Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea. General exercise training improves ventilatory and peripheral muscle strength and endurance in chronic airflow limitation. Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men: a randomised controlled trial Longer term effects of very low energy diet on obstructive sleep apnoea in cohort derived from randomised controlled trial: prospective observational follow-up study Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study. The effect of exercise training on obstructive sleep apnea and sleep quality: a randomized controlled trial. Effect of Orlistat on Weight Regain and Cardiovascular Risk Factors Following a Very-Low-Energy Diet in Abdominally Obese Patients Longitudinal study of moderate weight change and sleep-disordered breathing. Two year reduction in sleep apnea symptoms and associated diabetes incidence after weight loss in severe obesity. Effects of exercise training in patients with chronic heart failure and sleep apnea. Changes in breathing and the pharynx after weight loss in obstructive sleep apnea. Effect of Weight Reduction on Rhinometric Measurements in Overweight Patients with Obstructive Sleep Apnea A diet and exercise program to improve clinical outcomes in patients with obstructive sleep apnea--a feasibility study. The effect of a very low-calorie diet-induced weight loss on the severity of obstructive sleep apnoea and autonomic nervous function in obese patients with obstructive sleep apnoea syndrome. Obstructive sleep apnea syndrome: are we missing an at-risk population? Exercise training effect on obstructive sleep apnea syndrome. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. A two-year weight reduction program in obese sleep apnea patients. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Long-term maintenance of weight loss after a very-low-calorie diet: a randomized blinded trial of the efficacy and tolerability of sibutramine. Long-term maintenance of weight loss with sibutramine in a GP setting following a specialist guided very-low-calorie diet: a double-blind, placebo-controlled, parallel group study A cognitive-behavioral weight reduction program in the treatment of obstructive sleep apnea syndrome with or without initial nasal CPAP: a randomized study.
RATIONALE Obesity is the most important risk factor for obstructive sleep apnea ( OSA ) . However , although included in clinical guidelines , no r and omized controlled studies have been performed on the effects of weight reduction on mild OSA . OBJECTIVES The aim of this prospect i ve , r and omized 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 objective ly 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 result ing 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 We studied the impact of a 6-wk supervised , multimodality endurance exercise training program ( EXT ) on strength and endurance of ventilatory and peripheral muscles in patients with chronic airflow limitation ( CAL ) , and determined whether potential improvements contributed to relief of exertional breathlessness ( B ) and perceived leg effort/discomfort ( LE ) , respectively . Twenty breathless patients with stable CAL ( FEV1 = 41 + /- 3 % predicted ; mean + /- SEM ) were tested at 6-wk intervals at baseline , after a nonintervention control period ( pre-EXT ) , and post-EXT . Measurements included : pulmonary function tests ( PFTs ) , maximal inspiratory/expiratory pressures ( MIP , MEP ) , inspiratory muscle endurance ( V(LIM ) ) , quadriceps strength and endurance , exercise endurance , and submaximal cycle exercise with cardioventilatory and symptom responses . Measurements at baseline and pre-EXT were identical . Post-EXT , PFTs did not change ; exercise endurance measured on the treadmill , cycle ergometer , arm ergometer , and by 6-min walk distance increased 40 + /- 8 % , 43 + /- 10 % , 12 + /- 5 % , and 34 + /- 9 % , respectively ( p < 0.05 ) ; quadriceps strength increased 21 + /- 5 % ( p < 0.01 ) ; MIP and MEP increased 29 + /- 11 % and 27 + /- 11 % , respectively ( p < 0.05 ) ; V(LIM ) increased almost threefold ( p < 0.05 ) . At isotime near end-exercise , B , LE , carbon dioxide production ( VCO2 ) , oxygen consumption ( VO2 ) , ventilation , and breathing frequency ( F ) all fell after EXT ( p < 0.05 ) : deltaB correlated with deltaF ( r = 0.58 , p < 0.01 ) . Increased MIP and V(LIM ) did not correlate with improved breathlessness or exercise endurance . Similarly , changes in quadriceps strength and endurance did not correlate with changes in LE or exercise endurance . In conclusion , general nonspecific EXT improved ventilatory and peripheral muscle function in severe CAL , but such improvements did not appear to contribute significantly to reduced exertional symptoms and enhanced exercise performance Objective To assess the effect of weight loss induced by a very low energy diet on  moderate and severe obstructive sleep apnoea in obese men . Design Single centre , two arm , parallel , r and omised , controlled , open label trial . Blocked r and omisation procedure used for treatment allocation . Setting Outpatient obesity clinic in a university hospital in Stockholm , Sweden . Participants 63 obese men ( body mass index 30 - 40 , age 30 - 65 years ) with moderate to severe obstructive