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Published ahead of print on November 14, 2008, doi:10.1164/rccm.200805-669OC

Am. J. Respir. Crit. Care Med., Volume 179, Number 4, February 2009, 320-327

A more recent version of this article appeared on February 15, 2009
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Submitted on May 2, 2008
Accepted on November 13, 2008

Lifestyle Intervention with Weight Reduction-First Line Treatment in Mild Obstructive Sleep Apnea

Henri PI Tuomilehto1*, Juha M Seppa2, Markku M Partinen3, Markku Peltonen4, Helena Gylling5, Jaakko OI Tuomilehto6, Esko J Vanninen7, Jouko Kokkarinen8, Johanna K Sahlman1, Tarja Martikainen5, Erkki JO Soini9, Jukka Randell8, Hannu Tukiainen8, and Matti Uusitupa10

1 Department of Otorhinolaryngology, Institute of Clinical Medicine, Kuopio University Hospital, and University of Kuopio, Kuopio, Finland, 2 Department of Otorhinolaryngology, Institute of Clinical Medicine, Kuopio University Hospital, and University of Kuopio, Kuopio , Finland, 3 Department of Neurology, Skogby Sleep Clinic, Rinnekoti Research Center, Espoo, University of Helsinki, Helsinki, Finland, 4 Department of Health Promotion and Chronic Diseases Prevention, National Public Health Institute, Helsinki, Finland, 5 School of Public Health and Clinical Nutrition, University of Kuopio, and Kuopio University Hospital, Kuopio, Finland, 6 Department of Public Health, University of Helsinki, Helsinki, Finland, 7 Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, and University of Kuopio, Institute of Clinical Medicine, Kuopio, Finland, 8 Respiratory Medicine, Institute of Clinical Medicine, Kuopio University Hospital, and University of Kuopio, Kuopio, Finland, 9 Department of Social Pharmacy, Center for Pharmaceutical Policy and Economics, University of Kuopio, Kuopio, Finland, 10 School of Public Health and Clinical Nutrition, University of Kuopio, Kuopio, Finland

* To whom correspondence should be addressed. 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 carried out on the effects of weight reduction upon 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 (BMI 28-40) with mild OSA were recruited. The intervention group (N=35) completed 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. Changes in symptoms and 15D-Quality of Life (QoL) 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, BMI -3.5±2.1 mean±SD), and there was a statistically significant difference in the mean change of AHI between the study groups (P=0.017). The adjusted odds ratio for having mild OSA was markedly lowered [OR 0.24 (95% CI 0.08-0.72, P=0.011)] in the intervention group. All common symptoms related to OSA, and some features of QoL improved after the lifestyle intervention. Changes in AHI were strongly associated with changes in weight and waist circumference. Conclusions: VLCD and 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. Clinical trial registered at www.clinicaltrials.gov, ID: NCT00486746
Key words: obstructive sleep apnea • obesity • lifestyle intervention • weight reduction




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