Obstructive sleep apnoea and 12-month weight loss in adults with class 3 obesity attending a multidisciplinary weight management program

Abstract

Background Although there is a strong association between obesity and obstructive sleep apnoea (OSA), the effects of OSA and CPAP therapy on weight loss are less well known. The aim of this study in adults with class 3 obesity attending a multidisciplinary weight management program was to assess the relationship between OSA and CPAP usage, and 12-month weight change. Methods A retrospective cohort study of all patients commencing an intensive multidisciplinary publicly funded weight management program in Sydney, Australia, between March 2018 and March 2019. OSA was diagnosed using laboratory overnight sleep studies. Demographic and clinical data, and use of CPAP therapy was collected at baseline and 12 months. CPAP use was confirmed if used ≥4 h on average per night on download. Results Of the 178 patients who joined the program, 111 (62.4 %) completed 12 months in the program. At baseline, 63.1 % (n=70) of patients had OSA, of whom 54.3 % (n=38) were using CPAP. The non-OSA group had more females compared to the OSA with CPAP group and OSA without CPAP group (90.2 % vs. 57.9 % and 62.5 %, respectively; p=0.003), but there were no significant baseline differences in BMI (50.4±9.3 vs. 52.1±8.7 and 50.3±9.5 kg/m2, respectively; p=0.636). There was significant weight loss across all three groups at 12 months. However, there were no statistically significant differences across groups in the percentage of body weight loss (OSA with CPAP: 6.3±5.6 %, OSA without CPAP: 6.8±6.9 %, non-OSA: 7.2±6.5 %; p=0.844), or the proportion of patients who achieved ≥5 % body weight loss (OSA with CPAP: 57.9 %, OSA without CPAP: 59.4 %, non-OSA: 65.9 %; p=0.743). In patients with T2DM, there was a significant reduction in HbA1c from baseline to 12 months (7.8±1.7 % to 7.3±1.4 %, p=0.03), with no difference between groups (p=0.997). Conclusions This multidisciplinary weight management program resulted in significant weight loss at 12 months, regardless of OSA diagnosis or CPAP use in adults with class 3 obesity. Larger studies are needed to further investigate the effects of severity of OSA status and CPAP use in weight management programs. Until completed, this study suggests that the focus should remain on implementing lifestyle changes and weight management regardless of OSA status.

Community‐based care needs for adults with class III obesity before and after tertiary weight management: An exploratory study

“…Our study addressed the widespread lack of research into the specific community‐based needs of individuals with severe obesity, and highlighted factors contributing to inadequacies within the current community‐based care model. While WMPs have been demonstrated to help patients attain a mean weight loss of around 6% at 12 months, weight regain is a major problem in this population 24–26 . Patients and clinicians in our study expressed concern for the lack of targeted support available once patients have left tertiary programs, identifying the loss of regular support from the clinic as a significant barrier to maintaining weight loss.…”

“…While WMPs have been demonstrated to help patients attain a mean weight loss of around 6% at 12 months, weight regain is a major problem in this population. [24][25][26] Patients and clinicians in our study expressed concern for the lack of targeted support available once patients have left tertiary programs, identifying the loss of regular support from the clinic as a significant barrier to maintaining weight loss. Weightstigma, co-morbid mental health conditions, and social isolation have been reported to hinder engagement with existing communitybased services and/or support groups.…”

Clinical Use of the Edmonton Obesity Staging System for the Assessment of Weight Management Outcomes in People with Class 3 Obesity

“…This may possibly result from the multidisciplinary nature of the program, which included on site supervised exercise classes, and the attention provided to manage physical and mental health co-morbidities in these patients with higher EOSS scores [ 28 ]. We have also demonstrated that the presence of obstructive sleep apnoea as well as use of CPAP did not affect weight outcomes at 12 months in this cohort [ 30 ], nor did the presence of T2DM at baseline affect weight loss at 6 months [ 31 ].…”

“…All patients were seen by a physician, dietitian and psychologist. The weight management program has been described in detail previously [ 28 , 29 , 30 , 31 ]. Dietary advice was personalised, which included but was not limited to advice for a 500 Kcal reduced diet, partial meal replacement and/or a low-calorie diet.…”

Application and Diagnostic Performance of Two-Dimensional Shear Wave Elastography and Liver Fibrosis Scores in Adults with Class 3 Obesity

“…This was a cross-sectional study conducted in a hospital-based, publicly funded, multidisciplinary weight management program in Sydney, Australia, as previously described [ 42 , 43 , 44 , 45 ]. The study participants were recruited between February 2021 and December 2022, and they included all newly enrolled patients in the program who attended at least one physician appointment.…”