The Role of Weight Management in the Treatment of Adult Obstructive Sleep Apnea. An Official American Thoracic Society Clinical Practice Guideline

Hudgel, David W.; Patel, Sanjay R.; Ahasic, Amy M.; Bartlett, Susan J.; Bessesen, Daniel H.; Coaker, Melisa A.; Fiander, Michelle; Grunstein, Ron; Gurubhagavatula, Indira; Kapur, Vishesh K.; Lettieri, Christopher J.; Naughton, Matthew T.; Owens, Robert L.; Pépin, Jean-Louis; Tuomilehto, Henri; Wilson, Kevin C.

doi:10.1164/rccm.201807-1326st

Cited by 174 publications

(109 citation statements)

References 134 publications

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“…Maxillomandibular osteotomy and upper airway stimulation seem to be as efficient as CPAP in selected young patients with OSA without comorbidities. Finally, lifestyle interventions, including weight loss (25), exercise (26), and/or positional therapy (27) can be considered as able to at least reduce OSA severity.…”

Section: Discussionmentioning

confidence: 99%

Pitolisant for Daytime Sleepiness in Patients with Obstructive Sleep Apnea Who Refuse Continuous Positive Airway Pressure Treatment. A Randomized Trial

Dauvilliers

Verbraecken

Partinen

et al. 2020

Am J Respir Crit Care Med

248

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Rationale: Excessive daytime sleepiness is a common disabling symptom in obstructive sleep apnea syndrome. Objectives: To evaluate the efficacy and safety of pitolisant, a selective histamine H3 receptor antagonist with wake-promoting effects, for the treatment of daytime sleepiness in patients with moderate to severe obstructive sleep apnea refusing continuous positive airway pressure treatment. Methods: In an international, multicenter, double-blind, randomized (3:1), placebo-controlled, parallel-design trial, pitolisant was individually titrated at up to 20 mg/d over 12 weeks. The primary endpoint was the change in the Epworth Sleepiness Scale score. Key secondary endpoints were maintenance of wakefulness assessed on the basis of the Oxford Sleep Resistance test, safety, Clinical Global Impression of severity, patient's global opinion, EuroQol quality-oflife questionnaire, and Pichot fatigue questionnaire. Measurements and Main Results: A total of 268 patients with obstructive sleep apnea (75% male; mean age, 52 yr; apnea-hypopnea index, 49/h; baseline sleepiness score, 15.7) were randomized (200 to pitolisant and 68 to placebo) and analyzed on an intention-totreat basis. The Epworth Sleepiness Scale score was reduced more with pitolisant than with placebo (22.8; 95% confidence interval, 24.0 to 21.5; P , 0.001). Wake maintenance tests were not improved. The Pichot fatigue score was reduced with pitolisant. The overall impact of pitolisant was confirmed by both physicians' and patients' questionnaires. Adverse event incidence, mainly headache, insomnia, nausea, and vertigo, was similar in the pitolisant and placebo groups (29.5% and 25.4%, respectively), with no cardiovascular or other significant safety concerns. Conclusions: Pitolisant significantly reduced self-reported daytime sleepiness and fatigue and improved patient-reported outcomes and physician disease severity assessment in sleepy patients with obstructive sleep apnea refusing or nonadherent to continuous positive airway pressure. Clinical trial registered with www.clinicaltrials.gov (NCT01072968) and EU Clinical Trials Register (EudraCT 2009-017251-94).

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Section: Discussionmentioning

confidence: 99%

Pitolisant for Daytime Sleepiness in Patients with Obstructive Sleep Apnea Who Refuse Continuous Positive Airway Pressure Treatment. A Randomized Trial

Dauvilliers

Verbraecken

Partinen

et al. 2020

Am J Respir Crit Care Med

248

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“…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]. Moreover, weight loss plus CPAP have synergistic effects on weight and metabolic parameters compared with each intervention alone [83].…”

