Does intentional weight loss improve daytime sleepiness? A systematic review and meta‐analysis

Abstract

Obesity is associated with excessive daytime sleepiness, but its causality remains unclear. We aimed to assess the extent to which intentional weight loss affects daytime sleepiness. Electronic databases were searched through 24 October 2016. Studies involving overweight or obese adults, a weight loss intervention and repeated valid measures of daytime sleepiness were included in the review. Two independent reviewers extracted data on study characteristics, main outcome (change in daytime sleepiness score standardized by standard deviation of baseline sleepiness scores), potential mediators (e.g. amount of weight loss and change in apnoea-hypopnoea index) and other co-factors (e.g. baseline demographics). Forty-two studies were included in the review. Fifteen before-and-after studies on surgical weight loss interventions showed large improvements in daytime sleepiness, with a standardized effect size of -0.97 (95% confidence interval [CI] -1.21 to -0.72). Twenty-seven studies on non-surgical weight loss interventions showed small-to-moderate improvement in daytime sleepiness, with a standardized effect size of -0.40 (95%CI -0.52 to -0.27), with no difference between controlled and before-and-after studies. We found a nonlinear association between amount of weight loss and change in daytime sleepiness. This review suggests that weight loss interventions improve daytime sleepiness, with a clear dose-response relationship. This supports the previously hypothesized causal effect of obesity on daytime sleepiness. It is important to assess and manage daytime sleepiness in obese patients.

Effects of Exercise Domain and Intensity on Sleep in Women and Men with Overweight and Obesity

“…Furthermore, decreased sleepiness was associated with reductions in android fat after 3 and 6 months. The latter observations are in line with previous studies reporting associations between improvements in sleepiness and reductions in weight and WC during weight loss interventions [39]. Participants who felt less sleepy in response to the intervention could very likely be more physically active and spend less time on sedentary activities that are also associated with consumption of energy-dense snacks and beverages [40].…”

Weight loss and lifestyle interventions for obstructive sleep apnoea in adults: Systematic review and meta‐analysis

“…The reductions of these parameters, although may not imply full remission of OSA, are still clinically relevant. These enhancements have also been found in previous meta‐analyses where primary OSA outcomes were reduced through dietary weight loss and exercise‐training . These latter interventions may not only involve weight loss but also, in turn, a reduction of high levels of leptin; a hormone linked to inhibitory effects on respiratory centre modulation as well as to energy homeostasis .…”

“…These enhancements have also been found in previous meta-analyses where primary OSA outcomes were reduced through dietary weight loss and exercise-training. [19][20][21][22][23][24] These latter interventions may not only involve weight loss but also, in turn, a reduction of high levels of leptin; a hormone linked to inhibitory effects on respiratory centre modulation as well as to energy homeostasis. 80 Thus, weight loss through diet and exercise-training may lead to enhancements of the upper airway structure and function, resting lung volume and, through reductions of leptin levels, respiratory modulation, and balancing of energy intake and expenditure.…”

“…Previous systematic reviews and meta‐analyses about the effects of these interventions on OSA have been conducted, concluding that weight loss is effective in reducing primary OSA outcomes (AHI; oxygen desaturation index, ODI; and EDS). However, there were a reduced number of studies included in these meta‐analyses, so the standardization of results was not feasible.…”

“…1,18 Such interventions may include weight loss through hypocaloric diet and moderate exercise, smoking and alcohol avoidance, and sleep hygiene. 1,18 Previous systematic reviews and meta-analyses about the effects of these interventions on OSA have been conducted, 15,[19][20][21][22][23][24] concluding that weight loss is effective in reducing primary OSA outcomes (AHI; oxygen desaturation index, ODI; and EDS). However, there were a reduced number of studies included in these meta-analyses, so the standardization of results was not feasible.…”