sleep apnoea ( apnoea-hypopnoea index ( AHI ) ≥15 ) , treated with continuous positive airway pressure . Interventions The intervention group received a liquid very low energy diet ( 2.3 MJ/day ) for seven weeks to promote weight loss , followed by two weeks of gradual introduction of normal food , reaching 6.3 MJ/day at week 9 . The control group adhered to their usual diet during the nine weeks of follow-up . Main outcome measure AHI , the major disease severity index for obstructive sleep apnoea . Data from all r and omised patients were included in an intention to treat analysis ( baseline carried forward for missing data ) . Results Of the 63 eligible patients , 30 were r and omised to intervention and 33 to control . Two patients in the control group were dissatisfied with allocation and immediately discontinued . All other patients completed the trial . Both groups had a mean AHI of 37 events/h ( SD 15 ) at baseline . At week 9 , the intervention group ’s mean body weight was 20 kg ( 95 % confidence interval 18 to 21 ) lower than that of the control group , while its mean AHI was 23 events/h ( 15 to 30 ) lower . In the intervention group , five of 30 ( 17 % ) were disease free after the energy restricted diet ( AHI < 5 ) , with 15 of 30 ( 50 % ) having mild disease ( AHI 5 - 14.9 ) , whereas the AHI of all patients in the control group except one remained at 15 or higher . In a subgroup analysis of the intervention group , baseline AHI significantly modified the effectiveness of treatment , with a greater improvement in AHI in patients with severe obstructive sleep apnoea ( AHI > 30 ) at baseline compared with those with moderate ( AHI 15 - 30 ) sleep apnoea ( AHI −38 v −12 , P<0.001 ) , despite similar weight loss ( −19.2 v −18.2 kg , P=0.55 ) . Conclusion Treatment with a low energy diet improved  obstructive sleep apnoea in obese men , with the greatest effect in patients with severe disease . Long term treatment studies are needed to vali date weight loss as a primary treatment strategy for obstructive sleep apnoea . Trial registration Current Controlled Trials IS RCT N70090382 Objective To determine whether initial improvements in obstructive sleep apnoea after a very low energy diet were maintained after one year in patients with moderate to severe obstructive sleep apnoea . Design Single centre , prospect i ve observational follow-up study . Setting Outpatient obesity clinic in a university hospital in Stockholm , Sweden . Participants 63 men aged 30 - 65 with body mass index ( BMI ) 30 - 40 and moderate to severe obstructive sleep apnoea defined as an apnoea-hypopnoea index ≥15 ( events/hour ) , all treated with continuous positive airway pressure . Intervention A one year weight loss programme , consisting of an initial very low energy diet for nine weeks ( seven weeks of 2.3 MJ/day and two weeks of gradual introduction of normal food ) followed by a weight loss maintenance programme . Main outcome measure Apnoea-hypopnoea index , the main index for severity of obstructive sleep apnoea . Data from all patients were analysed ( baseline carried forward for missing data ) . Results Of 63 eligible patients , 58 completed the very low energy diet period and started the weight maintenance programme and 44 completed the full programme ; 49 had complete measurements at one year . At baseline the mean apnoea-hypopnoea index was 36 events/hour . After the very low energy diet  period , apnoea-hypopnoea index was improved by −21 events/hour ( 95 % confidence interval −17 to −25 ) and weight by −18 kg ( −16 to −19 ; both P<0.001 ) . After one year the apnoea-hypopnoea index had improved by −17 events/hour ( −13 to −21 ) and body weight by −12 kg ( −10 to −14 ) compared with baseline ( both P<0.001 ) . Patients with severe obstructive sleep apnoea at baseline had greater improvements in apnoea-hypopnoea index ( −25 events/hour ) compared with patients with moderate disease ( −7 events/hour , P<0.001 ) . At one year , 30/63 ( 48 % , 95 % confidence interval 35 % to 60 % ) no longer required continuous positive airway pressure and 6/63 ( 10 % , 2 % to 17 % ) had total remission of obstructive sleep apnoea ( apnoea-hypopnoea index < 5 events/hour ) . There was a dose-response association between weight loss and apnoea-hypopnoea index at follow-up ( β=0.50 events/kg , 0.11 to 0.88 ; P=0.013 ) . Conclusion Initial improvements in obstructive sleep apnoea after treatment with a very low energy diet can be maintained after one year in obese men with moderate to severe disease . Those who lose the most weight or have severe sleep apnoea at baseline benefit most . Trial registration Current Controlled Trials 70090382 AIM The aim of this long-term prospect i ve study was to evaluate the effect of treating obstructive sleep apnoea ( OSA ) on the rate of cardiovascular events in coronary artery disease ( CAD ) . METHODS AND RESULTS We prospect ively studied 54 patients ( mean age 57.3 + /- 10.1 years ) with both CAD ( > or = 70 % coronary artery stenosis ) and OSA ( apnoea-hypopnoea index > or = 15 ) . In 25 patients , OSA was treated with continuous positive airway pressure ( n=21 ) or upper airway surgery ( n=4 ) ; the remaining 29 patients declined treatment for their OSA . The median follow-up was 86.5 + /- 39 months . The two groups