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Weight loss and treatment of obstructive sleep apnea (OSA).
Lifestyle intervention with weight reduction. First-line treatment in mild OSA.
Tuomilehto HPI, Seppa JM, Partinen MM, Peltonen M, Uusitupa M.
American Journal of Respiratory and Critical Care Medicine.2009, 178:320-327.
There is a strong link between being overweight or obese and the development of obstructive sleep apnea (OSA). This is probably because when you are obese, the amount of fat in the neck increases and puts pressure on the throat causing it to get narrow, thus making it easier for it to collapse and block breathing during sleep. Because of this, all overweight patients with OSA are advised to lose weight. This randomized, controlled study from Finland focused on whether weight loss would be an effective form of treatment for OSA. The study involved 81 patients who were predominantly middle-aged, obese (average body mass index, BMI, of 33 kg/m2) men. The patients had mild OSA with an average of 10 breathing pauses (apneas and hypopneas) per hour of sleep (apnea-hypopnea index or AHI) recorded from a home apnea monitoring equipment. These patients had mild excessive daytime sleepiness with an average score of 10 on the Epworth Sleepiness Scale (ESS; a value of 10 or greater indicates excessive daytime sleepiness). The patients were randomized into either the treatment (weight loss) or control group. The treatment group received extensive advice on the importance of losing weight and were placed on a very low calorie diet (VLCD, approximately 600 to 800 kcal/day) for a period of 12 weeks at the start of the study. After the VLCD program was completed, the patients were advised to increase their exercise levels. They also had regular meetings with the nutritionist (14 visits in total) during the course of the study. The patients in the control group were given general information about diet and exercise at baseline, and during clinic visits 3 and 12 months later. After 12 months, the weight loss group lost an average of 10.7 kg which was significantly greater than the average loss of 2.4 kg in the control group. Also, the mean AHI for the weight loss group was significantly lower at 6 versus 10 for the control group. Further, OSA was cured (AHI < 5 on final home apnea monitoring) in 65% of patients in the intervention arm in contrast to only 35% of patients in the control group. Also, statistical analysis showed that weight loss was linked to improvements in AHI such that the greater the weight loss, the greater the reduction in AHI. The alleviation of OSA in the weight loss group was associated with significantly greater improvements in sleep quality and quality of life than in the control group. However, there were no significant decreases in daytime sleepiness, blood pressure or fasting blood glucose levels in the weight loss group compared to the control group. In summary, this study demonstrated that weight loss can improve and even cure mild OSA in association with improvements in some aspects of quality of life, but without any improvement in daytime sleepiness.
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