Effect of Mediterranean diet<i>versus</i>prudent diet combined with physical activity on OSAS: a randomised trial

Papandreou, Christopher; Schiza, Sophia; Bouloukaki, Izolde; Kafatos, Anthony; Siafakas, Nikolaos M.; Tzanakis, Νikolaos

doi:10.1183/09031936.00103411

Cited by 54 publications

(61 citation statements)

References 50 publications

(47 reference statements)

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“…Very low energy diets have been widely used according to a variety of protocols; however, there are only two diets that have been tested against each other specifically in OSA patients, the Mediterranean diet versus the prudent diet [77]. The AHI during rapid eye movement sleep was reduced in the Mediterranean diet group compared to the prudent diet.…”

Section: Osa and Liver Damagementioning

confidence: 99%

“…Recent evidence suggests that exercise training may be associated with a reduction in OSA severity [78,87,88,90] and, not surprisingly, improved exercise capacity [84,85,87,91]. Exercise alone may also improve OSA severity without significant weight loss [77,88,90]. More specifically, KLINE et al [91] tested the effects of aerobic exercise for 4 days per week in a supervised environment at moderate intensity (equating to 150 minutes per week) combined with resistance training.…”

Section: Osa and Liver Damagementioning

confidence: 99%

“…Six randomised controlled trials have compared the effect of intensive lifestyle changes versus routine care in OSA [74][75][76][77][78][79]. The trials were mixed in duration, design and protocols employed, and no consistency was observed in the diet, exercise or structuring of the programmes employed (table 1).…”

Section: Osa and Liver Damagementioning

confidence: 99%

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Sleep apnoea and metabolic dysfunction

Bonsignore¹,

Borel²,

Machan³

et al. 2013

European Respiratory Review

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Obstructive sleep apnoea (OSA) is a highly prevalent condition often associated with central obesity. In the past few years, several studies have analysed the potential independent contribution of OSA to the pathogenesis of metabolic abnormalities, including type 2 diabetes, the metabolic syndrome and nonalcoholic fatty liver disease. New perspectives in OSA patient care have been opened by the promotion of lifestyle interventions, such as diet and exercise programmes that could improve both OSA and the metabolic profile. The rich clinical literature on this subject, together with the growing amount of data on pathophysiological mechanisms provided by animal studies using the chronic intermittent hypoxia model, urged the organising Committee of the Sleep and Breathing meeting to organise a session on sleep apnoea and metabolic dysfunction, in collaboration with the European Association for the Study of Diabetes. This review summarises the state-of-the-art lectures presented in the session, more specifically the relationship between OSA and diabetes, the role of OSA in the metabolic consequences of obesity, and the effects of lifestyle interventions on nocturnal respiratory disturbances and the metabolic profile in OSA patients. @ERSpublications Treatment of obesity and metabolic diseases through diet and exercise should be part of OSA management besides CPAP

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Section: Osa and Liver Damagementioning

confidence: 99%

Section: Osa and Liver Damagementioning

confidence: 99%

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Sleep apnoea and metabolic dysfunction

Bonsignore¹,

Borel²,

Machan³

et al. 2013

European Respiratory Review

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“…A growing body of evidence in OSAS supports the beneficial role of weight reduction, induced by diet alone [9][10][11][12] or in combination with exercise [13], leading to a reduction in apnoeas and hypopnoeas. A recent study conducted at the University of Crete examined the effect of the Mediterranean diet (MD) compared with that of a prudent diet on obese adults with moderate-to-severe OSAS who were treated with CPAP while receiving counselling to increase their physical activity [14]. The results showed that people following the MD had a reduced number of disturbances, known as apnoeas, during the rapid eye movement (REM) stage of sleep, which usually accounts for approximately 25% of total sleep during the night.…”

Section: Editorialmentioning

confidence: 99%

Weight Reduction Programs in Obese Sleep Apnea Patients: The Role of the Mediterranean Diet

