Change in weight and central obesity by positive airway pressure treatment in obstructive sleep apnea patients: longitudinal data from the ESADA cohort

Abstract

The effect of positive airway pressure treatment on weight and markers of central obesity in patients with obstructive sleep apnea remains unclear. We studied the change in body weight and anthropometric measures following positive airway pressure treatment in a large clinical cohort. Patients with obstructive sleep apnea with positive airway pressure treatment from the European Sleep Apnea Database registry (n = 1,415, 77% male, age 54 ± 11 [mean ± SD] years, body mass index 31.7 ± 6.4 kg/m , apnea-hypopnea index 37 ± 24 n per hr, Epworth Sleepiness Scale 10.2 ± 5.0) were selected. Changes in body mass index and neck/waist/hip circumferences at baseline and at follow-up visit were analysed. Overall, body mass index (0.0 [95% confidence interval, -0.1 to 0.2] kg/m ) and neck circumference (0.0 (95% confidence interval, -0.1 to 0.1] cm) were unchanged after positive airway pressure treatment compared with baseline (follow-up duration 1.1 ± 1.0 years and compliance 5.2 ± 2.1 hr per day). However, in non-obese (body mass index <30 kg/m ) patients, positive airway pressure treatment was associated with an increased body mass index and waist circumference (0.4 [0.3-0.5] kg/m and 0.8 [0.4-1.2] cm, respectively, all p < 0.05), and weight gain was significantly associated with higher positive airway pressure compliance and longer positive airway pressure treatment duration. In the obese subgroup, body mass index was reduced after positive airway pressure treatment (-0.3 [-0.5 to -0.1] kg/m , p < 0.05) mainly in patients with a strong reduction in Epworth Sleepiness Scale. In conclusion, positive airway pressure therapy was not found to systematically change body mass index in the European Sleep Apnea Database cohort, but the response was heterogeneous. Our findings suggest that weight gain may be restricted to an obstructive sleep apnea phenotype without established obesity. Lifestyle intervention needs to be considered in both lean and obese patients with obstructive sleep apnea receiving positive airway pressure treatment.

Adipose tissue as a key player in obstructive sleep apnoea

“…In the European Sleep Apnea Database cohort, CPAP response was heterogeneous and CPAP usage was not found to systematically change BMI. Weight gain and increases in waist circumference were restricted to an OSA phenotype without established obesity [81]. As recently supported by American Thoracic Society consensus guidelines, these data together suggest that additional therapies for body weight reduction must be recommended for overweight or obese patients with OSA initiated on CPAP [82].…”

Long-Term Effects of Continuous Positive Airway Pressure (CPAP) Therapy on Obesity and Cardiovascular Comorbidities in Patients with Obstructive Sleep Apnea and Resistant Hypertension—An Observational Study

“…Positive airway pressure therapy was not found to systematically change BMI in the European Sleep Apnea Database cohort (n = 1415, 77% male, mean age 54 ± 1 years, BMI 31.7 ± 6.4 kg/m 2 , apnea-hypopnea index 37 ± 24 n/h, Epworth Sleepiness Scale (ESS) 10.2 ± 5.0), but the response was heterogeneous. In the obese subgroup, BMI was reduced after positive airway pressure treatment (−0.3 [−0.5 to −0.1] kg/m 2 , p < 0.05) mainly in patients with a strong reduction in ESS [25].…”

Positive airway pressure (PAP) treatment reduces glycated hemoglobin (HbA1c) levels in obstructive sleep apnea patients with concomitant weight loss: Longitudinal data from the ESADA

“…It is possible that healthcare providers might have addressed important lifestyle changes, diet, physical activity or specific medical therapy for weight reduction particularly well in the obese OSA patients. Indeed, weight reduction at follow‐up in our study cohort was more common and pronounced in the obese and morbidly obese OSA patients (Basoglu et al., 2018).…”