Section: Impact Of Cpap Treatment On Adipose Tissue and Ectopic Fatmentioning

confidence: 70%

“…Beside bariatric surgery or pharmacological intervention to facilitate weight loss, a further unexplored strategy is physical exercise, which has been demonstrated to lead to adaptive changes of WAT associated with improvement in metabolic health [96]. Only a small number of studies have investigated this treatment approach in OSA demonstrating a minor improvement in quality of life with inconsistent decreases in OSA severity and weight [82,97]. However, we are lacking long-term RCTs on this subject and specifically, data on metabolic outcomes.…”

Section: Current Limitations and Future Directivesmentioning

confidence: 99%

Adipose tissue as a key player in obstructive sleep apnoea

et al. 2019

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Obstructive sleep apnoea (OSA) is a major health concern worldwide and adversely affects multiple organs and systems. OSA is associated with obesity in >60% of cases and is independently linked with the development of numerous comorbidities including hypertension, arrhythmia, stroke, coronary heart disease and metabolic dysfunction. The complex interaction between these conditions has a significant impact on patient care and mortality. The pathophysiology of cardiometabolic complications in OSA is still incompletely understood; however, the particular form of intermittent hypoxia (IH) observed in OSA, with repetitive short cycles of desaturation and re-oxygenation, probably plays a pivotal role. There is fast growing evidence that IH mediates some of its detrimental effects through adipose tissue inflammation and dysfunction. This article aims to summarise the effects of IH on adipose tissue in experimental models in a comprehensive way. Data from well-designed controlled trials are also reported with the final goal of proposing new avenues for improving phenotyping and personalised care in OSA.

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“…The choice of surgical procedure should be based on weighing potential risks of surgery against the maximum possible anticipated weight loss. OSA may persist despite the resolution of OHS after weight reduction surgery (119).…”

Section: American Thoracic Society Documentsmentioning

confidence: 99%

Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline

Mokhlesi¹,

Masa²,

Brožek³

et al. 2019

Am J Respir Crit Care Med

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196

146

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; on behalf of the American Thoracic Society Assembly on Sleep and Respiratory Neurobiology THIS OFFICIAL CLINICAL PRACTICE GUIDELINE OF THE AMERICAN THORACIC SOCIETY WAS APPROVED MAY 2019 Background: The purpose of this guideline is to optimize evaluation and management of patients with obesity hypoventilation syndrome (OHS). Methods: A multidisciplinary panel identified and prioritized five clinical questions. The panel performed systematic reviews of available studies (up to July 2018) and followed the Grading of Recommendations, Assessment, Development, and Evaluation evidence-to-decision framework to develop recommendations. All panel members discussed and approved the recommendations. Recommendations: After considering the overall very low quality of the evidence, the panel made five conditional recommendations. We suggest that: 1) clinicians use a serum bicarbonate level ,27 mmol/L to exclude the diagnosis of OHS in obese patients with sleepdisordered breathing when suspicion for OHS is not very high (,20%) but to measure arterial blood gases in patients strongly suspected of having OHS, 2) stable ambulatory patients with OHS receive positive airway pressure (PAP), 3) continuous positive airway pressure (CPAP) rather than noninvasive ventilation be offered as the first-line treatment to stable ambulatory patients with OHS and coexistent severe obstructive sleep apnea, 4) patients hospitalized with respiratory failure and suspected of having OHS be discharged with noninvasive ventilation until they undergo outpatient diagnostic procedures and PAP titration in the sleep laboratory (ideally within 2-3 mo), and 5) patients with OHS use weight-loss interventions that produce sustained weight loss of 25% to 30% of body weight to achieve resolution of OHS (which is more likely to be obtained with bariatric surgery). Conclusions: Clinicians may use these recommendations, on the basis of the best available evidence, to guide management and improve outcomes among patients with OHS.

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The Role of Weight Management in the Treatment of Adult Obstructive Sleep Apnea. An Official American Thoracic Society Clinical Practice Guideline

Cited by 174 publications

References 134 publications

Pitolisant for Daytime Sleepiness in Patients with Obstructive Sleep Apnea Who Refuse Continuous Positive Airway Pressure Treatment. A Randomized Trial

Pitolisant for Daytime Sleepiness in Patients with Obstructive Sleep Apnea Who Refuse Continuous Positive Airway Pressure Treatment. A Randomized Trial

Adipose tissue as a key player in obstructive sleep apnoea

Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline

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