Treatment Preferences For Comorbid Obesity and Obstructive Sleep Apnea (PRO-CON OSA) Survey: Patient and Provider...

Approximately one of ten US adults has comorbid obesity and obstructive sleep apnea (COBOSA). Traditionally, sleep medicine management of COBOSA focused on continuous positive airway pressure (CPAP). Recently, tirzepatide (a once-weekly injection) was approved for COBOSA after demonstrating substantial reduction of weight and OSA severity in efficacy trials. We assessed patient and provider attitudes towards these therapies for COBOSA.

We conducted an online survey (November 2024-August 2025) targeting US adults with OSA and/or obesity ("patients") and sleep medicine providers. The survey assessed treatment acceptability, preferences, and informational needs.

The main analysis included 461 patients (86% with sleep apnea diagnosis, 49% with COBOSA) and 114 providers. Overall, 70% of respondents found both CPAP and tirzepatide at least somewhat acceptable, with significantly different response patterns (P<.001): providers found CPAP more acceptable than tirzepatide, whereas patients rated both therapies similar. When asked to choose a preferred long-term therapy assuming equal effectiveness, patients favored tirzepatide (48% vs 21%), while providers preferred CPAP (52% vs 27%). Providers with experience prescribing injectable weight-loss medications were more aligned with patient views. Both groups supported combination therapy, though patients were less enthusiastic than providers (61% vs 86%). Both groups valued a wide range of outcomes for decision making-across symptom, sleep, and cardiometabolic health domains-and emphasized the importance of safety, long-term data, and costs.

Patients and providers view CPAP and/or tirzepatide as acceptable options for COBOSA, but preferences diverge. Given equipoise, comparative effectiveness trials are urgently needed to guide individualized treatment strategies.

Current Knowledge/Study Rationale: The weight-loss medication tirzepatide has recently emerged as a potential treatment option for patients with obstructive sleep apnea (OSA) and comorbid obesity (COBOSA), but little is known about patient and provider attitudes toward this therapy compared with the current first-line treatment of continuous positive airway pressure (CPAP) or what information they need to make informed choices between these options.Study Impact: This survey demonstrates high levels of acceptability for both tirzepatide and CPAP, supporting clinical equipoise. It also highlights the priorities, concerns, and decision-making factors most relevant to patients and providers, providing a foundation for future comparative trials and implementation efforts that are aligned with stakeholder needs and preferences.