Effectiveness of an intensive weight-loss program for severe OSA in patients undergoing CPAP treatment: a randomized controlled trial

Abstract

Study Objectives: To determine whether an intensive weight-loss program (IWLP) is effective for reducing weight, the severity of obstructive sleep apnea (OSA), and metabolic variables in patients with obesity and severe OSA undergoing continuous positive airway pressure treatment. Methods: Forty-two patients were randomized to the control (CG, n = 20) or the intervention group (IG, n = 22), who followed a 12-month IWLP. The primary outcome was a reduction in the apnea-hypopnea index (AHI) as measured at 3 and 12 months by full polysomnography. Metabolic variables, blood pressure, body fat composition by bioimpedance, carotid intima media thickness, and visceral fat by computed tomography were also assessed. Results: Mean age was 49 (6.7) years, body mass index 35 (2.7) kg/m 2 , and AHI 69 (20) events/h. Weight reduction was higher for the IG than the CG at 3 and 12 months, −10.5 versus −2.3 kg (P <.001), and −8.2 versus −0.1 kg (P <.001), respectively, as was loss of visceral fat at 12 months. AHI decreased more in the IG at 3 months (−23.72 versus −9 events/h) but the difference was not significant at 12 months, though 28% of patients from the IG had an AHI < 30 events/h compared to none in the CG (P =.046). At 12 months, the IG showed a reduction in C-reactive protein (P =.013), glycated hemoglobin (P =.031) and an increase in high density lipoprotein cholesterol (P = .027). Conclusions: An IWLP in patients with obesity and severe OSA is effective for reducing weight and OSA severity. It also results in an improvement in lipid profiles, glycemic control, and inflammatory markers.

Weight reduction added to CPAP decreases blood pressure and triglyceride level in OSA: Systematic review and meta‐analysis

“…The studies applying continuous long‐term caloric restriction were the most efficient in decreasing both TG and LDL levels (favoring the combination therapy over CPAP alone) 28,33 . Controversial changes were reported for HDL 27–29 . Overall, our analysis suggest that the addition of WL to CPAP could decrease the risk of atherogenesis further via improving lipid parameters.…”

“…Eight randomized controlled studies representing 2627 patients met the criteria for inclusion and provided data for our meta‐analyses. Three studies compared the combination therapy with CPAP, 27 , 28 , 29 three with WL, 30 , 31 , 32 and two studies compared the combination therapy with both CPAP and WL. 33 , 34 These two latter studies reported data of overlapping populations, therefore, we refrained from using both of them in the same analysis to avoid over‐representation of any population.…”

Review of the Management of Obstructive Sleep Apnea and Pharmacological Symptom Management

“…In 2019, a randomized controlled trial was conducted to analyze the effectiveness of an intensive weight-loss regimen and its effect on decreasing OSA severity in patients with severe OSA. They concluded that weight loss decreased OSA symptom severity and, additionally, these patients saw decreased cholesterol, biomarkers of inflammation, and blood glucose [42]. Positional therapy, where OSA patients sleep in a position other than on their back, has been found to be useful in preventing airway collapse.…”

Obstructive Sleep Apnea in Adults: What Primary Care Physicians Need to Know

“…The study concluded that through an intensive weight loss program, patients with obesity and severe OSA benefited from reduced weight and OSA severity. Secondary outcomes included improvements in lipid profiles, glycemic control, and inflammatory markers [ 41 ]. Another adjunct therapy to OSA is positional therapy.…”