Sleep Apnea, Obesity, and HF OSA, obesity, and HF have a complex interaction.259 In the Sleep Heart Health Study, OSA was detected in 37% of patients with HF, with a higher prevalence of OSA in men than in women.260 In men, the main risk factor for OSA was obesity, whereas in women, it was older age. Studies have reported a prevalence of OSA of 11% to 26% in patients with HFrEF and 40% to 50% in patients The greater associations of HFpEF with obesity and of hypertension with both OSA and obesity may be factors in the higher prevalence of OSA in this patient population. Although no randomized trials have been performed to evaluate the effect of treatment of OSA on longer-term outcomes of mortality and morbid- ity in patients with HF, smaller short-term studies have suggested that treatment of OSA with continuous posi- tive airway pressure is associated with an improvement in EF, dyspnea, and QOL in patients with HFrEF233,234 and in BP, diastolic function, and cardiac remodeling in patients Whether weight loss in obese patients with HF will result in improvements in OSA and associ- ated cardiovascular abnormalities and, more important, in longer-term outcomes in patients with OSA and HF (in HFpEF and HFrEF) remains an area for future research. Recommendations Harmonized With Existing Guidelines There are no specific recommendations for weight loss in the 2013 ACCF/AHA focused update guidelines on but the guidelines acknowledge that obesity and in- sulin resistance are important risk factors for the devel- opment of HF and that there are no large-scale studies on the safety or efficacy of weight loss with diet, exer- cise, or bariatric surgery in obese patients with HF. 