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Lifestyle Intervention with Weight Reduction

First-line Treatment in Mild Obstructive Sleep Apnea

¹ Department of Otorhinolaryngology, Institute of Clinical Medicine, Kuopio University Hospital, and University of Kuopio; ² Skogby Sleep Clinic, Rinnekoti Research Center, Espoo, and Department of Neurology, University of Helsinki; ³ Department of Health Promotion and Chronic Diseases Prevention, National Public Health Institute, Helsinki; ⁴ School of Public Health and Clinical Nutrition, University of Kuopio, and Kuopio University Hospital; ⁵ Department of Public Health, University of Helsinki, Helsinki; ⁶ Institute of Clinical Medicine, Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, and University of Kuopio; ⁷ Institute of Clinical Medicine, Respiratory Medicine, Kuopio University Hospital, and University of Kuopio; ⁸ Center for Pharmaceutical Policy and Economics, Department of Social Pharmacy, University of Kuopio; and ⁹ School of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, Finland

Correspondence and requests for reprints should be addressed to Henri Tuomilehto, M.D., Ph.D., Department of Otorhinolaryngology, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio, Finland. E-mail: henri.tuomilehto{at}kuh.fi

Rationale: Obesity is the most important risk factor for obstructive sleep apnea (OSA). However, although included in clinical guidelines, no randomized controlled studies have been performed on the effects of weight reduction on mild OSA.

Objectives: The aim of this prospective, randomized controlled parallel-group 1-year follow-up study was to determine whether a very low calorie diet (VLCD) with supervised lifestyle counseling could be an effective treatment for adults with mild OSA.

Methods: Seventy-two consecutive overweight patients (body mass index, 28–40) with mild OSA were recruited. The intervention group (n = 35) completed the VLCD program with supervised lifestyle modification, and the control group (n = 37) received routine lifestyle counseling. The apnea–hypopnea index (AHI) was the main objectively measured outcome variable. Change in symptoms and the 15D-Quality of Life tool were used as subjective measurements.

Measurements and Main Results: The lifestyle intervention was found to effectively reduce body weight (–10.7 ± 6.5 kg; body mass index, –3.5 ± 2.1 [mean ± SD]). There was a statistically significant difference in the mean change in AHI between the study groups (P = 0.017). The adjusted odds ratio for having mild OSA was markedly lowered (odds ratio, 0.24 [95% confidence interval, 0.08–0.72]; P = 0.011) in the intervention group. All common symptoms related to OSA, and some features of 15D-Quality of Life improved after the lifestyle intervention. Changes in AHI were strongly associated with changes in weight and waist circumference.

Conclusions: VLCD combined with active lifestyle counseling resulting in marked weight reduction is a feasible and effective treatment for the majority of patients with mild OSA, and the achieved beneficial outcomes are maintained at 1-year follow-up.

Key Words: obstructive sleep apnea • obesity • lifestyle intervention • weight loss

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Obesity is the most important risk factor for obstructive sleep apnea (OSA), and both obesity and OSA are increasing public health burdens. However, although included in clinical guidelines, no randomized controlled studies have been carried out on the effects of weight reduction on mild OSA. What This Study Adds to the Field This study indicates that lifestyle intervention with early weight reduction is a feasible, low-cost, and curative treatment for the vast majority of patients with mild OSA. The treatment also results in an improvement of other obesity-related risk factors for cardiovascular diseases.

 

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