Does obesity cause sleep apnoea and can Mounjaro help?

A very common medical condition globally, sleep apnoea is a disorder that stops you from breathing in your sleep. Although there are a few sleep apnoea causes, you are at higher risk if you are obese due to the excess fat deposits in your neck known as pharyngeal fat. 

Losing weight via lifestyle choices such as dieting and exercise may reduce symptoms, but if it’s proving ineffective, then weight loss injections may be suggested by a healthcare provider. 

Because of this, we have looked at a new study showing remarkable results for the use of weight loss injections like Mounjaro on the effects it has on sleep apnoea, which has shown that it may be a very effective alternative treatment.

What is sleep apnoea?

Sleep apnoea is a potentially serious disorder where your breathing can frequently stop during sleep. The most common type is called obstructive sleep apnoea, with one study suggesting it affects up to 1 billion people worldwide^[1]. It’s important to treat sleep apnoea as it can lead to other problems such as:

• High blood pressure
• Increased chance of a stroke
• Type 2 diabetes
• Heart disease
• Depression

If you are snoring loudly and feel tired even after a full night’s sleep, then it’s possible that you have sleep apnoea. Sleep apnoea symptoms can slightly overlap between the two different types (obstructive sleep apnoea and central sleep apnoea). They can be:

• Difficulty staying asleep, otherwise known as insomnia
• Excessive daytime tiredness
• Gasping for air during sleep
• Morning headache
• Irritability
• Loud snoring

Being diagnosed with sleep apnoea means that you would need to contact the DVLA as you must not drive until symptoms are under control. You can read more about this here.

When your airways become too narrow in your sleep, this stops you from breathing properly (sleep apnoea). Causes for this have been linked to:

• Obesity
• Age
• Smoking and drinking alcohol
• Sleeping on your back
• Having large tonsils
• Having chronic obstructive pulmonary disease (COPD)

Not everyone who has sleep apnoea snores, but if you have any symptoms of sleep apnoea and find yourself feeling fatigued, sleepy and irritable, then contact your GP to look into this further.

The most common sleep apnoea treatment is with a ‘continuous positive airway pressure’ (CPAP) machine. This uses pressure to keep your airways open to ensure you don’t stop breathing.

The different types of sleep apnoea

Obstructive sleep apnoea (OSA)

This type of sleep apnoea occurs when the muscles in the back of your throat become too relaxed. When this happens, your airway narrows or closes as you inhale, meaning you’re not getting enough air. 

At this point, your brain can tell that the amount of oxygen in your blood is lower and that you’re not breathing properly; this will wake you up to reopen the airway. You’re usually awake for such a short period that you won’t remember it in the morning.

This can make it difficult to reach a deep sleep as the process can repeat itself up to 30 times in one hour, for the entire night. If you record audio of yourself sleeping, you may notice snorting, choking or gasping when this occurs.

Whilst this can affect anyone, certain factors can increase your risk, such as:

• Excess weight
• Having a thicker neck
• Being male (two to three times more likely)^[2]
• Being older - those 60 and over are more likely to develop CSA^[3]

Central sleep apnoea (CSA)

This is a less common form of sleep apnoea, and happens when your brain doesn’t send the necessary signals to the muscles that help you breathe. It means that there is no effort being made by your body to breathe for a short duration. 

In this instance, you are likely to wake up with shortness of breath and will likely struggle to get to sleep and stay asleep.

Repeatedly waking up throughout the night makes it nearly impossible to have a proper night’s sleep. Those with central sleep apnoea are much more likely to experience fatigue, daytime sleepiness, and irritability, which can also affect concentration.

Things that can increase the chances of having this form of sleep apnoea include:

• Being older
• Being male
• Having congestive heart failure increases the risk
• Using opioid medicines
• Stroke

Mixed or complex sleep apnoea

This is a combination of both obstructive sleep apnoea and central sleep apnoea. It can only be recognised by a healthcare provider through an attended overnight sleep study, where the effects of both can be recorded. 

How obesity affects sleep apnoea

Will losing weight get rid of sleep apnoea?

Obesity and sleep apnoea go hand in hand, with excess weight being the leading risk factor of sleep apnoea in both its development and its severity. Studies have shown that even losing up to 5-10% of your body weight is enough to improve or in some cases, even resolve the condition^[4].

Whilst using a CPAP machine is the most common treatment for sleep apnoea, if you are obese, then it’s recommended to focus on lifestyle changes to lose weight in addition to this treatment. This will best improve your chances of reducing symptoms, as the two approaches work better together rather than alone.

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Benefits of weight loss for sleep apnoea

How weight loss injections like Mounjaro help improve sleep apnoea

With the complex relationship that sleep apnoea and excessive weight have, it’s evident that losing weight can significantly improve this condition. One of the emerging breakthroughs in weight loss has been weight loss injections, such as Mounjaro (tirzepatide). 

Mounjaro has recently been used in a study^[5] to determine if it can help reduce the number of times people with moderate to severe sleep apnoea are awoken during the night. The study showed that the treatment significantly reduced the severity of sleep apnoea in comparison to the placebo, regardless of whether the participants were on CPAP therapy or not.

The average number of times someone with moderate sleep apnoea can be awoken can be between 15-20 times an hour, whilst in severe cases this can be in excess of 30^[6].

In both CPAP and non-CPAP users, Mounjaro reduced the amount of events in an hour by around 25 to 29 events. This is compared to about 5 events an hour in the placebo groups. This suggests that the treatment may even be beneficial without the use of CPAP.

Approaches to weight loss

Dietary advice

Changing your food intake and opting for a calorie-restricted diet is an optimal way of reducing your weight and the severity of your sleep apnoea. For males, this is recommended to be roughly 1500-1800 calories, while for females, it is only about 1200-1500 calories.

It’s advised to try and stick to a diet for at least six months, aiming to lose between one to two pounds a week for a healthy and sustainable target. Losing weight slowly makes you more likely to maintain your weight loss because of the habits you have formed along the way.

Exercise

Increasing your physical activity day-to-day is a great way to help aid your weight loss. For example, you can do things like:

• Take the stairs instead of the escalator or lift
• Take breaks from sitting at your desk to stand or walk
• Walking - doing this 30 minutes a day, 5 days a week, can improve high blood pressure, reduce stress, and improve sleep quality.

Medical treatments

If you continue to have a lot of excess weight and previous attempts at losing weight with long-term diet and exercise aren’t working, then a doctor may recommend weight loss medication or surgery. 

Whilst CPAP therapy continues to be the primary method of treating sleep apnoea, it does appear that new treatments may be on the horizon. Even though Mounjaro is not currently indicated as a treatment for obstructive sleep apnoea, it may be considered after further research.

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