title: Effects of CPAP on body weight in patients with obstructive sleep apnoea: a meta-analysis of randomised trials.
abstract: BACKGROUND
  The impact of obstructive sleep apnoea (OSA) treatment with CPAP on weight is not clear. This meta-analysis was designed to assess whether OSA treatment with CPAP promotes changes in body mass index (BMI) and weight.
  
  
  METHODS
  We searched PubMed, SCOPUS and Cochrane Central Register electronic databases through 1 October 2013 (including papers in press at that time), without language restrictions. We identified randomised trials of CPAP versus controls with a minimum treatment duration of 4 weeks that objectively measured BMI. Data were independently abstracted and reviewed by two investigators using a standardised protocol.
  
  
  RESULTS
  We included a total of 3181 patients from 25 randomised trials that measured BMI and weight. All studies enrolled mainly overweight and obese patients. The fixed-effects meta-analysis revealed that CPAP promoted significant increase on BMI (Hedges' g=0.14, 95% CI 0.07 to 0.21, I(2)=16.2%) and weight (Hedges' g=0.17, 95% CI 0.10 to 0.24, I(2)=0%). The funnel plot revealed low risk of publication bias. Meta-regression analyses including age, gender, baseline BMI, baseline weight, OSA severity, CPAP compliance, use of sham CPAP, study duration, study design (crossover/parallel), study origin (Western/Eastern), recommendation for dietary changes or physical activity, revealed that no single predictor influenced the main outcome for weight. Baseline weight was a predictor of increased BMI after CPAP.
  
  
  CONCLUSIONS
  OSA treatment with CPAP promotes significant increase in BMI and weight. Additional therapies for body weight reduction must be recommended for overweight or obese patients with OSA initiated on CPAP.
authors.affiliation: Center of Clinical and Epidemiologic Research (CPCE),University of Sao Paulo, Sao Paulo, Brazil Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil Faculdade de Medicina (FMUSP), University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Luciano F
authors.initials: LF
authors.lastname: Drager
authors.affiliation: Center of Clinical and Epidemiologic Research (CPCE),University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: André R
authors.initials: AR
authors.lastname: Brunoni
authors.affiliation: Center of Clinical and Epidemiologic Research (CPCE),University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Raimundo
authors.initials: R
authors.lastname: Jenner
authors.affiliation: Heart Institute (InCor), University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Geraldo
authors.initials: G
authors.lastname: Lorenzi-Filho
authors.affiliation: Center of Clinical and Epidemiologic Research (CPCE),University of Sao Paulo, Sao Paulo, Brazil Faculdade de Medicina (FMUSP), University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Isabela M
authors.initials: IM
authors.lastname: Benseñor
authors.affiliation: Center of Clinical and Epidemiologic Research (CPCE),University of Sao Paulo, Sao Paulo, Brazil Faculdade de Medicina (FMUSP), University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Paulo A
authors.initials: PA
authors.lastname: Lotufo
mesh_terms: D015992:Body Mass Index; D045422:Continuous Positive Airway Pressure; D006801:Humans; D009765:Obesity / Q000150:complications; D016032:Randomized Controlled Trials as Topic; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000628:therapy*; D015430:Weight Gain
keywords: Sleep apnoea