The effect of sibutramine-assisted weight loss in men with obstructive sleep apnoea

Abstract

Objective: Obstructive sleep apnoea (OSA) occurs frequently in obese patients and may be reversible with weight loss. Obstructive sleep apnoea and obesity are both independent risk factors for hypertension and increased sympathetic activity. Sibutramine has been increasingly used in the management of obesity, but is relatively contraindicated in patients with hypertension. No studies have investigated the effect of sibutramine on OSA, blood pressure and heart rate. We aimed to assess the changes in OSA and cardiovascular parameters in obese men with OSA enrolled in a sibutramine-assisted weight loss programme (SIB-WL). Design: Open uncontrolled cohort study of obese male subjects with OSA in an SIB-WL. Subjects: Eighty-seven obese (body mass index ¼ 34.272.8 kg/m 2 ) middle-aged (46.379.3 years) male subjects with symptomatic OSA (Epworth score 13.473.6; respiratory disturbance index (RDI) 46.0723.1 events/h) completed the study. Results: At 6 months, there was significant weight loss (8.374.7 kg, Po0.0001), as well as a reduction in waist and neck circumference and sagittal height (all Po0.0001). These changes were accompanied by a reduction in OSA severity (RDI fell by 16.3719.4 events/h and Epworth score by 4.574.6), both Po0.0001). There was no significant change to systolic (P ¼ 0.07) or diastolic blood pressure (P ¼ 0.87); however, there was a mild rise in resting heart rate (Po0.0001). Conclusion: Moderate (B10%) weight loss with SIB-WL results in improvement in OSA severity without increase in blood pressure in closely monitored OSA subjects.

Slow wave sleep in patients with respiratory failure

“…8 For instance in 93 of our severe OSA patients (average 46 years), mean SWS was 11%. 9 In contrast, in our department, increased SWS% has frequently been observed clinically in patients with hypercapnic respiratory failure. This phenomenon is not easily explained by current understanding of factors affecting sleep architecture in sleep-breathing disorders.…”

The use of sibutramine in the management of obesity and related disorders: An update

“…97,98 In an uncontrolled study in 87 obese patients, sibutramine (10 mg/day for six months) reduced body weight and improved markers of obstructive sleep apnea severity (respiratory disturbance index and Epworth score). 99 There was a significant correlation between weight loss and the improvement in obstructive sleep apnea markers. 99 In a smaller, shorter-term, placebocontrolled study (20 patients with obstructive sleep apnea given sibutramine 15 mg/day for one month) sibutramine had no effect on polysomnographic variables (sleep efficiency and apnea-hypopnea index).…”

“…99 There was a significant correlation between weight loss and the improvement in obstructive sleep apnea markers. 99 In a smaller, shorter-term, placebocontrolled study (20 patients with obstructive sleep apnea given sibutramine 15 mg/day for one month) sibutramine had no effect on polysomnographic variables (sleep efficiency and apnea-hypopnea index). 100 However, no change in body weight was observed in this study.…”

Non-positive airway pressure therapy for obstructive sleep apnea

“…In a large population-based prospective cohort study of 690 persons, a 10% weight loss was correlated with a 26% decrease in AHI, showing that even minimal weight loss can be beneficial in patients with OSA [54]. Although weight loss reduces OSA severity, it does not necessarily resolve the disease and there is substantial individual variability in the impact of weight loss on OSA [44,55]. Some studies showed improvement in sleep-disordered breathing after weight loss but no cure of the disorder.…”

“…The magnitude of the decrease in AHI after weight loss was higher in patients with the most severe OSA. Current data show that weight reduction not only improves breathing pattern but also increases REM and deep sleep (up to 10% and 17%, respectively) as well as the AHI [43][44][45][46][47][48][49][50][51][52][53]. In a large population-based prospective cohort study of 690 persons, a 10% weight loss was correlated with a 26% decrease in AHI, showing that even minimal weight loss can be beneficial in patients with OSA [54].…”