Treatment preferences for comorbid obesity and obstructive sleep apnea (PRO-CON OSA) survey: Patient and provider preferences for CPAP and/or tirzepatide.

PURPOSE: Approximately one of ten US adults has comorbid obesity and obstructive sleep apnea (COBOSA). Traditionally, sleep medicine management of COBOSA focused on continuous positive airway pressure (CPAP). Recently, tirzepatide (a once-weekly injection) was approved for COBOSA after demonstrating substantial reduction of weight and OSA severity in efficacy trials. We assessed patient and provider attitudes towards these therapies for COBOSA. METHODS: We conducted an online survey (November 2024–August 2025) targeting US adults with OSA and/or obesity (“patients”) and sleep medicine providers. The survey assessed treatment acceptability, preferences, and informational needs. RESULTS: The analysis included 461 patients (86% with sleep apnea, 49% with COBOSA; ~5% response rate) and 114 providers. Overall, 70% of respondents found both CPAP and tirzepatide at least somewhat acceptable, with significantly different response patterns (P < .001): providers found CPAP more acceptable than tirzepatide, whereas patients rated both therapies similar. When asked to choose a preferred long-term therapy assuming equal effectiveness, patients favored tirzepatide (48% vs. 21%), while providers preferred CPAP (52% vs. 27%). Providers with experience prescribing injectable weight-loss medications were more aligned with patient views. Both groups supported combination therapy, though patients were less enthusiastic than providers (61% vs. 86%). Both groups valued a wide range of outcomes for decision making—across symptom, sleep, and cardiometabolic domains—and emphasized the importance of safety, long-term data, and costs. CONCLUSIONS: Patients and providers view CPAP and/or tirzepatide as acceptable options for COBOSA, but preferences diverge. Given equipoise, comparative effectiveness trials are urgently needed to guide individualized treatment strategies.

Duke Scholars

Author Yuliya Vladimirovna Lokhnygina Biostatistics & Bioinformatics, Division of Biostatistics

Author Christopher Lindsell Biostatistics & Bioinformatics, Division of Biostatistics