Divergent Treatment Preferences for Comorbid Obesity and Sleep Apnea Observed Between Patients and Providers

A groundbreaking study set to be unveiled at the upcoming SLEEP 2025 annual meeting reveals a paradigm shift in treatment preferences for individuals grappling with the dual burden of obesity and obstructive sleep apnea (OSA). This chronic condition, which affects roughly 30 million American adults, is characterized by frequent airway collapse during sleep, leading to significant disruptions in breathing and overall health. The newly released data highlight a notable divergence between sleep medicine professionals and patients regarding the preferred therapeutic strategies, marking an important moment in understanding and addressing this complex comorbidity.

Continuous positive airway pressure (CPAP) has long been established as the gold standard intervention for obstructive sleep apnea. The therapy uses a regulated stream of airway pressure delivered through a specialized mask to maintain upper airway patency during sleep, thus mitigating apnea episodes. Despite its demonstrated clinical efficacy, adherence to CPAP protocols has historically been challenged by patient discomfort and lifestyle interference. In contrast, tirzepatide, a GLP-1 and GIP receptor agonist initially developed for metabolic disorders, has recently gained FDA approval under the trade name Zepbound for treating moderate to severe OSA in obese adults. Tirzepatide’s emergence as a viable option introduces a pharmacological counterpoint to the mechanical approach of CPAP.

The study harnessed data from an extensive, nationwide online survey involving over 350 patients alongside sleep medicine clinicians affiliated with the University of California, San Diego (UCSD). The patient cohort predominantly consisted of individuals with both obesity and obstructive sleep apnea, many of whom had undergone multiple weight loss attempts and reported previous experience with therapies including CPAP and tirzepatide or related agents like semaglutide. These robust datasets permitted a granular assessment of real-world treatment attitudes from both clinical and patient perspectives.

Results depicted a compelling dichotomy: while more than three-quarters of respondents within both populations recognized CPAP and tirzepatide as acceptable therapeutic modalities, there was a marked contrast in preference hierarchy. Almost half of the patients expressed a predilection for tirzepatide over CPAP, assuming the two treatments demonstrated equal effectiveness. Conversely, more than half of the sleep medicine specialists exhibited a preference for CPAP, underscoring clinicians’ enduring confidence in its clinical utility. These findings illuminate a fundamental tension between clinical prudence and patient inclinations in managing comorbid obesity and OSA.

Further intrigue arises from attitudes toward combination therapy, wherein CPAP is used alongside tirzepatide. While a substantial majority of healthcare providers endorsed this integrative approach, patients displayed comparatively subdued enthusiasm. This disparity suggests potential concerns related to treatment complexity, tolerability, or patient burden when multiple modalities are involved. Understanding these divergent viewpoints is critical, particularly as precision medicine and individualized treatment plans become increasingly prioritized in sleep healthcare.

According to lead author Ahmed Khalaf, a sleep technician specializing in pulmonary, critical care, and sleep medicine at UCSD, these findings underscore an urgent need for rigorous comparative effectiveness research. “Data derived from real-world clinical settings comparing CPAP and tirzepatide will be indispensable in bridging the preference gap between providers and patients,” Khalaf notes. He emphasizes that aligning treatment strategies with patient values and expectations is essential to fostering adherence and optimizing therapeutic success over time.

Obstructive sleep apnea remains a multifaceted disorder, intricately tied to metabolic health. The co-occurrence of obesity complicates management and prognosis, with excess adiposity exacerbating airway obstruction and contributing to systemic inflammation and cardiovascular risk. CPAP addresses the mechanical blockages intrinsic to OSA, whereas tirzepatide’s weight-reducing and metabolic effects may indirectly alleviate apnea severity by diminishing the anatomical and physiological contributors to airway collapse. This complementary biological interplay justifies the exploration of combined therapeutic regimens.

Dr. Chris Schmickl, principal investigator and assistant professor of medicine at UCSD, reflected on the unexpected divergence in treatment priorities. He remarked on the necessity for clinicians to appreciate and validate patients’ treatment perceptions. “Recognizing and reconciling these differing attitudes is vital for devising realistic, patient-centered care strategies,” Schmickl says. He advocates for further qualitative and quantitative investigations to decode the underlying factors shaping these preferences, including psychosocial variables and lived experiences with disease and therapy.

The FDA’s recent endorsement of Zepbound (tirzepatide) signals a transformative chapter in sleep apnea therapeutics. While Zepbound effectively reduces apnea severity, it does not represent a definitive cure, leaving room for adjunctive interventions such as CPAP to solidify long-term clinical outcomes. This therapeutic evolution may recalibrate how sleep specialists approach the intertwined challenges of obesity and OSA, fostering nuanced, multimodal treatment landscapes.

Funding for this pivotal research originated from the National Institutes of Health and the American Academy of Sleep Medicine Foundation, emphasizing its significance and potential broader impact. The research abstract appeared in an online supplement of the journal Sleep, providing transparent access to the scientific community and catalyzing dialogue ahead of its formal presentation at SLEEP 2025 in Seattle, a premier event conducted by the Associated Professional Sleep Societies, which represents a synergistic collaboration between the American Academy of Sleep Medicine and the Sleep Research Society.

In sum, the PRO-CON OSA survey casts new light on the evolving therapeutic terrain for patients contending with comorbid obesity and obstructive sleep apnea. The nuanced preferences expressed by patients and providers underscore the multifaceted nature of treatment decision-making, emphasizing shared decision-making frameworks to reconcile differences and tailor optimized care paradigms. As new pharmacological agents like tirzepatide emerge alongside traditional modalities, ongoing research and patient engagement will be pivotal in shaping the future landscape of sleep apnea treatment.