title: Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea.
abstract: BACKGROUND
  Obesity is the most important risk factor for obstructive sleep apnea (OSA). However, although included in clinical guidelines, no randomized controlled studies have been performed on the effects of weight reduction on mild OSA.
  
  
  OBJECTIVE
  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 (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 objectively measured outcome variable. Change in symptoms and the 15D-Quality of Life tool were used as subjective measurements.
  
  
  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 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.
authors.affiliation: Department of Otorhinolaryngology, Institute of Clinical Medicine, University of Kuopio, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio, Finland. henri.tuomilehto@kuh.fi
authors.forename: Henri P I
authors.initials: HP
authors.lastname: Tuomilehto
authors.forename: Juha M
authors.initials: JM
authors.lastname: Seppä
authors.forename: Markku M
authors.initials: MM
authors.lastname: Partinen
authors.forename: Markku
authors.initials: M
authors.lastname: Peltonen
authors.forename: Helena
authors.initials: H
authors.lastname: Gylling
authors.forename: Jaakko O I
authors.initials: JO
authors.lastname: Tuomilehto
authors.forename: Esko J
authors.initials: EJ
authors.lastname: Vanninen
authors.forename: Jouko
authors.initials: J
authors.lastname: Kokkarinen
authors.forename: Johanna K
authors.initials: JK
authors.lastname: Sahlman
authors.forename: Tarja
authors.initials: T
authors.lastname: Martikainen
authors.forename: Erkki J O
authors.initials: EJ
authors.lastname: Soini
authors.forename: Jukka
authors.initials: J
authors.lastname: Randell
authors.forename: Hannu
authors.initials: H
authors.lastname: Tukiainen
authors.forename: Matti
authors.initials: M
authors.lastname: Uusitupa
mesh_terms: D015992:Body Mass Index; D003376:Counseling / Q000379:methods*; D004038:Diet, Reducing / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000178:diet therapy*; D016017:Odds Ratio; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D015431:Weight Loss