title: Does intentional weight loss improve daytime sleepiness? A systematic review and meta-analysis.
abstract: Obesity is associated with excessive daytime sleepiness, but its causality remains unclear. We aimed to assess the extent to which intentional weight loss affects daytime sleepiness. Electronic databases were searched through 24 October 2016. Studies involving overweight or obese adults, a weight loss intervention and repeated valid measures of daytime sleepiness were included in the review. Two independent reviewers extracted data on study characteristics, main outcome (change in daytime sleepiness score standardized by standard deviation of baseline sleepiness scores), potential mediators (e.g. amount of weight loss and change in apnoea-hypopnoea index) and other co-factors (e.g. baseline demographics). Forty-two studies were included in the review. Fifteen before-and-after studies on surgical weight loss interventions showed large improvements in daytime sleepiness, with a standardized effect size of -0.97 (95% confidence interval [CI] -1.21 to -0.72). Twenty-seven studies on non-surgical weight loss interventions showed small-to-moderate improvement in daytime sleepiness, with a standardized effect size of -0.40 (95%CI -0.52 to -0.27), with no difference between controlled and before-and-after studies. We found a nonlinear association between amount of weight loss and change in daytime sleepiness. This review suggests that weight loss interventions improve daytime sleepiness, with a clear dose-response relationship. This supports the previously hypothesized causal effect of obesity on daytime sleepiness. It is important to assess and manage daytime sleepiness in obese patients.
authors.affiliation: Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.|Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.|Obesity and Population Health Unit, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia.|Obesity and Population Health Unit, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: W L
authors.identifier: 0000-0002-1844-5986
authors.initials: WL
authors.lastname: Ng
authors.affiliation: Obesity and Population Health Unit, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia.
authors.forename: C E
authors.initials: CE
authors.lastname: Stevenson
authors.affiliation: Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.|Obesity and Population Health Unit, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia.|Obesity and Population Health Unit, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Wong
authors.affiliation: Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.|Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona, USA.
authors.forename: S
authors.initials: S
authors.lastname: Tanamas
authors.affiliation: Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.|Obesity and Population Health Unit, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia.|Obesity and Population Health Unit, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Boelsen-Robinson
authors.affiliation: Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.|Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
authors.forename: J E
authors.initials: JE
authors.lastname: Shaw
authors.affiliation: General Respiratory and Sleep Medicine, Department of Allergy, Immunology, and Respiratory Medicine, The Alfred, Melbourne, Australia.|Department of Medicine, Monash University, The Alfred Hospital, Melbourne, Australia.
authors.forename: M T
authors.initials: MT
authors.lastname: Naughton
authors.affiliation: Clinical Obesity Research, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Dixon
authors.affiliation: Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.|Obesity and Population Health Unit, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia.|Obesity and Population Health Unit, Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Peeters
mesh_terms: D050110:Bariatric Surgery; D006801:Humans; D009765:Obesity / Q000150:complications* / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D050177:Overweight / Q000150:complications* / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D040242:Risk Reduction Behavior; D012894:Sleep Stages / Q000502:physiology*; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Daytime sleepiness; intervention; obesity; weight loss