Comorbid obesity and OSA treatment preferences found to differ among patients and providers

Sleep medicine professionals favour continuous positive airway pressure therapy as treatment for comorbid obesity and obstructive sleep apnoea (OSA), while patients lean toward treatment with tirzepatide, according to a study presented at the SLEEP 2025 annual meeting.

"The results highlight a need for real-world comparative effectiveness data of CPAP vs. tirzepatide, and a potential mismatch between patient and provider preferences when managing comorbid obesity and OSA," said lead author, Dr Ahmed Khalaf, a sleep technician in the pulmonary, critical care and sleep medicine division at University of California, San Diego. "Understanding these differences is critical for shared decision-making throughout the care plan, which may ultimately impact adherence and treatment success."

Nearly 30 million adults in the US have OSA, a chronic disease that involves repeated collapse of the upper airway during sleep, which is commonly treated with CPAP therapy, which uses mild levels of air pressure, provided through a mask, to keep the airway open during sleep.

According to a recent statement from the American Academy of Sleep Medicine, the FDA approval of Zepbound (tirzepatide) for moderate to severe OSA in adults with obesity is a positive development for patients and clinicians, who now have another treatment option for this common and under-diagnosed sleep disorder.

While Zepbound can reduce the severity of OSA, it may not cure the disease. Therefore, for some patients who have OSA, combining another treatment with Zepbound may be ideal to promote long-term results.

For this preliminary analysis, the researchers used data from an ongoing, national online survey including responses from 17 UCSD sleep medicine professionals and 365 patients; 42% of participants were women.

Nearly 53% of patients were living with comorbid obesity and OSA, 73% reported three or more prior attempts at weight loss, 23% reported being current or past users of tirzepatide and/or semaglutide, and 78% reported being current or past users of CPAP.

Results show that more than 75% of patients and clinicians considered CPAP and tirzepatide to be acceptable treatment options. However, patients preferred tirzepatide over CPAP should evidence demonstrate equal effectiveness (48% vs. 35%), while sleep medicine professionals tended to favour CPAP over tirzepatide (53% vs. 26%). While both groups supported a treatment plan that combines CPAP with tirzepatide, patients were less enthusiastic than sleep medicine professionals about combination therapy (61% vs. 88%).

Dr Chris Schmickl, principal investigator and assistant professor of medicine at University of California, San Diego, was surprised by the divergence in treatment preferences between patients and providers.

"Recognising differing attitudes toward treatment is crucial for developing a realistic and achievable action plan," said Schmickl. "Additional research to understand the underlying reasons behind these preferences will offer valuable insights for providers to guide treatment decisions."