Do you keep your partner awake with your snoring? Perhaps you’ve been told you gasp for breath during the night? Or maybe tiredness or brain fog has you suspecting your quality of sleep is not ideal? If you’ve never been tested for sleep disorders, it may surprise you to know that there is a strong link between obstructive sleep apnoea and obesity. In my latest article, I’ll explain the correlation between the two conditions, and why the link is often bidirectional. Learn some of the important things to note about obstructive sleep apnoea, and how bariatric surgery may help.
What is obstructive sleep apnoea?
Obstructive Sleep Apnoea (OSA) is a sleep-related breathing disorder characterised by repetitive episodes of partial or complete upper airway obstruction during sleep. These episodes lead to disrupted sleep, oxygen desaturation, and increased cardiovascular and metabolic stress.
Common symptoms include:
- Loud snoring
- Witnessed apnoeas or gasping during sleep
- Daytime fatigue and sleepiness
- Morning headaches
- Poor concentration or mood disturbances
There is strong evidence that people with untreated moderate to severe OSA have increased risk of high blood pressure, heart attack, stroke, diabetes, depression and accidents.
The link between OSA and obesity
There is a strong, well-established relationship between excess weight and OSA. Obesity contributes to OSA through increased fat deposition around the neck, tongue, and upper airway, leading to airway narrowing and collapsibility. Central adiposity (accumulation of fat in the lower torso around the abdominal area) also reduces lung volume, compounding upper airway instability during sleep.
A 2025 review of data around obesity and sleep disorders Obesity and sleep disorders: A bidirectional relationship explained that obesity is a significant risk factor for OSA, with evidence now suggesting half of patients with OSA are obese. Evidence also suggests that the prevalence of OSA increases with BMI, and weight gain has been associated with the development and progression of OSA.
Why OSA matters for bariatric patients
1. Pre-operative screening and management
Because of the high prevalence of OSA in patients with obesity, we routinely screen for symptoms and, where indicated, refer patients for a sleep study prior to bariatric surgery. Identifying and managing OSA pre-operatively with Continuous Positive Airway Pressure (CPAP) therapy is crucial.
Untreated OSA increases the risk of perioperative complications such as:
- Hypoxia during anaesthesia
- Cardiac arrhythmias
- Postoperative respiratory depression
In fact, the American Society for Metabolic and Bariatric Surgery (ASMBS) recommends that all patients undergoing bariatric surgery be screened for OSA and treated appropriately to minimise these risks. This advice is also followed internationally including in Australia.
2. Impact of weight loss on OSA
One of the many benefits of weight loss following bariatric surgery is the potential improvement, or even resolution, of OSA.
A 2023 systemic review and meta-analysis published in Frontiers on Sleep examined the impact of bariatric surgery on breathing-related polysomnography parameters (key measurements of OSA). Findings support the positive impact of bariatric surgery on OSA with significant reduction in Apnoea-Hypopnoea Index (AHI), as well as oxygen desaturation index (ODI).
For some patients, successful surgery can reduce or eliminate the need for CPAP therapy, improve sleep quality, and reduce associated risks such as hypertension, cardiovascular disease, and impaired glucose tolerance.
The American Academy of Sleep Medicine now recommends bariatric surgical consultation for OSA patients with a BMI over 40. While Australian clinical GP guidelines recommend “aggressive management of obesity” alongside Continuous positive airway pressure (CPAP) treatment to reduce cardiovascular risk with OSA in obese patients.
3. Postoperative considerations
Even after surgery, it is important for patients with known OSA to continue using CPAP until they are reassessed. Improvements in symptoms may be felt early, but a formal sleep study is often required to confirm remission. We recommend reassessment approximately 6–12 months post-operatively, depending on weight loss and symptom resolution.
We also continue to monitor for signs of residual OSA and ensure that other contributors to sleep disturbance, such as gastro-oesophageal reflux disease (GERD) or micronutrient deficiencies are addressed as part of holistic follow-up care.
Key points to remember about sleep apnoea for individuals with obesity
- OSA screening is important. OSA is common in individuals with obesity. Screening and treatment for OSA is essential before bariatric surgery, as it can impact your surgical risk and recovery.
- Weight loss is recommended for obese patients with OSA. Weight loss after bariatric surgery often leads to significant improvements in OSA.
- Ongoing follow-up is important. OSA is a serious condition, and it is essential to assess sleep health, including the need for continued CPAP therapy after bariatric surgery.
At Mackay & McLeod Weight Loss Surgeons, we take a multidisciplinary and evidence-based approach to your care. If you suffer from poor sleep, excessive daytime tiredness, or suspect you may have OSA, please speak with us. Treating sleep apnoea is an important step on your journey toward better health and wellbeing.
Got questions? Book a confidential surgical consultation
If you have questions about sleep apnoea, bariatric surgery, or whether you’re a suitable candidate, contact us at Mackay & McLeod to schedule a consultation.
Disclaimer: This blog post is for informational purposes only and does not substitute professional medical advice. Always consult a healthcare provider for personal medical guidance.
