title: Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes.
abstract: OBJECTIVE
  To examine whether the initial benefit of weight loss on obstructive sleep apnea (OSA) severity at 1 year is maintained at 4 years.
  
  
  METHODS
  Randomized controlled trial with follow-up at 1, 2, and 4 years.
  
  
  METHODS
  4 Look AHEAD clinical centers.
  
  
  METHODS
  Two hundred sixty-four obese adults with type 2 diabetes and OSA.
  
  
  METHODS
  Intensive lifestyle intervention with a behavioral weight loss program or diabetes support and education.
  
  
  METHODS
  Change in apnea-hypopnea index on polysomnogram.
  
  
  RESULTS
  The intensive lifestyle intervention group's mean weight loss was 10.7 ± 0.7 (standard error), 7.4 ± 0.7, and 5.2 ± 0.7 kg at 1, 2, and 4 years respectively, compared to a less than 1-kg weight loss for the control group at each time (P < 0.001). Apnea-hypopnea index difference between groups was 9.7 ± 2.0, 8.0 ± 2.0, and 7.7 ± 2.3 events/h at 1, 2 and 4 years respectively (P < 0.001). Change in apnea-hypopnea index over time was related to the amount of weight loss (P < 0.0001) and intervention, independent of weight loss (P = 0.001). Remission of OSA at 4 years was 5 times more common with intensive lifestyle intervention (20.7%) than diabetes support and education (3.6%).
  
  
  CONCLUSIONS
  Among obese adults with type 2 diabetes and OSA, intensive lifestyle intervention produced greater reductions in weight and apnea-hypopnea index over a 4 year period than did diabetes support and education. Beneficial effects of intensive lifestyle intervention on apneahypopnea index at 1 year persisted at 4 years, despite an almost 50% weight regain. Effect of intensive lifestyle intervention on apnea-hypopnea index was largely, but not entirely, due to weight loss.
authors: University of Pennsylvania, Philadelphia, PA, USA. skuna@mail.med.upenn.edu
authors: Samuel T
authors: ST
authors: Kuna
authors: David M
authors: DM
authors: Reboussin
authors: Kelley E
authors: KE
authors: Borradaile
authors: Mark H
authors: MH
authors: Sanders
authors: Richard P
authors: RP
authors: Millman
authors: Gary
authors: G
authors: Zammit
authors: Anne B
authors: AB
authors: Newman
authors: Thomas A
authors: TA
authors: Wadden
authors: John M
authors: JM
authors: Jakicic
authors: Rena R
authors: RR
authors: Wing
authors: F Xavier
authors: FX
authors: Pi-Sunyer
authors: Gary D
authors: GD
authors: Foster
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy*; D005247:Feeding Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000628:therapy*; D010353:Patient Education as Topic; D017286:Polysomnography; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Apnea-hypopnea index; polysomnogram
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