CPAP, Weight Loss, or Both for Obstructive Sleep Apnea
Open accessAbstract
BACKGROUND: Obesity and obstructive sleep apnea tend to coexist and are associated with inflammation, insulin resistance, dyslipidemia, and high blood pressure, but their causal relation to these abnormalities is unclear. METHODS: We randomly assigned 181 patients with obesity, moderate-to-severe obstructive sleep apnea, and serum levels of C-reactive protein (CRP) greater than 1.0 mg per liter to receive treatment with continuous positive airway pressure (CPAP), a weight-loss intervention, or CPAP plus a weight-loss intervention for 24 weeks. We assessed the incremental effect of the combined interventions over each one alone on the CRP level (the primary end point), insulin sensitivity, lipid levels, and blood pressure. RESULTS: Among the 146 participants for whom there were follow-up data, those assigned to weight loss only and those assigned to the combined interventions had reductions in CRP levels, insulin resistance, and serum triglyceride levels. None of these changes were observed in the group receiving CPAP alone. Blood pressure was reduced in all three groups. No significant incremental effect on CRP levels was found for the combined interventions as compared with either weight loss or CPAP alone. Reductions in insulin resistance and serum triglyceride levels were greater in the combined-intervention group than in the group receiving CPAP only, but there were no significant differences in these values between the combined-intervention group and the weight-loss group. In per-protocol analyses, which included 90 participants who met prespecified criteria for adherence, the combined interventions resulted in a larger reduction in systolic blood pressure and mean arterial pressure than did either CPAP or weight loss alone. CONCLUSIONS: In adults with obesity and obstructive sleep apnea, CPAP combined with a weight-loss intervention did not reduce CRP levels more than either intervention alone. In secondary analyses, weight loss provided an incremental reduction in insulin resistance and serum triglyceride levels when combined with CPAP. In addition, adherence to a regimen of weight loss and CPAP may result in incremental reductions in blood pressure as compared with either intervention alone. (Funded by the National Heart, Lung, and Blood Institute; ClinicalTrials.gov number, NCT0371293 .).
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The impact of CPAP therapy on glycaemic control is uncertain.
“However, the impact of CPAP therapy on glycaemic control is uncertain (Chirinos et al., 2014; Reutrakul & Mokhlesi, 2017).”
From Obstructive sleep apnea: transition from pathophysiology to an integrative disease model (2022) · cites this paper as Chirinos et al., 2014
The Discussion reports mixed findings from earlier studies on CPAP and insulin resistance, which supports uncertainty about a related metabolic effect. But this trial measured insulin sensitivity, not glycaemic control directly, and found no improvement with CPAP alone; it also excluded people with diabetes. The citation therefore supports the claim only indirectly. (LLM, conf=0.83)
Experimental — accuracy not yet measuredSince obesity confers additional cardiovascular risk to OSA patients, weight loss directly benefits cardiovascular health.
“Since obesity confers additional CV risk to OSA patients, weight loss directly benefits CV health.215”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [215]
Experimental — accuracy not yet measuredCPAP's effect on cardiovascular biomarkers such as C-reactive protein and lipids is more variable than its effect on blood pressure.
“Although most (but not all) studies and the above meta-analysis support a modest effect of CPAP on blood pressure, the effect on biomarkers associated with cardiovascular risk such as C-reactive protein has been more variable.”
From Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association (2016) · cites this paper as [170]
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Improving obesity and blood pressure
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Review of and Updates on Hypertension in Obstructive Sleep Apnea
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Adipose tissue as a key player in obstructive sleep apnoea
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Obesity and Obstructive Sleep Apnea
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Does remote monitoring change OSA management and CPAP adherence?
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The impact of exercise on sleep and sleep disorders
Korkutata, A., Korkutata, M., & Lazarus, M. (2025) · npj Biological Timing and Sleep · doi:10.1038/s44323-024-00018-w · Cited by 101 · see citing works
Changes in Energy Metabolism after Continuous Positive Airway Pressure for Obstructive Sleep Apnea
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Obstructive Sleep Apnea and Cardiometabolic Disease: Obesity, Hypertension, and Diabetes
Tasali, E., Pamidi, S., Covassin, N., & Somers, V. K. (2025) · Circulation Research · doi:10.1161/circresaha.125.325676 · Cited by 100 · see citing works
Continuous positive airway pressure therapy in obstuctive sleep apnea: benefits and alternatives
Cao, M. T., Sternbach, J. M., & Guilleminault, C. (2017) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2017.1305893 · Cited by 99 · see citing works
On the cutting edge of obstructive sleep apnoea: where next?
