Effect of an Interdisciplinary Weight Loss and Lifestyle Intervention on Obstructive Sleep Apnea Severity

Abstract

IMPORTANCEObesity is the leading cause of obstructive sleep apnea (OSA); however, the effects of weight loss and lifestyle interventions on OSA and comorbidities remain uncertain. OBJECTIVE To evaluate the effect of an interdisciplinary weight loss and lifestyle intervention on OSA and comorbidities among adults with moderate to severe OSA and overweight or obesity. DESIGN, SETTING, AND PARTICIPANTS The Interdisciplinary Weight Loss and Lifestyle Intervention for OSA (INTERAPNEA) study was a parallel-group open-label randomized clinical trial conducted at a hospital-based referral center in Granada, Spain, from April 1, 2019, to October 23, 2020. The study enrolled 89 Spanish men aged 18 to 65 years with moderate to severe OSA and a body mass index (calculated as weight in kilograms divided by height in meters squared) of 25 or greater who were receiving continuous positive airway pressure (CPAP) therapy. The sole inclusion of men was based on the higher incidence and prevalence of OSA in this population, the differences in OSA phenotypes between men and women, and the known effectiveness of weight loss interventions among men vs women. INTERVENTIONS Participants were randomized to receive usual care (CPAP therapy) or an 8-week weight loss and lifestyle intervention involving nutritional behavior change, aerobic exercise, sleep hygiene, and alcohol and tobacco cessation combined with usual care. MAIN OUTCOMES AND MEASURES The primary end point was the change in the apnea-hypopnea index (AHI) from baseline to the intervention end point (8 weeks) and 6 months after intervention. Secondary end points comprised changes in other OSA sleep-related outcomes, body weight and composition, cardiometabolic risk, and health-related quality of life. RESULTS Among 89 men (mean [SD] age, 54.1 [8.0] years; all of Spanish ethnicity; mean [SD] AHI, 41.3 [22.2] events/h), 49 were randomized to the control group and 40 were randomized to the intervention group. The intervention group had a greater decrease in AHI (51% reduction; change, -21.2 events/h; 95% CI, -25.4 to -16.9 events/h) than the control group (change, 2.5 events/h; 95% CI, -2.0 to 6.9 events/h) at the intervention end point, with a mean between-group difference of -23.6 events/h (95% CI, -28.7 to -18.5 events/h). At 6 months after intervention, the reduction in AHI was 57% in the intervention group, with a mean between-group difference of -23.8 events/h (95% CI, -28.3 to -19.3 events/h). In the intervention group, 18 of 40 participants (45.0%) no longer required CPAP therapy at the intervention end point, and 6 of 40 participants (15.0%) attained complete OSA remission. At 6 months after intervention, 21 of 34 participants (61.8%) no longer required CPAP therapy, and complete remission of OSA was attained by 10 of 34 participants (continued) Key Points Question Is an interdisciplinary weight loss and lifestyle intervention combined with usual care (continuous positive airway pressure [CPAP] therapy) effective for the treatment of moderate to severe obstructive sleep ...

The Case for Early Use of Glucagon-like Peptide-1 Receptor Agonists in Obstructive Sleep Apnea Patients with Comorbid Diabetes and Metabolic Syndrome

“…Fortunately, pharmacological interventions such as glucagon-like peptide-1 receptor agonists (GLP-1RA) that treat the obesity-diabetes-OSA triad can make substantial inroads in reversing the trends in morbidity and cost associated with obesity-related illnesses. Indeed, recent studies showed that weight loss via lifestyle modifications and pharmacotherapy can lead to resolution of OSA [ 34 , 35 ]. For example, a randomized controlled trial (RCT) intervention of lifestyle and other interventions that led to weight loss was associated with discontinuation of continuous positive airway pressure therapy in 62% of OSA patients at the 6-month follow-up [ 34 , 36 ].…”

“…Indeed, recent studies showed that weight loss via lifestyle modifications and pharmacotherapy can lead to resolution of OSA [ 34 , 35 ]. For example, a randomized controlled trial (RCT) intervention of lifestyle and other interventions that led to weight loss was associated with discontinuation of continuous positive airway pressure therapy in 62% of OSA patients at the 6-month follow-up [ 34 , 36 ].…”

Effect of a Weight Loss and Lifestyle Intervention on Dietary Behavior in Men with Obstructive Sleep Apnea: The INTERAPNEA Trial

“…Potential participants were men aged 18-65 years with CPAP-treated moderate-to-severe OSA (i.e., AHI equal or greater than 15 events per hour of sleep) and a body mass index (BMI) equal to or greater than 25 kg/m 2 . The sole inclusion of men in our sample was not only based on the higher incidence and prevalence of OSA in this population [1], but also on the well-evidenced differences between men and women in OSA phenotypes [38] and the effectiveness of weight loss interventions [20,37,[39][40][41]. Exclusion criteria included present participation in a weight loss program, presence of any psychological/psychiatric disorder, and/or any other primary sleep disorder which was not secondary to OSA.…”

“…This study included two groups: a usual-care/control group, which received CPAP as the standard care of OSA, and a weight loss and lifestyle intervention group, which received an eight-week interdisciplinary intervention, including nutritional behavior change, aerobic exercise, sleep hygiene, and alcohol and tobacco cessation, combined with usual-care. Changes in OSA severity and body weight at 6 months after intervention indicated that participants in the intervention group reduced a significantly greater amount of their initial AHI and body weight (57% and 7%, respectively) than those in the usual-care/control group (2% and 1%) [20]. INTERAPNEA provides an opportunity to examine the effects of a behavior-induced weight loss intervention on dietary behavior and diet quality in men with moderate-to-severe OSA who received, among other intervention components, nutritional education and behavior change.…”

“…Given the complex and reciprocal interaction between OSA and obesity [16], weight loss and lifestyle interventions, including dietary change and exercise, are strongly recommended [17,18] and appears to significantly improve OSA severity, cardiometabolic comorbidities, and, thus, health-related quality of life [19][20][21][22][23][24]. However, most previous studies in this regard only include calorie-restricted diets [25], which may not be the most efficient approach for long-lasting and sustainable dietary behavior change [26,27].…”