Sleep Apnea Risk May Persist After Weight Loss

Anatomy, Sleep Position, Aging, and Other Factors Matter

Man snoring loudly
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Being overweight or obese may worsen your obstructive sleep apnea. You might conclude that weight loss may eliminate the condition, but this may not always be the case. Why might sleep apnea persist after weight loss? Learn about some of the other factors that contribute to sleep apnea.

Basics of Sleep Apnea

Obstructive sleep apnea occurs when the tissues of the upper airway collapse repeatedly during sleep, leading to sleep fragmentation or drops in the oxygen levels of the blood.

It is associated with familiar symptoms: snoring, excessive daytime sleepiness, getting up to urinate, and teeth grinding. Moreover, it can worsen other medical conditions, including hypertension, diabetes, and the risks of heart attack and even stroke.

The collapse of the airway that characterizes the disorder often involves the tissues of the soft palate, uvula, and tongue shifting into and blocking the throat. When this occurs, the brain sends out an alerting signal via a burst of cortisol that causes a brief awakening to increase muscle tone along the airway and restore normal breathing. When the airway is extra crowded, with fat deposited along the throat and at the base of the tongue, this narrowing increases the risk for sleep apnea. Therefore, people who are overweight or obese are more likely to suffer from the condition.

How Much Weight Is Too Much?

It can be difficult to predict exactly how much extra weight is important to an individual’s risk.

For example, if you are 50 pounds overweight, this likely significantly increases your chances of having sleep apnea. But what about 15 pounds? It may depend on your anatomy with other features conveying more or less risk. In addition, women are at lower risk if they have not yet entered menopause (with 12 consecutive months without a menstrual period).

This is due to the likely protective effects of estrogen and progesterone on maintaining the muscles of the airway.

In addition, the degree of weight loss associated with resolution of sleep apnea may also vary. It can be helpful to look for improvement of the presenting symptoms, such as snoring and daytime sleepiness, as weight loss occurs. If you are using continuous positive airway pressure (CPAP), you may start to notice discomfort from the pressure and sometimes air swallowing (aerophagia). If you are requiring lower pressures with AutoCPAP based on data from your compliance data check, this could be a sign that your sleep apnea is resolving.

When at least 10% of your body weight is lost, it may be useful to repeat a sleep study. It doesn’t matter if the weight loss has occurred secondary to bariatric surgery or due to diet and exercise. Often the goal is to reach a body mass index (BMI) that is below 25. The repeat testing may be timed to occur when your weight loss has plateaued, especially if you have met your weight loss goals and reached a normal or even ideal body weight.

You should consult with your physician about your goals and whether it may be time to reassess your sleep.

Why Might Sleep Apnea Persist After Weight Loss?

It is possible that additional weight loss may be required to improve your condition, especially if you continue to be overweight or obese. In addition, there are other risk factors that may contribute to your degree of obstructive sleep apnea, including:

As discussed above, your anatomy may predispose you to the condition, even at a healthy weight. For example, a deviated nasal septum or a recessed lower jaw may contribute among those with a normal weight. A careful examination by your sleep specialist may identify these issues.

Other causes of sleep apnea can be reversible or outright avoided. Alcohol is a muscle relaxant and it can affect the muscles of the upper airway as well, leading to its collapse. Drinking in the few hours before your bedtime may therefore exacerbate sleep apnea. Certain prescription medications may have a similar effect. If you are a smoker, this increases your risk of both snoring and sleep apnea.

Allergies may lead to nasal congestion and swelling along the airway. Decreased airflow through the nose and throat may worsen sleep apnea in susceptible individuals. Fortunately, proper allergy treatment with saline rinses or sprays, nasal steroid sprays, and other oral medications may help alleviate this contribution.

Many people have worsened snoring and sleep apnea when they sleep on their backs. This is due to gravity shifting the soft tissues, especially the tongue, into the airway and leading to disrupted airflow. Some will benefit from learning to sleep on their sides, which may be aided by the use of positional therapy like a tennis ball t-shirt or other devices.

Sleep apnea is almost invariably worsened during rapid eye movement (REM) sleep. This occurs because REM sleep is when we have our most vivid dreams and in order to prevent the acting out of these dreams, the body is actively paralyzed from the brainstem. This paralysis affects almost all muscle of the body (except the diaphragm and eye muscles). As a result, the airway also becomes paralyzed and this relaxation can worsen the degree of sleep apnea. REM sleep has other favorable effects – including memory processing and learning – and is not something that we should hope to avoid.

Finally, there is one factor that contributes to sleep apnea that cannot be avoided: aging. In general, our risk of developing sleep apnea increases as we get older, especially through middle age. It may stabilize in our later years, so that if you are going to develop sleep apnea based on your anatomy and other factors, there comes a point when you either have it or you will never get it. As mentioned previously, women are at increased risk of developing sleep apnea after the onset of menopause.

If you are concerned that you may have persistent sleep apnea after weight loss, speak with your sleep specialist about getting a test to reassess your condition. You can also explore some of the other reasons it may persist and identify appropriate treatment options to do something about it.


Kryger, MH et al. "Principles and Practice of Sleep Medicine." Elsevier, 5th edition.

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