Malhotra, A., Orr, J. E., & Owens, R. L. (2015) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(15)00051-x · Cited by 98 · see citing works
Mechanisms and treatment of obesity-related hypertension—Part 1: Mechanisms
Parvanova, A. I., Reseghetti, E., Abbate, M., & Ruggenenti, P. L. (2023) · Clinical Kidney Journal · doi:10.1093/ckj/sfad282 · Cited by 98 · see citing works
Sleep Apnea and Sleep Habits: Relationships with Metabolic Syndrome
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Treatment options in obstructive sleep apnea
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Current and novel treatment options for obstructive sleep apnoea
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Sleep Apnea Syndrome (SAS) Clinical Practice Guidelines 2020
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Impact of Weight Loss Management in OSA
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Multimodal Remote Monitoring of High Cardiovascular Risk Patients With OSA Initiating CPAP
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Weight Loss Medications in the Treatment of Obesity and Hypertension
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Obstructive sleep apnea and cardiovascular disease, a story of confounders!
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New developments in the use of positive airway pressure for obstructive sleep apnea.
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Obstructive Sleep Apnea–Induced Neurogenic Nocturnal Hypertension
Kario, K., Hettrick, D. A., Prejbisz, A., & Januszewicz, A. (2021) · Hypertension · doi:10.1161/hypertensionaha.120.16378 · Cited by 72 · see citing works
Recognition and Management of Resistant Hypertension
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Novel avenues to approach non-CPAP therapy and implement comprehensive obstructive sleep apnoea care
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Metabolic dysfunction in OSA: Is there something new under the sun?
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Impact of Mandibular Advancement Therapy on Endothelial Function in Severe Obstructive Sleep Apnea
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S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen – Kapitel „Schlafbezogene Atmungsstörungen“
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Obstructive Sleep Apnea and Hypertension: A Review of the Relationship and Pathogenic Association
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A Randomized Controlled Study to Examine the Effect of a Lifestyle Modification Program in OSA
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From CPAP to tailored therapy for obstructive sleep Apnoea
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The Systemic Inflammome of Severe Obesity before and after Bariatric Surgery
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Hypertension in Obesity: Novel Insights
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Mild obstructive sleep apnoea: clinical relevance and approaches to management
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Sleep-disordered breathing, type 2 diabetes and the metabolic syndrome
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- Authors
- Chirinos, J. A., Gurubhagavatula, I., Teff, K., Rader, D. J., Wadden, T. A., Townsend, R., Foster, G. D., Maislin, G., Saif, H., Broderick, P., Chittams, J., Hanlon, A. L., & Pack, A. I.
- Affiliations
- Hospital of the University of Pennsylvania (US)
- Monell Chemical Senses Center (US)
- Temple University (US)
- University of Pennsylvania (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2014-06-12
- Volume
- 370
- Issue
- 24
- Pages
- 2265-2275
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC4138510
- OpenAlex
- W2128816837
- Cited by
- 523
- References
- 40
- Citations by year
- 2026: 32 · 2025: 31 · 2024: 36 · 2023: 38 · 2022: 44 · 2021: 33 · 2020: 36 · 2019: 51 · 2018: 47 · 2017: 47 · 2016: 57 · 2015: 48 · 2014: 21 · 2013: 1 · 2012: 1
- FWCI
- 38.34
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion, other-oa)
- Funders
- National Heart, Lung, and Blood Institute (HL-R01080076, P01HL094307, R01HL080076)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Keywords
- obstructive sleep apnea, obesity, continuous positive airway pressure, weight loss, C-reactive protein, inflammation, insulin resistance, serum triglycerides, blood pressure, serum lipids
- MeSH terms
- Adult, Aged, Blood Pressure, C-Reactive Protein, Combined Modality Therapy, Female, Humans, Insulin Resistance, Male, Middle Aged, Obesity, Triglycerides, Weight Loss, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure, Intention to Treat Analysis
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