A two-year weight reduction program in obese sleep apnea patients.
OBJECTIVE
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
Prospective intervention study of 33 consecutive obese OSAS patients (24 men, 9 women); 19 subjects used continuous positive airway pressure and 4 used mandibular 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.
Nerfeldt
Pia
P
Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Diseases, Huddinge, Stockholm, Sweden. pia.nerfeldt@karolinska.se
Nilsson
Bengt Y
BY
Mayor
Liliana
L
Uddén
Joanna
J
Friberg
Danielle
D
D000328:Adult; D000368:Aged; D001521:Behavior Therapy / Q000379:methods; D045422:Continuous Positive Airway Pressure; D004038:Diet, Reducing / Q000379:methods; D017097:Electric Impedance; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000178:diet therapy / Q000628:therapy*; D011446:Prospective Studies; D011615:Psychotherapy, Group / Q000379:methods; D011788:Quality of Life; D012120:Respiration Disorders / Q000150:complications; D012891:Sleep Apnea Syndromes / Q000150:complications* / Q000628:therapy; D014851:Wakefulness; D015431:Weight Loss