title: A Randomized Controlled Study to Examine the Effect of a Lifestyle Modification Program in OSA.
abstract: BACKGROUND
  Obesity is an important risk factor for OSA. This study aimed to assess the effect of weight reduction through a lifestyle modification program (LMP) on patients with moderate to severe OSA.
  
  
  METHODS
  This was a parallel group, randomized controlled trial. Altogether, 104 patients with moderate to severe OSA diagnosed on portable home sleep monitoring were randomized to receive a dietician-led LMP or usual care for 12 months. The primary outcome was reduction of apnea-hypopnea index (AHI) at 12 months as assessed by portable home sleep monitoring.
  
  
  RESULTS
  In the intention-to-treat analysis (ITT), LMP (n = 61) was more effective in reducing AHI from baseline (16.9% fewer events in the LMP group vs 0.6% more events in the control group, P = .011). LMP was more effective in reducing BMI (-1.8 kg/m2, 6.0% of the initial BMI; -0.6 kg/m2, 2.0% of the initial BMI in control group; P < .001). The reduction in daytime sleepiness as assessed by Epworth Sleepiness Scale was not significant in ITT but was more in the LMP group (-3.5 in the LMP group vs -1.1 in the control group, P = .004) by treatment per protocol analysis. There was modest improvement in mental health in the Short Form Health Survey. Eating behavior was improved with increased intake of protein and fiber. These changes were observed 4 months after the initial intensive diet counseling and persisted at 12 months.
  
  
  CONCLUSIONS
  LMP was effective in reducing the severity of OSA and daytime sleepiness. The beneficial effect was sustained in 12 months.
  
  
  BACKGROUND
  ClinicalTrials.gov; No.: NCT01384760; URL: www.clinicaltrials.gov.
authors.affiliation: Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
authors.forename: Susanna S S
authors.initials: SSS
authors.lastname: Ng
authors.affiliation: Centre for Nutritional Studies, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
authors.forename: Ruth S M
authors.initials: RSM
authors.lastname: Chan
authors.affiliation: Centre for Nutritional Studies, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
authors.forename: Jean
authors.initials: J
authors.lastname: Woo
authors.affiliation: Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
authors.forename: Tat-On
authors.initials: TO
authors.lastname: Chan
authors.affiliation: Centre for Nutritional Studies, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
authors.forename: Bernice H K
authors.initials: BHK
authors.lastname: Cheung
authors.affiliation: Centre for Nutritional Studies, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
authors.forename: Mandy M M
authors.initials: MMM
authors.lastname: Sea
authors.affiliation: Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
authors.forename: Kin-Wang
authors.initials: KW
authors.lastname: To
authors.affiliation: Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
authors.forename: Ken K P
authors.initials: KKP
authors.lastname: Chan
authors.affiliation: Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ngai
authors.affiliation: Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
authors.forename: Wing-Ho
authors.initials: WH
authors.lastname: Yip
authors.affiliation: Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.
authors.forename: Fanny W S
authors.initials: FWS
authors.lastname: Ko
authors.affiliation: Division of Respiratory Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China. Electronic address: dschui@cuhk.edu.hk.
authors.forename: David S C
authors.initials: DSC
authors.lastname: Hui
mesh_terms: D002681:China / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D017286:Polysomnography; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012894:Sleep Stages / Q000502:physiology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D015431:Weight Loss