The role of weight management in sleep disordered breathing

Sleep disordered breathing (SDB) has a significant impact on public health, with obesity being a major contributing factor. Obstructive sleep apnoea (OSA) and obesity hypoventilation syndrome (OHS) are primary conditions in SDB, strongly linked to increased body mass index. Obesity exacerbates airway narrowing, reduces lung volumes and promotes inflammation, aggravating OSA and OHS. Weight loss, achieved through nutritional therapies, pharmacotherapy or surgical therapies, reduces apnoea-hypopnea index and associated obesity-related complications. Caloric restriction and exercise provide modest improvements, often independently of substantial weight reduction. Bariatric surgery achieves substantial improvements in many cases but displays variability in outcomes. Emerging pharmacological treatments, such as glucagon-like peptide-1 receptor agonists, show promise for patients with concurrent obesity and SDB. Personalised interventions, including physiological phenotyping and multidisciplinary management, would provide effective treatment strategies. Further research into long-term outcomes, novel therapies and mechanisms beyond weight reduction is essential. Obesity prevention also remains crucial for mitigating the burden of SDB globally. This review will evaluate the role of obesity management strategies in improving SDB outcomes, and will highlight the bidirectional relationship between obesity and SDB, emphasising an integrated patient-centred approach.