were similar at baseline in age , body mass index , smoking history , hypertension , hypercholesterolaemia , diabetes mellitus , number of diseased vessels , left ventricular ejection fraction , and CAD therapy . Treatment of risk factors other than OSA was similar in the two groups . The endpoint ( a composite of cardiovascular death , acute coronary syndrome , hospitalisation for heart failure , or need for coronary revascularisation ) was reached in 6 ( 6/25 , 24 % ) and 17 ( 17/29 , 58 % ) patients with and without OSA treatment , respectively ( P<0.01 ) . OSA treatment significantly reduced the risk of occurrence of the composite endpoint ( hazard ratio 0.24 ; 95 % confidence interval , 0.09 - 0.62 ; p<0.01 ) and of each of its components . CONCLUSIONS Our data indicate that the treatment of OSA in CAD patients is associated with a decrease in the occurrence of new cardiovascular events , and an increase in the time to such events STUDY OBJECTIVES To evaluate the efficacy of a 12-week exercise training program for reducing  obstructive sleep apnea ( OSA ) severity  and improving sleep quality , and to explore possible mechanisms by which exercise may reduce OSA severity . DESIGN R and omized controlled trial . SETTING Clinical exercise physiology center , sleep laboratory . PARTICIPANTS Forty-three sedentary and overweight/obese adults aged 18 - 55 years with at least moderate-severity untreated OSA ( screening apnea-hypopnea index [ AHI ] ≥ 15 ) . INTERVENTIONS Participants r and omized to exercise training ( n = 27 ) met 4 times/week for 12 weeks and performed 150 min/week of moderate-intensity aerobic activity , followed by resistance training twice/week . Participants r and omized to a stretching control ( n = 16 ) met twice weekly for 12 weeks to perform low-intensity exercises design ed to increase whole-body flexibility . MEASUREMENTS AND RESULTS OSA severity was assessed with one night of laboratory polysomnography ( PSG ) before and following the 12-week intervention . Measures of sleep quality included PSG , actigraphy ( 7 - 10 days ) , and the Pittsburgh Sleep Quality Index . Compared with stretching , exercise result ed in a significant AHI reduction  ( exercise : 32.2 ± 5.6 to 24.6 ± 4.4 , stretching : 24.4 ± 5.6 to 28.9 ± 6.4 ; P < 0.01 ) as well as significant changes in oxygen desaturation index ( ODI ; P = 0.03 ) and stage N3 sleep ( P = 0.03 ) . Reductions in AHI and ODI were achieved without a significant decrease in body weight . Improvements in actigraphic sleep and subjective sleep quality were also noted following exercise compared with stretching . CONCLUSIONS Exercise training had moderate treatment efficacy for the reduction of AHI in sedentary overweight/obese adults , which suggests that exercise may be beneficial for the management of OSA beyond simply facilitating weight loss . TRIAL REGISTRATION Clinical trials.gov identification number NCT00956423 OBJECTIVE —To investigate the efficacy of orlistat on the maintenance of weight loss over 3 years following a major weight loss induced by very-low-energy diet ( VLED ) in obese patients with metabolic risk factors such as dyslipidemia , impaired fasting glucose , and diet-treated type 2 diabetes . RESEARCH DESIGN AND METHODS —Initially , weight loss was induced by an 8-week VLED ( 600–800 kcal/day ) in 383 patients with a mean BMI of 37.5 kg/m2 ( range 30.0–45.2 ) . Those who lost ≥5 % of their body weight ( 309 of 383 patients ) were then r and omized to receive lifestyle counseling for 3 years together with either orlistat 120 mg t.i.d . or matching placebo capsules . Primary end points were the maintenance of ≥5 % weight loss after 3 years . Additionally , differences in the development of type 2 diabetes between orlistat and placebo were analyzed . RESULTS —The VLED induced a mean weight loss of 14.4 ± 2 .. 0 kg among the subsequently r and omized patients . The mean weight gain after 3 years was lower with orlistat than with placebo ( 4.6 ± 8.6 vs. 7.0 ± 7.1 kg ; P < 0.02 ) . The number of participants who achieved ≥5 % weight loss also favored orlistat ( 67 vs. 56 % ; P = 0.037 ) . Waist circumference was significantly more reduced in the orlistat group ( P < 0.05 ) , but no other differences in the risk factors were observed between the two groups . The incidences of new cases of type 2 diabetes were significantly reduced in the orlistat group ( 8 cases out of 153 subjects ) versus placebo ( 17 cases out of 156 subjects ) ( P = 0.041 ) . CONCLUSIONS —The addition of orlistat to lifestyle intervention was associated with maintenance of an extra 2.4 kg weight loss after VLED for up to 3 years in obese subjects . The combination of orlistat and lifestyle intervention was associated with a reduced occurrence of type 2 diabetes CONTEXT Excess body weight is positively associated with sleep-disordered breathing ( SDB ) , a prevalent condition in the US general population . No large study has been conducted of the longitudinal association between SDB and change in weight . OBJECTIVE To measure the independent longitudinal association between weight change and change in SDB severity . DESIGN Population -based , prospect i ve cohort study conducted from July 1989 to January 2000 . SETTING AND PARTICIPANTS Six hundred ninety r and omly selected employed