Lifestyle Intervention with Weight Reduction: First-line Treatment in Mild Obstructive Sleep Apnea

Obesity is the most important risk factor for obstructive sleep apnea (OSA). However, although included in clinical guidelines, no randomized controlled studies have been performed on the effects of weight reduction on mild OSA. The aim of this prospective, randomized controlled parallel-group 1-yea...

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Published in:	American journal of respiratory and critical care medicine Vol. 179; no. 4; pp. 320 - 327
Main Authors:	Tuomilehto, Henri P. I, Seppa, Juha M, Partinen, Markku M, Peltonen, Markku, Gylling, Helena, Tuomilehto, Jaakko O. I, Vanninen, Esko J, Kokkarinen, Jouko, Sahlman, Johanna K, Martikainen, Tarja, Soini, Erkki J. O, Randell, Jukka, Tukiainen, Hannu, Uusitupa, Matti, on behalf of Kuopio Sleep Apnea Group
Format:	Journal Article
Language:	English
Published:	New York, NY Am Thoracic Soc 15-02-2009 American Thoracic Society
Subjects:	Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Blood. Blood coagulation. Reticuloendothelial system Body Mass Index Clinical practice guidelines Counseling Counseling - methods Diabetes Diet, Reducing - methods Female Follow-Up Studies Hospitals Humans Intensive care medicine Life Style Lifestyles Male Medical sciences Metabolic syndrome Middle Aged Obesity Obesity - complications Obesity - diet therapy Odds Ratio Otolaryngology Overweight Pharmacology. Drug treatments Primary care Prospective Studies Public health Quality of Life Risk Factors Risk Reduction Behavior Severity of Illness Index Sleep apnea Sleep Apnea, Obstructive - etiology Sleep Apnea, Obstructive - prevention & control Sleep disorders Surveys and Questionnaires Treatment Outcome Weight control Weight Loss Finland obstructive sleep apnea Obesity Nervous system diseases Intensive care Sleep apnea syndrome Treatment Respiratory disease Nutrition disorder Weight loss Nutritional status Resuscitation lifestyle intervention
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Summary:	Obesity is the most important risk factor for obstructive sleep apnea (OSA). However, although included in clinical guidelines, no randomized controlled studies have been performed on the effects of weight reduction on mild OSA. The aim of this prospective, randomized controlled parallel-group 1-year follow-up study was to determine whether a very low calorie diet (VLCD) with supervised lifestyle counseling could be an effective treatment for adults with mild OSA. Seventy-two consecutive overweight patients (body mass index, 28-40) with mild OSA were recruited. The intervention group (n = 35) completed the VLCD program with supervised lifestyle modification, and the control group (n = 37) received routine lifestyle counseling. The apnea-hypopnea index (AHI) was the main objectively measured outcome variable. Change in symptoms and the 15D-Quality of Life tool were used as subjective measurements. The lifestyle intervention was found to effectively reduce body weight (-10.7 +/- 6.5 kg; body mass index, -3.5 +/- 2.1 [mean +/- SD]). There was a statistically significant difference in the mean change in AHI between the study groups (P = 0.017). The adjusted odds ratio for having mild OSA was markedly lowered (odds ratio, 0.24 [95% confidence interval, 0.08-0.72]; P = 0.011) in the intervention group. All common symptoms related to OSA, and some features of 15D-Quality of Life improved after the lifestyle intervention. Changes in AHI were strongly associated with changes in weight and waist circumference. VLCD combined with active lifestyle counseling resulting in marked weight reduction is a feasible and effective treatment for the majority of patients with mild OSA, and the achieved beneficial outcomes are maintained at 1-year follow-up.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23
ISSN:	1073-449X 1535-4970
DOI:	10.1164/rccm.200805-669OC