title: Sleep architecture following a weight loss intervention in overweight and obese patients with obstructive sleep apnea and type 2 diabetes: relationship to apnea-hypopnea index.
abstract: OBJECTIVE
  To determine if weight loss and/ or changes in apnea-hypopnea index (AHI) improve sleep architecture in overweight/ obese adults with type 2 diabetes (T2D) and obstructive sleep apnea (OSA).
  
  
  METHODS
  This was a randomized controlled trial including 264 overweight/ obese adults with T2D and OSA. Participants were randomized to an intensive lifestyle intervention (ILI) or a diabetes and support education (DSE) control group. Measures included anthropometry, AHI, and sleep at baseline and year-1, year-2, and year-4 follow-ups.
  
  
  RESULTS
  Changes in sleep duration (total sleep time [TST]), continuity [wake after sleep onset (WASO)], and architecture stage 1, stage 2, slow wave sleep, and REM sleep) from baseline to year 1, 2, and 4 did not differ between ILI and DSE. Repeated-measure mixed-model analyses including data from baseline through year-4 for all participants demonstrated a significant positive association between AHI and stage 1 sleep (p < 0.001), and a significant negative association between AHI and stage 2 (p = 0.01) and REM sleep (p < 0.001), whereas changes in body weight had no relation to any sleep stages or TST. WASO had a significant positive association with change in body weight (p = 0.009).
  
  
  CONCLUSIONS
  Compared to control, the ILI did not induce significant changes in sleep across the 4-year follow-up. In participants overall, reduced AHI in overweight/ obese adults with T2D and OSA was associated with decreased stage 1, and increased stage 2 and REM sleep. These sleep architecture changes are more strongly related to reductions in AHI than body weight, whereas WASO may be more influenced by weight than AHI.
  
  
  BACKGROUND
  NCT00194259.
authors.affiliation: Columbia University, New York, NY.
authors.forename: Ari
authors.initials: A
authors.lastname: Shechter
authors.affiliation: Columbia University, New York, NY.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: St-Onge
authors.affiliation: University of Pennsylvania, Philadelphia, PA and Philadelphia Veterans Affairs Medical Center, Philadelphia, PA.
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Kuna
authors.affiliation: Clinilabs, New York, NY.
authors.forename: Gary
authors.initials: G
authors.lastname: Zammit
authors.affiliation: Columbia University, New York, NY.
authors.forename: Arindam
authors.initials: A
authors.lastname: RoyChoudhury
authors.affiliation: University of Pittsburgh, Pittsburgh, PA.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.affiliation: Brown University, Providence, RI.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Millman
authors.affiliation: Wake Forest University, Winston-Salem, NC.
authors.forename: David M
authors.initials: DM
authors.lastname: Reboussin
authors.affiliation: University of Pennsylvania, Philadelphia, PA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Wadden
authors.affiliation: University of Pittsburgh, Pittsburgh, PA.
authors.forename: John M
authors.initials: JM
authors.lastname: Jakicic
authors.affiliation: Columbia University, New York, NY.
authors.forename: F Xavier
authors.initials: FX
authors.lastname: Pi-Sunyer
authors.affiliation: Brown University, Providence, RI.
authors.forename: Rena R
authors.initials: RR
authors.lastname: Wing
authors.affiliation: Temple University, Philadelphia, PA.
authors.forename: Gary D
authors.initials: GD
authors.lastname: Foster
mesh_terms: D000328:Adult; D000368:Aged; D000886:Anthropometry; D001049:Apnea / Q000453:epidemiology / Q000503:physiopathology; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D004038:Diet, Reducing; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D050177:Overweight / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D010353:Patient Education as Topic / Q000379:methods; D017286:Polysomnography / Q000379:methods; D011237:Predictive Value of Tests; D012016:Reference Values; D018570:Risk Assessment; D040242:Risk Reduction Behavior; D012890:Sleep / Q000502:physiology*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D012894:Sleep Stages / Q000502:physiology; D012895:Sleep, REM / Q000502:physiology; D016896:Treatment Outcome; D015431:Weight Loss / Q000502:physiology*
keywords: obesity; obstructive sleep apnea; sleep architecture; type 2 diabetes