Should weight loss be the first-line treatment for obstructive sleep apnoea? A pro-con debate

Obstructive sleep apnoea (OSA) is a common disorder associated with substantial morbidity. Although obesity is an important pathogenetic factor in OSA, the incorporation of weight loss into routine OSA care is currently limited. The development of glucagon-like peptide-1 (GLP-1) agonists has revolutionised obesity management and raises questions about the role of weight loss in OSA care. A debate was held at the 8th Sleep and Breathing Conference in April 2025 on whether weight loss should be first-line treatment for patients with OSA. Arguments in favour include the large and growing proportion of OSA attributable to excess weight, the effectiveness of modern weight-loss therapies in producing significant weight loss and the extent to which weight loss produces effects on clinical outcomes beyond OSA, such as the positive impact on cardiovascular and metabolic disease incidence and control. Conversely, arguments against include the fact that not all patients with OSA have obesity, the limited impact of weight loss on OSA resolution and the considerable data gap with obesity strategies in OSA including the lack of direct comparisons with CPAP on patient-centred outcomes and the impact on long-term health benefits in OSA patients specifically. Clearly, while more research is needed and treatment decisions should be personalised, clinicians need to gain competency with the use of novel weight-loss treatments as an essential part of OSA care.