1. A randomized controlled trial of moderate to severe overweight in men with obstructive sleep apnea treated with continuous positive airway pressure (CPAP) has led to an interdisciplinary weight loss and lifestyle change regime. It showed the subsequent improvement in clinical symptoms.
Level of evidence assessment: 1 (excellent)
Survey summary: Survey Obstructive sleep apnea (OSA) is a sleep disorder caused by overnight respiratory dysfunction, with intermittent airway disruptions resulting in periods of apnea and poor sleep quality. The main cause of this condition is obesity. Continuous positive airway pressure (CPAP) machines are common and very effective in managing OSA, but they can be resource-intensive, cumbersome for patients, and inadequate treatment compliance. This study by Carneiro-Barrera et al sought to evaluate the effectiveness of interdisciplinary weight loss and lifestyle interventions in patients with CPAP-dependent OSA with moderate to severe obesity. A total of 89 men were enrolled in the study, 49 participants were randomized to the control group, and 40 were randomized to the intervention group. The average age of the participants was 54.1 years. All were Spanish. The baseline socio-demographic factors were balanced between the two groups. The main result was a decrease in the number of apnea events per sleep, as measured by the Apnea Hypopnea Index (AHI). Participants in the intervention group experienced a mean decrease in AHI from 41.6 events / hour at baseline to 20.4 / hour after 8 weeks and to 17.8 / hour at 6 months. Participants in the control group did not experience any significant changes in AHI over time. At the end of the intervention period, 57.5% of patients in the intervention group improved their OSA score in at least one category (ie, severe to moderate or moderate to mild), and 15.0% experienced complete remission. Improvements in cardiac metabolism risk factors (ie, oxyhemoglobin desaturation index) were stable after the intervention period. This randomized controlled trial by Carneiro-Barrera et al. Reduces the severity of obstructive sleep apnea in patients who are overweight and have moderate to severe OSA at baseline, resulting in weight loss and health. Clearly demonstrated the benefits of lifestyle changes. Although it is well established in the literature that obesity is a major risk factor for OSA, this evidence further reinforces and achieves how effective weight loss is in controlling OSA symptoms. Establish a viable and sustainable system. The main limitation of this study is that the findings apply only to men. Further research is needed to consider women with OSA. In addition, little detail was given about the nature of the intervention, making it difficult to broadly reproduce weight loss interventions and ensure access to personal care for the general population. The strengths of this study include rigorous methodologies and thorough analysis (that is, some measured biological parameters indicate the success of long-term intervention). Weight loss and healthy lifestyle interventions should be encouraged among overweight people who are experiencing OSA.
Click here to read this survey at JAMA Network Open
Related reading: Does obstructive sleep apnea and sleep improve in response to interdisciplinary weight loss interventions in obese adolescents?Systematic review and meta-analysis
detail [randomized, controlled trial]: To assess this clinical problem, several hospitals in Spain conducted a parallel, open-label, randomized controlled trial named INTERAPNEA. Eligible patients were men aged 18-65 years with moderate to severe OSA treated with CPAP (defined as more than 15 apnea events per night) and an obesity index of 25 or higher. Randomized between April 2019 and January 2020 at the Sleep and Breathing Clinic. All patients completed baseline history and physical examination and were then randomized to a control or intervention group. The intervention consisted of an eight-week interdisciplinary weight loss and lifestyle change program. The five “modules” of this program were changes in nutritional behavior, moderate aerobic exercise, smoking cessation, avoidance of alcohol intake, and sleep hygiene. The program was conducted through weekly group classes by trainers and interventions were assessed for feasibility outside the study environment. Polysomnography was performed at baseline, at the end of the 8-week intervention period, and 6 months later. Fourteen participants were not available for 6-month follow-up data collection and were evaluated with the intent of dealing with analytics. The remaining participants were analyzed by protocol. The mean change in AHI score over time in the intervention group was 51%, or -21.2 events / hour at 8 weeks (95% confidence interval 25.4 to –16.9 events / hour) and –23.8 events / hour from baseline at 6 months. It was (–28.3 ~ –19.3 events / hour). Mean changes in AHI among control group participants were 2.5 events / hour (–2.0 to 6.9 events / hour) and –0.8 events / hour (–5.8 to 4.1 events / hour) over 8 weeks. The mean weight loss was 7.1 kg (95% confidence interval -8.6 to -5.5 kg) in the intervention group after 8 weeks of treatment, compared to -0.3 kg (-1.9 to 1.4 kg) in the control group. Health-related quality of life was also significantly improved in the intervention group, as seen in the sleep apnea quality of life index. Mean changes over 8 weeks were 0.8 points (95% confidence interval 0.5-1.1) and 0.1 (-0.3 to 0.4) points between the intervention groups. No significant changes in health-related quality of life were observed between the controls at 8 weeks or 6 months.
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