Wisconsin residents ( mean age at baseline , 46 years ; 56 % male ) who were evaluated twice at 4-year intervals for SDB . MAIN OUTCOME MEASURES Percentage change in the apnea-hypopnea index ( AHI ; apnea events + hypopnea events per hour of sleep ) and odds of developing moderate-to-severe SDB ( defined by an AHI > or = 15 events per hour of sleep ) , with respect to change in weight . RESULTS Relative to stable weight , a 10 % weight gain predicted an approximate 32 % ( 95 % confidence interval [ CI ] , 20%-45 % ) increase in the AHI . A 10 % weight loss predicted a 26 % ( 95 % CI , 18%-34 % ) decrease in the AHI . A 10 % increase in weight predicted a 6-fold ( 95 % CI , 2.2 - 17.0 ) increase in the odds of developing moderate-to-severe SDB . CONCLUSIONS Our data indicate that clinical and public health programs that result in even modest weight control are likely to be effective in managing SDB and reducing new occurrence of SDB STUDY OBJECTIVES To evaluate the effect of bariatric surgery on  sleep apnea symptoms and obesity-associated morbidity  in patients with severe obesity . DESIGN Prospect i ve study . SETTING University hospitals and community centers in Sweden . INTERVENTION We investigated the influence of  weight loss surgery ( n=1729 ) on  sleep apnea symptoms and obesity-related morbidity using a  conservatively treated group ( n=1748 ) as a control . MEASUREMENTS AND RESULTS Baseline BMI in surgical group ( 42.2+/-4.4 kg/m(2 ) ) and control group ( 40.1+/-4.6 kg/m(2 ) ) changed -9.7+/-5 kg/m(2 ) and 0+/-3 kg/m(2 ) , respectively , at 2-year follow-up . In the surgery group , there was a marked improvement in all obstructive sleep apnea ( OSA ) symptoms compared with the control group ( P < 0.001 ) . Persistence of snoring ( 21.6 vs 65.5 % , adjusted OR 0.14 , 95 % CI 0.10 - 0.19 ) and apnea ( 27.9 vs 71.3 % , adjusted OR 0.16 , 95 % I 0.10 - 0.23 ) were much less in the surgery group compared with controls . Compared with subjects with no observed apnea at follow-up ( n=2453 ) , subjects who continued to have or developed observed apnea ( n=404 ) had a higher incidence of diabetes ( adjusted OR 2.03 , 95 % CI 1.19 - 3.47 ) and hypertriglyceridemia ( adjusted OR 1.86 , 95 % CI 1.07 - 3.25 ) but not hypertension ( adjusted OR 1.09 , 95 % CI 0.65 - 1.83 ) or hypercholesterolemia ( adjusted OR 0.91 , 95 % CI 0.53 - 1.58 ) . CONCLUSION Bariatric surgery results in a marked improvement in sleep apnea symptoms at 2 years . Despite adjustment for weight change and baseline central obesity , subjects reporting loss of OSA symptoms had a lower 2-year incidence of diabetes and hypertriglyceridemia . Improvement in OSA in patients losing weight may provide health benefits in addition to weight loss alone STUDY OBJECTIVES To test the effects of exercise training on sleep and neurovascular control in patients with systolic heart failure with and without sleep disordered breathing . DESIGN Prospect i ve interventional study . SETTING Cardiac rehabilitation and exercise physiology unit and sleep laboratory . PATIENTS Twenty-five patients with heart failure , aged 42 to 70 years , and New York Heart Association Functional Class I-III were divided into 1 of 3 groups : obstructive sleep apnea ( n=8 ) , central sleep apnea ( n=9 ) and no sleep apnea ( n=7 ) . INTERVENTIONS Four months of no-training ( control ) followed by 4 months of an exercise training program ( three 60-minute , supervised , exercise sessions per week ) . MEASURES AND RESULTS Sleep ( polysomnography ) , microneurography , forearm blood flow ( plethysmography ) , peak VO2 , and quality of life were evaluated at baseline and at the end of the control and trained periods . No significant changes occurred in the control period . Exercise training reduced muscle sympathetic nerve activity ( P < 0.001 ) and increased forearm blood flow ( P < 0.01 ) , peak VO2 ( P < 0.01 ) , and quality of life ( P < 0.01 ) in all groups , independent of the presence of sleep apnea . Exercise training improved the apnea-hypopnea index , minimum 0O saturation , and amount stage 3 - 4 sleep ( P < 0.05 ) in patients with obstructive sleep apnea but had no significant effects in patients with central sleep apnea . CONCLUSIONS The beneficial effects of exercise training on neurovascular function , functional capacity , and quality of life in patients with systolic dysfunction and heart failure occurs independently of sleep disordered breathing . Exercise training lessens the severity of obstructive sleep apnea but does not affect central sleep apnea in patients with heart failure and sleep disordered breathing The effect of weight loss following dietary restriction on disordered breathing on the pharyngeal airway is controversial in patients with obstructive sleep apnea ( OSA ) . We therefore prospect ively studied eight patients before and after dietary-induced weight loss .  