title: Longer term effects of very low energy diet on obstructive sleep apnoea in cohort derived from randomised controlled trial: prospective observational follow-up study.
abstract: 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.
  
  
  METHODS
  Single centre, prospective observational follow-up study.
  
  
  METHODS
  Outpatient obesity clinic in a university hospital in Stockholm, Sweden.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Obesity Unit, Department of Medicine (Huddinge), Karolinska Institute, SE-141 86 Stockholm, Sweden.
authors.forename: Kari
authors.initials: K
authors.lastname: Johansson
authors.forename: Erik
authors.initials: E
authors.lastname: Hemmingsson
authors.forename: Richard
authors.initials: R
authors.lastname: Harlid
authors.forename: Ylva
authors.initials: Y
authors.lastname: Trolle Lagerros
authors.forename: Fredrik
authors.initials: F
authors.lastname: Granath
authors.forename: Stephan
authors.initials: S
authors.lastname: Rössner
authors.forename: Martin
authors.initials: M
authors.lastname: Neovius
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D002149:Energy Intake; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000178:diet therapy; D011446:Prospective Studies; D012891:Sleep Apnea Syndromes / Q000178:diet therapy* / Q000209:etiology; D013548:Sweden; D016896:Treatment Outcome