannakouris N, Kechribari I, et al. Dose-response relationship between weight loss and improvements in obstructive sleep apnea severity after a diet/lifestyle intervention: secondary analyses of the "MIMOSA" randomized clinical trial.. 2022;18(5):1251-1261. J Clin Sleep Med

Funding

Competing interests

All authors have seen and approved this manuscript. Material and financial support for the study was provided by the Postgraduate Program (Master of Science) “Applied Nutrition and Dietetics,” Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece. The funder was not involved in study design and methodology, data analyses and interpretation, manuscript preparation, or the authors’ decision to submit the present work for publication. The authors report no conflicts of interest.

PubMed

How weight loss relates to improvements in sleep apnea after diet and lifestyle changes

Abstract

Funding

Competing interests

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