Mean weight loss was 20.6 kg + /- 12.8 SD . After weight loss there were significant improvements in PO2 and PCO2 measured during wakefulness , and in the number of desaturation episodes per hour of sleep , average desaturation per episode , and number of movement arousals . The number of apneas and hypopneas significantly decreased in six of eight patients . There was a significant correlation between body mass index and number of disordered breathing events . Nasopharyngeal collapsibility and pulse flow resistance decreased in awake patients after weight loss . We conclude that moderate weight loss in obese patients with OSA improves oxygenation during both sleep and wakefulness , decreases the number of disordered breathing events in many patients , decreases the collapsibility of the nasopharyngeal airway Background Elevated nasal resistance and obesity predispose to obstructive sleep apnea ( OSA ) . Weight loss has been shown to result in an alleviation of OSA , but its effect on nasal airflow has not been studied . Methods This study was a prospect i ve , r and omized , controlled study with two parallel groups . A total of 52 adult overweight patients ( body mass index [ BMI ] , 28–40 kg/m2 ) with mild obstructive sleep apnea ( apnea – hypopnea index { AHI } , 5–15 ) were r and omized into two study groups . The intervention group ( n = 26 ) followed a very low calorie diet with a supervised lifestyle intervention while the control group ( n = 26 ) received routine lifestyle counseling . The changes in BMI , total nasal resistance , total nasal volume , and quality of life scores ( Mini Rhinoconjunctivitis Quality of Life Question naire , MiniRQLQ ) were assessed at baseline and after the intervention at 3 months . Results The reduction in BMI in the intervention group was significantly greater than that achieved by patients in the control group ( 5.4 kg/m2 versus 0.5 kg/m2 ) . Accordingly , AHI was reduced by 3.2 events/hour in the intervention group and by 1.3 in the control group . However , there were no significant changes in rhinometric measurements despite significant weight loss . There was no correlation between the reduction of BMI and the change in nasal resistance or MiniRQLQ scores . Conclusion Weight reduction does not seem to have any effect on nasal resistance or volume in overweight patients with mild OSA . Patients with OSA and impaired nasal breathing need specific medical or surgical treatment to restore nasal airflow STUDY OBJECTIVES To assess the feasibility and efficacy of a novel 16-week exercise and diet program for important clinical outcomes in obstructive sleep apnea ( OSA ) . METHODS Cohort study assessing sleep disordered breathing , cardiovascular risk factors , and neurobehavioral function prior to and following completion of the 16-week program . The program used a proprietary very low energy diet ( Optifast , Novartis ) , and subjects participated in a supervised exercise schedule , which included both aerobic and resistance training . Follow-up contact was made at 12 months after program exit . Consecutive patients with newly diagnosed sleep apnea were approached who had an apnea-hypopnea index ( AHI ) of 10 to 50 , a body mass index ( BMI ) of greater than 30 kg/m2 , no significant comorbidities , and able to exercise . RESULTS All data are presented as mean [ SD ] . Of 21 patients with OSA who were approached , 12 middle-aged ( 42.3 [ 10.4 ] years old ) , obese ( BMI 36.1 [ 4.3 ] kg/m2 ) , and predominantly female ( 75 % ) subjects with mild to moderate OSA were enrolled ( AHI 24.6 [ 12.0 ] ) .  Weight loss was significant ( 12.3 [ 9.6 ] kg , p < 0.001 ) , and 5 of the 10 who completed the program were able to independently maintain good weight loss at 12 months . At the 16-week assessment , there was a small nonsignificant fall in the AHI . Six of the 10 subjects had a reduction in sleep disordered breathing , and the AHI was less than 10 in 3 patients . There were significant improvements in neurobehavioral and cardiometabolic outcomes . Snoring improved in most subjects , but the improvement was clinical ly important ( a score of < 2 ) in only 7 . CONCLUSIONS A supportive diet and exercise program may be of benefit to obese patients with mild to moderate sleep apnea . The results of this feasibility study showed significant weight loss and improvement in clinical ly important neurobehavioral and cardiometabolic outcomes but no significant change in sleep disordered breathing . These promising preliminary results need confirmation with a larger r and omized trial The aim of this study was to examine the effect of a very low-calorie diet (VLCD)-induced weight loss on the severity of obstructive sleep apnoea ( OSA ) , blood pressure and cardiac autonomic regulation in obese patients with obstructive sleep apnoea syndrome ( OSAS ) . A total of 15 overweight patients ( 14 men and one woman , body weight 114 + /- 20 kg , age 52 + /- 9 years , range 39 - 67 years ) with OSAS were studied prospect ively . They were advised to follow a 2.51 - 3.35 MJ ( 600 - 800 kcal ) diet daily for a 3-month period . In the beginning of the study , the patients underwent nocturnal sleep studies , autonomic function tests and 24-h electrocardiograph ( ECG ) recording . In addition , 15 age-matched , normal-weight subjects were studied . They underwent the Valsalva test , the deep-breathing test and assessment of heart rate variability at rest . The sleep studies and autonomic function tests were repeated after the weight loss period . There was a significant reduction in weight ( 114 + /- 20 kg to 105 + /- 21 kg , P < 0.001 ) , the weight loss being 9.2 + /- 4.0 kg ( range 2.3 - 19.5 kg ) . This was associated with a significant