Batool-Anwar Salma, Goodwin James L, Drescher Amy A, Baldwin Carol M, Simon Richard D, Smith Terry W, Quan Stuart F
Brigham and Women's Hospital, Boston, MA.
University of Arizona College of Medicine, Tucson, AZ.
J Clin Sleep Med. 2014 May 15;10(5):465-72. doi: 10.5664/jcsm.3686.
Patients with severe OSA consume greater amounts of cholesterol, protein, and fat as well as have greater caloric expenditure. However, it is not known whether their activity levels or diet change after treatment with CPAP. To investigate this issue, serial assessments of activity and dietary intake were performed in the Apnea Positive Pressure Long-term Efficacy Study (APPLES); a 6-month randomized controlled study of CPAP vs. sham CPAP on neurocognitive outcomes.
Subjects were recruited into APPLES at 5 sites through clinic encounters or public advertisement. After undergoing a diagnostic polysomnogram, subjects were randomized to CPAP or sham if their AHI was ≥ 10. Adherence was assessed using data cards from the devices. At the Tucson and Walla Walla sites, subjects were asked to complete validated activity and food frequency questionnaires at baseline and their 4-month visit.
Activity and diet data were available at baseline and after 4 months treatment with CPAP or sham in up to 231 subjects (117 CPAP, 114 Sham). Mean age, AHI, BMI, and Epworth Sleepiness Score (ESS) for this cohort were 55 ± 13 [SD] years, 44 ± 27 /h, 33 ± 7.8 kg/m(2), and 10 ± 4, respectively. The participants lacking activity and diet data were younger, had lower AHI and arousal index, and had better sleep efficiency (p < 0.05). The BMI was higher among women in both CPAP and Sham groups. However, compared to women, men had higher AHI only in the CPAP group (50 vs. 34). Similarly, the arousal index was higher among men in CPAP group. Level of adherence defined as hours of device usage per night at 4 months was significantly higher among men in CPAP group (4.0 ± 2.9 vs. 2.6 ± 2.6). No changes in consumption of total calories, protein, carbohydrate or fat were noted after 4 months. Except for a modest increase in recreational activity in women (268 ± 85 vs. 170 ± 47 calories, p < 0.05), there also were no changes in activity patterns.
Except for a modest increase in recreational activity in women, OSA patients treated with CPAP do not substantially change their diet or physical activity habits after treatment. .
重度阻塞性睡眠呼吸暂停（OSA）患者摄入的胆固醇、蛋白质和脂肪量更多，热量消耗也更大。然而，尚不清楚他们在接受持续气道正压通气（CPAP）治疗后的活动水平或饮食是否会发生变化。为了研究这个问题，在睡眠呼吸暂停正压通气长期疗效研究（APPLES）中对活动和饮食摄入量进行了系列评估；这是一项为期6个月的随机对照研究，比较CPAP与假CPAP对神经认知结局的影响。
通过临床接诊或公开招募，在5个地点将受试者纳入APPLES研究。在进行诊断性多导睡眠图检查后，如果受试者的呼吸暂停低通气指数（AHI）≥10，则将其随机分为CPAP组或假CPAP组。使用设备的数据卡评估依从性。在图森和瓦拉瓦拉研究点，要求受试者在基线和4个月随访时完成经过验证的活动和食物频率问卷。
在多达231名受试者（117名CPAP组，114名假CPAP组）中获得了基线以及CPAP或假CPAP治疗4个月后的活动和饮食数据。该队列的平均年龄、AHI、体重指数（BMI）和爱泼华嗜睡量表（ESS）分别为55±13[标准差]岁、44±27次/小时、33±7.8kg/m²和10±4。缺乏活动和饮食数据的参与者更年轻，AHI和觉醒指数更低，睡眠效率更高（p<0.05）。CPAP组和假CPAP组中的女性BMI更高。然而，与女性相比，仅CPAP组中的男性AHI更高（50对34）。同样，CPAP组中的男性觉醒指数更高。以4个月时每晚设备使用小时数定义的依从水平在CPAP组中的男性中显著更高（4.0±2.9对2.6±2.6）。4个月后未发现总热量、蛋白质、碳水化合物或脂肪的摄入量有变化。除了女性的娱乐活动有适度增加（268±85对170±47卡路里，p<0.05）外，活动模式也没有变化。
除了女性的娱乐活动有适度增加外，接受CPAP治疗的OSA患者在治疗后饮食或身体活动习惯没有实质性改变。