Papandreou¹

2012

JNFS

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EditorialObstructive Sleep Apnoea Syndrome (OSAS) is considered to be one of the most prevalent sleep-related breathing disorders, with an enormous effect on public health. Approximately 2-4% of the general adult population experiences some degree of this syndrome [1]. This percentage increases even more with obesity, up to 20-40%, especially in individuals with an excessive Body Mass Index (BMI) > 30 kg/m 2 [2]. OSAS is associated with significant systemic consequences, including cardiovascular morbidity and mortality, and the risk increases with the severity of the syndrome [3]. The pathophysiology underlying the link between OSAS and the cardiovascular system is attributed largely to systemic inflammation and oxidative stress, which are both contributors to endothelial dysfunction [4]. The treatment modalities of OSAS include Continuous Positive Airway Pressure (CPAP), weight loss, upper airway surgery, and oral devices [5]. CPAP is the first line therapy, as a means of maintaining upper airway patency [6], and it is well known that this intervention reduces morbidity and mortality [7]. In severe cases of OSAS the weight loss strategy is essential and must accompany CPAP treatment [8]. A growing body of evidence in OSAS supports the beneficial role of weight reduction, induced by diet alone [9][10][11][12] or in combination with exercise [13], leading to a reduction in apnoeas and hypopnoeas. A recent study conducted at the University of Crete examined the effect of the Mediterranean diet (MD) compared with that of a prudent diet on obese adults with moderate-to-severe OSAS who were treated with CPAP while receiving counselling to increase their physical activity [14]. The results showed that people following the MD had a reduced number of disturbances, known as apnoeas, during the rapid eye movement (REM) stage of sleep, which usually accounts for approximately 25% of total sleep during the night. Recent reports have related an increase in disturbances during REM sleep with the risk of developing significant systemic consequences like diabetes type II. However, its clinical significance remains unclear.The findings also revealed that people following the MD also showed a greater adherence to the calorie restricted diet, an increase in physical activity and a greater decrease in abdominal fat. The MD promotes satiation and encourages consumption of a variety of palatable foods, optimizing adherence to a caloric restricted diet [15]. It is also possible that the MD along with increased physical activity could promote changes of relevant anthropometric determinants such as waist size and finally better outcome. It has been suggested that abdominal fat is a risk factor for OSAS in obese patients [16]. It is related with a reduction in pharyngeal lumen size due to fatty tissue within the airway or in its lateral walls, and a decrease in upper airway muscle protective force due to fatty deposits in the muscle. It has also been reported that abdominal fat is associated with reduced upper airway size secondary to th...

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“…Although data addressing weight loss in OSA patients are somewhat limited, the data available suggest that weight loss can be a highly effective treatment in the short term [7]. Such patients should also be followed closely because OSA may recur even in patients who maintain their weight loss [8].…”

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confidence: 99%

The effect of weight loss on obstructive sleep apnea (OSA) severity and position dependence in the bariatric population

2014

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Obstructive sleep apnea (OSA) is a common chronic disorder, whose severity and duration predisposes to neurocognitive and medical sequelae development and varies among individuals. Obstructive respiratory events can be more severe and frequent in the supine sleeping position: indeed, more than half of all patients with obstructive sleep apnea (OSA) can be classified as supine-related OSA. The anatomical and physiological mechanisms for this phenomenon have not been well explained yet. In the supine posture, due to the unfavourable gravitational effects, the upper airway calibre could be reduced, resistance is likely to be increased, and therefore, the tendency for the upper airway to collapse is worsening compared to lateral position.Since the first large study of Oksenberg et al. of 574 OSA patients, who found that 55.9 % had positional OSA (POSA) and the prevalence was higher in mild to moderate OSA patients (ranging from 65-69 %) than in severe OSA [1], several studies with similar findings were published. These patients tend to have less severe OSA, to be less obese and to be younger [2]. Even in those patients in whom the apnea hypopnea index (AHI) is not influenced by body position, the duration of apnea/hypopnea and the degree of associated desaturations seems to be worse in the supine position [3].Avoidance of the supine posture is efficacious and most studies report a positive effect of positional therapy (PT) on the AHI. Additionally, conservative treatment of OSA, including weight reduction, can be just as crucial. Improvement could be accomplished even by a modest weight loss; however, the compliance with this form of treatment is often very low. With this in mind, bariatric surgical procedures according to body mass index (BMI) stratification are preferred, achieving substantial weight loss and far exceeding the effectiveness of non-surgical weight loss programmes. In terms of longterm effectiveness, a recent study showed that patients have achieved and maintained a loss of nearly half of their excess weight for as long as 15 years after bariatric surgery [4].In this issue of Sleep and Breathing, Dr. Morong and colleagues tried to determine the prevalence of POSA in patients undergoing bariatric surgery and to evaluate the influence of bariatric surgery on POSA. Furthermore, based on previous studies, they choose four predictors for POSA: BMI, neck circumference, AHI and age. The study was performed on 162 patients, and 91 of them were finally analyzed. The authors found that the prevalence of POSA in patients undergoing bariatric surgery was significantly lower (34 %) than the prevalence noted in the general population, and a low AHI was shown to be the only significant independent predictor for the presence of POSA. Their principal finding was that weight loss following bariatric surgery, to a magnitude of 9 kg/m 2 with a concomitant reduction in AHI about 19 events/h and an improvement in desaturation indices, was related to the transition from non-positional OSA into positional OSA (~65 % of pat...

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Effect of Mediterranean dietversusprudent diet combined with physical activity on OSAS: a randomised trial

Cited by 54 publications

References 50 publications

Sleep apnoea and metabolic dysfunction

Sleep apnoea and metabolic dysfunction

Weight Reduction Programs in Obese Sleep Apnea Patients: The Role of the Mediterranean Diet

The effect of weight loss on obstructive sleep apnea (OSA) severity and position dependence in the bariatric population

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