improvement in the oxygen desaturation index ( ODI4 ) during sleep ( 31 + /- 20 - 19 + /- 18 , P < 0.001 ) . Before the weight loss the OSAS patients had significantly higher blood pressure ( 150 + /- 18 vs. 134 + /- 20 , P < 0.05 , for systolic blood pressure , 98 + /- 10 vs. 85 + /- 13 , P < 0.05 , for diastolic blood pressure ) and heart rate ( 67 + /- 10 beats min-1 vs. 60 + /- 13 , P < 0.05 ) at rest than the control group . They had also lower baroreflex sensitivity ( 4.7 + /- 2.8 ms mmHg-1 vs. 10.8 + /- 7.1 ms mmHg-1 , P < 0.01 ) . During the weight reduction , the blood pressure declined significantly , and the baroreflex sensitivity increased by 49 % . In conclusion , our experience shows that weight loss with  VLCD  is an effective treatment for OSAS . Weight loss improved significantly sleep apnoea and had favourable effects on blood pressure and baroreflex sensitivity that may have prognostic implication STUDY OBJECTIVES While age and body-mass index ( BMI ) are well-established risk factors for obstructive sleep apnea syndrome ( OSAS ) , this disorder occurs across a wide spectrum of ages and weights . Preconceptions regarding " classic " patients with OSAS may lead to underdiagnosis in at-risk population s , particularly younger nonoverweight individuals . We hypothesized that the severity of OSAS is independent of age and BMI in a younger less-obese population . METHODS Prospect i ve study of consecutive patients diagnosed with OSAS . Active-duty military , National Guardsmen , and civilians were compared to determine if age and BMI correlated with disease severity . RESULTS Two hundred seventy subjects ( 120 active-duty , 80 National Guardsmen , 70 civilians ) were included . Active-duty military members were significantly younger and less overweight than both National Guardsmen and civilians . Of the civilians , 64.3 % and , of National Guardsmen , 48.8 % were obese , whereas only 19.2 % of active-duty had a BMI > or = 30 kg/m2 ( p < .001 ) . However , the prevalence of severe disease did not differ between groups . Disease severity showed no correlation with BMI among active-duty subjects ( r = 0.09 , p = .33 ) . Of the active-duty subjects , 37.5 % had severe disease , as compared with 42.5 % of National Guard and 45.7 % of civilian subjects ( p = .18 and .09 , respectively ) . BMI did not differ between active-duty subjects with severe disease and those with mild to moderate OSAS ( 26.7 kg/m2 versus 26.9 kg/m2 , p = .40 ) . There was a low but significant correlation between age and AHI ( r = 0.21 , p = .02 ) among all subjects . CONCLUSIONS OSAS occurs in young nonobese individuals and should be considered in patients reporting excessive daytime sleepiness  , regardless of age or BMI The role , if any , of exercise training in the management of individuals with obstructive sleep apnea syndrome ( OSAS ) is unclear . Anecdotally , patients have reported improvement in symptoms with regular participation in an exercise regime . In this study , we evaluated the effects of an exercise training program and weight loss on physical and subjective measures associated with OSAS . Nine subjects with mild to moderate OSAS completed a six month supervised exercise program . Pre and post-training measures on polysomnographic testing , physical training , anthropometric measures , quality of life ( QOL ) , daytime somnolence and mood states were assessed . A significant decrease in the AHI ( p=0.002 ) was noted along with improvements ( p<0.05 ) in total sleep time , sleep efficiency , number of awakenings/hour , arousals/hour , apnea index and mean exercise training workloads . Significant decreases ( p<.001 ) in weight ( -6.2 kg ) and body mass index ( -1.6 ) were observed . Evaluation of QOL measures by the Health Status Question naire , Profile of Mood States and Epworth Sleepiness Scale showed significant changes in health status , affective state , and a decrease in daytime somnolence . Regular exercise training had a positive impact on the AHI , aerobic capacity , body mass index and QOL . However , exercise training alone was not an adequate intervention strategy for most individuals with OSAS but may serve well as an adjunct treatment strategy in the conservative management of individuals with mild to moderate OSAS BACKGROUND The belief that weight loss improves  obstructive sleep apnea ( OSA ) has limited empirical support . The purpose of this 4-center study was to assess the effects of weight loss on OSA over a 1-year period . METHODS The study included 264 participants with type 2 diabetes and a mean ( SD ) age of 61.2 ( 6.5 ) years , weight of 102.4 ( 18.3 ) kg , body mass index ( BMI ) ( calculated as weight in kilograms divided by height in meters squared ) of 36.7 ( 5.7 ) , and an apnea-hypopnea index ( AHI ) of 23.2 ( 16.5 ) events per hour . The participants were r and omly assigned to either a behavioral weight loss program developed specifically for obese patients with type 2 diabetes ( intensive lifestyle intervention [ ILI ] ) or 3 group sessions related to effective diabetes management ( diabetes support and education [ DSE ] ) . RESULTS The ILI participants lost more weight at 1 year than did DSE participants ( 10.8 kg vs 0.6 kg ; P < .001 ) . Relative to the DSE group , the ILI intervention was