News

Lifestyle modification program mitigates sleep apnea

Publish date: November 23, 2015
By
Matt Mahady
MDedge News

View on the News

Weight loss: Clear benefit, complex objective

Indisputably, obesity serves as a risk factor for obstructive sleep apnea. This study now adds to the growing literature demonstrating modest benefits of weight-loss on AHI, but potentially larger benefits on downstream outcomes. Despite these data, implementation of weight-loss treatments into everyday care has been limited at best. In part, this relates to a knowledge gap. Most physicians caring for patients with OSA have no training or experience in overseeing behavioral weight-loss programs, let alone prescribing weight-loss medications. Other barriers include access to ancillary staff such as nutritionists, and third-party payer coverage.

Recent guidelines identifying weight-loss counseling as a measure of OSA quality of care should energize providers to incorporate weight-loss education and interventions into clinical care. However, more research to identify effective yet feasible interventions is sorely needed. There is little argument that losing weight is a good thing. How to effectively help patients achieve this goal in the real world remains a key challenge that physicians caring for patients with OSA need to focus on.

Dr. Sanjay R. Patel is associate professor of medicine at Harvard Medical School, Boston. Dr. Reena Mehra is associate professor of medicine at the Cleveland Clinic. They reported no conflicts of interest relevant to this study. Their remarks were made in an editorial commentary accompanying Dr. Ng’s study (Chest 2015;148[5]:1127-29).


 

FROM CHEST

References

A dietitian-led lifestyle modification program helped improve obstructive sleep apnea severity and reduce daytime sleepiness over a 12-month period, Dr. Susanna S. S. Ng reported in Chest.

Dr. Ng and colleagues at the Chinese University of Hong Kong evaluated 104 patients aged 30-80 years with moderate to severe obstructive sleep apnea and a body mass index of at least 25 kg/mg2. All patients had an apnea-hypopnea index (AHI) of greater than 15. Patients were randomized to receive a dietitian-led lifestyle modification program or usual care for 12 months.

Patients in the lifestyle modification program met with a dietitian weekly for the first 4 months, then monthly for the rest of the year. They were advised to cut calories by 10%-20% and eat more protein and fiber, meet at least once with an exercise instructor, and engage in 30-minute aerobic exercise sessions 2-3 times per week. Diet advice was adjusted over time as patients lost weight. Patients in the control arm received lifestyle advice at baseline and at 6 months into the study.

Patients in the lifestyle modification arm lost an average of 1.8 kg while their AHI scores dropped 17% and BMI dropped 6%. Control patients lost 0.6 kg, their AHI scores increased 0.6%, and their BMI was reduced by 2% (Chest 2015;148[5]:1193-1203).

Changes in AHI correlated with changes in weight. AHI, first measured 4 months after the initial intensive diet counseling session, was maintained at 12-month follow-up assessment, with no rebound even after the intensive phase of the dietary intervention ended at 4 months. Secondary endpoint data also were encouraging. Reduction rates in daytime sleepiness and a modest improvement in mental health were seen in patients in the lifestyle modification group.

“This study has shown that a lifestyle modification program was an effective treatment modality in the majority of patients with moderate to severe OSA,” Dr. Ng and colleagues said, adding that “obesity and OSA are strongly associated. These new data provided strong evidence that weight reduction should be the core element in the treatment of OSA.”

Next Article:

Sleep medicine specialists issue statement on drowsy driving