Sleep Architecture Following a Weight Loss Intervention in Overweight and Obese Patients with Obstructive Sleep Apnea and Type 2 Diabetes: Relationship to Apnea-Hypopnea Index

Abstract

Study Objectives: To determine if weight loss and/or changes in apnea-hypopnea index (AHI) improve sleep architecture in overweight/obese adults with type 2 diabetes (T2D) and obstructive sleep apnea (OSA). Methods: This was a randomized controlled trial including 264 overweight/obese adults with T2D and OSA. Participants were randomized to an intensive lifestyle intervention (ILI) or a diabetes and support education (DSE) control group. Measures included anthropometry, AHI, and sleep at baseline and year-1, year-2, and year-4 follow-ups. Results: Changes in sleep duration (total sleep time [TST]), continuity [wake after sleep onset (WASO)], and architecture stage 1, stage 2, slow wave sleep, and REM sleep) from baseline to year 1, 2, and 4 did not differ between ILI and DSE. Repeated-measure mixed-model analyses including data from baseline through year-4 for all participants demonstrated a signifi cant positive association between AHI and stage 1 sleep (p < 0.001), and a signifi cant negative association between AHI and stage 2 (p = 0.01) and REM sleep (p < 0.001), whereas changes in body weight had no relation to any sleep stages or TST. WASO had a signifi cant positive association with change in body weight (p = 0.009). Conclusions: Compared to control, the ILI did not induce signifi cant changes in sleep across the 4-year follow-up. In participants overall, reduced AHI in overweight/obese adults with T2D and OSA was associated with decreased stage 1, and increased stage 2 and REM sleep. These sleep architecture changes are more strongly related to reductions in AHI than body weight, whereas WASO may be more infl uenced by weight than AHI. S C I E N T I F I C I N V E S T I G A T I O N SO besity, type 2 diabetes (T2D), and obstructive sleep apnea (OSA) are three related disorders which have been demonstrated to co-occur in patients. Indeed, obesity is established as one of the leading risk factors for the development of both T2D and OSA, and a high prevalence (~86.6%) of undiagnosed OSA was found in obese patients with T2D.1 Defi cits in sleep duration and/or quality may be a common link among these three factors. A growing body of both epidemiological and laboratory-based studies supports a role of short sleep duration in the development of obesity.2-4 Sleep curtailment is also associated with increased incidence of T2D as well as defi cits in glucose regulation. BRIEF SUMMARYCurrent Knowledge/Study Rationale: A growing body of evidence supports a relationship between sleep and obesity. A long-term weight loss intervention (up to 4 years) has previously been shown to improve the severity of sleep disordered breathing in a group of overweight and obese patients with obstructive sleep apnea (OSA) and type 2 diabetes, although the effects of the structured weight loss program on nocturnal sleep duration and architecture have not yet been explored. Study Impact: Although the weight loss intervention was effective in reducing the severity of OSA over a 4-year period, it did not lead to changes in the various po...

Weight loss surgery for obstructive sleep apnoea with obesity in adults: a systematic review and meta-analysis protocol

“…Young et al reported that men had a four times higher risk of sleep-disordered breathing (polysomnographically defined AHI of five or higher) for each SD increase in BMI 41. These and other studies support our hypothesis that weight loss surgery can improve weight loss outcomes, and may have a role in treating or curing OSA 19–22. However, currently, there is no meta-analysis to confirm this hypothesis, and this study will be the first systematic review and meta-analysis to assess the safety and efficacy of weight loss surgery for OSA with obesity in adults.…”

Effects of a lifestyle intervention on REM sleep‐related OSA severity in obese individuals with type 2 diabetes

“…Baseline characteristics, including demographics, anthropometry, OSA severity, sleep duration and architecture (TST, stage 1, 2, SWS, REM sleep), and HbA1c have been previously reported (Kuna et al, 2013, Shechter et al, 2014). No baseline between-group differences were observed.…”

“…However, in a secondary analysis, a minimum REM sleep duration threshold of 30 minutes was used as a requirement to calculate REM-AHI (Mokhlesi and Punjabi, 2012). Intrascorer reliability across the 4-year follow-up was assessed and confirmed (Shechter et al, 2014). …”

“…Unattended overnight PSG using a portable system were obtained at baseline, and at year-1, year-2, and year-4 follow-ups as previously described (Shechter et al, 2014, Kuna et al, 2013, Foster et al, 2009a). Recorded signals included electroencephalogram (C3-A2 and C4-A1), bilateral electrooculogram, chin electromyogram, electrocardiogram, rib cage and abdominal excursion, airflow via oronasal thermistry and nasal pressure cannula, oxygen saturation via pulse oximetry.…”

Laparoscopic Sleeve Gastrectomy Improves Excessive Daytime Sleepiness and Sleep Quality 6 Months Following Surgery: A Prospective Cohort Study

“…After bariatric surgery, it has been shown that the severity and symptoms of OSA decrease or sometimes even completely resolve with successful weight loss [ 6 ]. Overnight polysomnography (PSG) is the gold standard for the diagnosis of OSA [ 7 , 8 ]. However, not all patients who are morbidly obese are routinely tested and diagnosed for OSA by a PSG test.…”