associated with an adjusted ( SE ) decrease in AHI of 9.7 ( 2.0 ) events per hour ( P < .001 ) . At 1 year , more than 3 times as many participants in the ILI group than in the DSE group had total remission of their OSA , and the prevalence of severe OSA among ILI participants was half that of the DSE group . Initial AHI and weight loss were the strongest predictors of changes in AHI at 1 year ( P < .01 ) . Participants with a weight loss of 10 kg or more had the greatest reductions in AHI . CONCLUSIONS Physicians and their patients can expect that weight loss will result in significant and clinical ly relevant improvements in OSA among obese patients with type 2 diabetes . Trial Registration clinical trials.gov Identifier : NCT00194259 STUDY OBJECTIVES To evaluate the effects of a 2-year weight reduction program on respiratory disturbances , arousal index , daytime sleepiness , metabolic status , and quality of life in obese patients with obstructive sleep apnea syndrome ( OSAS ) . METHODS Prospect i ve intervention study of 33 consecutive obese OSAS patients ( 24 men , 9 women ) ; 19 subjects used continuous positive airway pressure and 4 used m and ibular retaining device  , except during nights with sleep recording . The program consisted of 8 weeks of low calorie diet followed by group meetings with behavioral change support . RESULTS Seventy percent of the patients completed the program ; 67 % completed the sleep recordings . The success rate for the apnea-hypopnea index ( AHI ) ( < 20 and reduction > or = 50 % ) was 15 % in the intention to treat ( ITT ) analysis . The AHI showed a nonsignificant decrease in mean values , from 43 to 28 . The oxygen desaturation index ( ODI ) decreased from 42 to 23 ( p = 0.010 ) , arousal index from 24 to 11 ( p = 0.019 ) , body mass index from 40 to 35 ( p = 0.003 ) and the Epworth Sleepiness Scale ( ESS ) from 9 to 5 ( p = 0.026 ) , all ITT . Metabolic status , physical functioning , and vitality evaluations improved only in the per protocol analysis . Reduction in weight correlated significantly to reductions in ESS ( p = 0.038 ) and insulin levels ( p = 0.002 ) , respectively . There were no differences based on gender or use/non-use of OSAS treatment device . CONCLUSIONS Our weight reduction program showed a limited success in reducing AHI . However , there were significant improvements in weight , ODI , arousal index , and subjective symptoms . We recommend the program as an adjunct treatment for well-motivated obese OSAS patients BACKGROUND Weight loss is associated with short-term amelioration and prevention of metabolic and cardiovascular risk , but whether these benefits persist over time is unknown . METHODS The prospect i ve , controlled Swedish Obese Subjects Study involved obese subjects who underwent gastric surgery and contemporaneously matched , conventionally treated obese control subjects . We now report follow-up data for subjects ( mean age , 48 years ; mean body-mass index , 41 ) who had been enrolled for at least 2 years ( 4047 subjects ) or 10 years ( 1703 subjects ) before the analysis ( January 1 , 2004 ) . The follow-up rate for laboratory examinations was 86.6 percent at 2 years and 74.5 percent at 10 years . RESULTS After two years , the weight had increased by 0.1 percent in the control group and had decreased by 23.4 percent in the surgery group ( P<0.001 ) . After 10 years , the weight had increased by 1.6 percent and decreased by 16.1 percent , respectively ( P<0.001 ) . Energy intake was lower and the proportion of physically active subjects higher in the surgery group than in the control group throughout the observation period . Two- and 10-year rates of recovery from diabetes , hypertriglyceridemia , low levels of high-density lipoprotein cholesterol , hypertension , and hyperuricemia were more favorable in the surgery group than in the control group , whereas recovery from hypercholesterolemia did not differ between the groups . The surgery group had lower 2- and 10-year incidence rates of diabetes , hypertriglyceridemia , and hyperuricemia than the control group ; differences between the groups in the incidence of hypercholesterolemia and hypertension were undetectable . CONCLUSIONS As compared with conventional therapy , bariatric surgery appears to be a viable option for the treatment of severe obesity , result ing in long-term weight loss , improved lifestyle , and , except for hypercholesterolemia , amelioration in risk factors that were elevated at baseline BACKGROUND Very-low-calorie diets are a well established method to achieve substantial short-term weight loss in obese patients , but long-term maintenance of the weight loss is very disappointing . A combined very-low-calorie diet and pharmacologic approach could be an effective means of prolonging its benefits . PATIENTS AND METHODS Eligible patients had a body-mass index greater than 30 kg/m2 ; those who lost 6 kg or more during a 4-week treatment with a very-low-calorie diet were r and omly assigned to 1 year of treatment with sibutramine  ( 10 mg ) or identical placebo . RESULTS In an intention-to-treat analysis , mean ( + /-SD ) absolute weight change at 1 year ( or study endpoint ) was -5.2 ( + /-7.5 ) kg in the 81 patients in the sibutramine group and + 0.5 ( + /-5.7 ) kg in the 78 patients in