For > 20 years, being overweight has been regarded as the most important cofactor contributing to the severity of obstructive sleep apnea (OSA).1 For this reason, the treatment of OSA includes means to achieve substantial weight loss. In this issue of CHEST (see page 618), Busetto et al introduce intragastric balloons into the field of bariatric surgery for OSA.
Weight loss associated with almost complete resolution of sleep apnea was observed by Schwartz et al2– in patients with OSA in whom the upper airway critical pressure fell below < 4 cm H2O. They concluded that weight loss was associated with a reduction in upper airway collapsibility and that resolution of sleep apnea depends on the absolute value to which the upper airway critical pressure falls. Unfortunately, only a few patients with sleep-related breathing disorders succeed in maintaining their dietary-achieved weight reduction. Guilleminault3 reports that only 3% of patients with OSA who had a significant improvement in their sleep apnea symptoms as a result of dietary weight loss maintained their weight after 5 years; many patients, in fact, regained their weight and even exceeded their baseline weights.