Lifestyle Modification to Treat Obstructive Sleep Apnea
Is weight reduction superior to usual care at reducing nocturnal respiratory events in obstructive sleep apnea (OSA)?
Consecutive study subjects were recruited from patients referred for suspicion of sleep apnea. All were age 30-80 years, with moderate to severe OSA (apnea-hypopnea index [AHI] >15 events/hour) and body mass index (BMI) >25 kg/m2. Exclusions included coexisting sleep disorders, mild OSA, pregnant women, and history of surgery to treat OSA. OSA status was assessed with home sleep monitoring. Patients were randomized 1:1 to participate in a lifestyle modification program (LMP) or usual care for 1 year. The intervention group participated in a dietitian led LMP with weekly dietary consultation for 16 weeks. A 10-20% caloric reduction was set as a general initial goal. Control group patients received lifestyle advice from a clinician at baseline and 6 months.
A total of 185 Chinese patients were screened and 104 (61 intervention, 43 controls) were included in the final analysis. Baseline characteristics were similar in the two groups. The intervention group reduced AHI from baseline 16.9% versus 0.6% more events in the control group (p = 0.011). The intervention group also reduced BMI compared to controls (-1.8 kg/m2 vs. -0.6 kg/m2 of the initial BMI, p < 0.001) as well as reduced the Epworth Sleepiness Scale score (-3.5 vs. -1.1 intervention, control, p = 0.004).
The authors concluded that LMP was effective at reducing AHI and daytime sleepiness, and this benefit was sustained at 1 year.
Obesity is a major risk for OSA. An intensive dietary counseling intervention strategy was superior to usual care at lowering apneic and hypopnea events among patients with moderate to severe OSA. The amount of weight reduction was strongly associated with fall in AHI. The decrease in AHI relative to lower BMI is similar to the 3:1 ratio (observed here, 16.9% reduction in AHI for 5.8% reduction in BMI). The LMP resulted in lower energy intake from fat and more from fiber and protein compared to controls at 12 months, despite the fact that >20% in the intervention group made <4 of the dietary consultations. Weight loss programs should be viewed as an adjunctive treatment for patients with OSA. Providers caring for this population must gain experience in behavior and lifestyle weight management programs, which might become one metric for assessing OSA quality of care.
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