the placebo group ( P = 0.004 ) . When compared with their weight at study entry ( before the very-low-calorie diet ) , 86 % of patients in the sibutramine group had lost at least 5 % of their weight , compared with only 55 % of those in the placebo group ( P < 0.001 ) at the study endpoint . Similarly , at month 12 , 75 % of subjects in the sibutramine group maintained at least 100 % of the weight loss achieved with a very-low-calorie diet , compared with 42 % in the placebo group ( P < 0.01 ) . CONCLUSION Following a very-low-calorie diet , sibutramine is effective in maintaining and improving weight loss for up to 1 year Objective : Very-low-calorie diets ( VLCDs ) are used to promote short-term weight loss in obese patients . However , long-term maintenance of weight loss is generally poor . We assessed the efficacy and safety of sibutramine in maintaining weight loss achieved in obese patients by means of a 3-month VLCD . Design : A multicenter double-blind , parallel-group trial conducted over 18 months , following a 3-month open label VLCD run-in . Setting : Eight hospital centers in The Netherl and s , with subsequent follow-up in general practice .Subjects : A total of 221 obese subjects , of whom 189 were r and omized ( mean screening BMI 36.6 kg/m2 ; mean age 42.6 y ) . Measurements : Patients were given a 3-month VLCD and were required to lose 10 % or more of their initial weight . A total of 189 patients completed this phase ( mean percentage weight loss 14.5±3.2 % ) and were r and omized to sibutramine 10 mg/day ( n=94 ) or matching placebo ( n=95 ) . All patients received a recommended diet and exercise program . The primary analysis was outcome in terms of achieving 80 % weight maintenance of the VLCD period at month 18 . Secondary analysis was percentage of initial weight loss maintained at months 6 , 12 , 18 and end point . Results : At month 18 , the odds ratio for achieving successful weight maintenance was 1.76 ( 95 % CI 1.06 , 2.93 ) in favor of sibutramine ( P=0.03 ) . In intention-to-treat analysis , more than 80 % of the weight loss achieved during the VLCD phase was maintained by 70 , 51 and 30 % of sibutramine-treated patients at months 6 , 12 and 18 , respectively , compared to 48 , 31 and 20 % of placebo-treated patients . The differences between the treatment groups were significant ( P≤0.03 ) at all time points . Conclusion : Weight loss achieved with a VLCD is more effectively maintained with sibutramine in combination with a recommended diet and exercise program than with placebo over a follow-up period of 18 months . Sibutramine is well tolerated , with a safety profile consistent with that seen in other previous trials BACKGROUND AND PURPOSE To evaluate ( a ) whether an active weight reduction strategy based on the cognitive-behavioral approach and an initial very-low-calorie diet might lead to short- and long-term weight loss and alleviation of OSAS ; and ( b ) whether the results of this intervention could be enhanced by combining it with nasal continuous positive airway pressure ( CPAP ) treatment during the first 6 months . PATIENTS AND METHODS Thirty-one obese male symptomatic sleep apnea patients underwent a 2-year weight reduction program with total follow-up of 36 months from baseline . The mean age ( + /-SD ) was 49.1+/-7.9 years , body mass index 43.8+/-5.4 , and oxygen desaturation index ( ODI4 ) 51.3+/-31.1 . The patients were r and omized to CPAP ( 17 patients ) and non-CPAP groups ( 14 patients ) . RESULTS The mean weight loss was 19.1+/-10.2 kg ( 14 % of the original weight ) for the whole group at 6 months , 18.3+/-13.2 ( 13 % ) at 12 months and 12.6+/-14.7 kg ( 9 % ) at 24 months . Excellent or good treatment results , as defined in terms of an ODI4 ( average number of oxygen desaturation events p/h>4 % from baseline ) reduction of at least 50 % from the baseline , were seen in 61 % of patients at 6 months and were still observable in 42 % of patients at 24 months . The correlations between changes in weight and in ODI4 were 0.59 ( P<0.01 ) at 6 months , 0.68 ( P<0.01 ) and 0.75 ( P<0.01 ) at 24 months . Adding CPAP treatment to the weight reduction therapy for the first 6 months did not result in greater weight loss or diminution of desaturation indices ( without CPAP ) at any time point . One year after the termination of the program the mean weight loss was 6.6+/-12.9 kg , and 42 % of patients still showed at least 5 % weight loss as compared with their original weight . CONCLUSION Satisfactory weight loss associated with improvement of OSAS could be achieved by means of a cognitive-behavioral weight loss program . Adding CPAP in the initial phase of the weight reduction program did not result in significantly greater weight loss
BACKGROUND Obstructive sleep apnea ( OSA ) is a common sleep disorder associated with several adverse health outcomes .
Given the close association between OSA and obesity , lifestyle and dietary interventions are commonly recommended to patients , but the evidence for their impact on OSA has not been systematic ally examined .
OBJECTIVES To conduct a systematic review and meta- analysis to assess the impact of weight loss through diet and physical activity on measures of OSA : apnea-hypopnea index ( AHI ) and oxygen desaturation index of 4 % ( ODI4 ) .