Department of Chest Diseases, Ege University, Izmir, Turkey.
Center for Sleep and Vigilance Disorders, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
J Sleep Res. 2018 Dec;27(6):e12705. doi: 10.1111/jsr.12705. Epub 2018 May 24.
The effect of positive airway pressure treatment on weight and markers of central obesity in patients with obstructive sleep apnea remains unclear. We studied the change in body weight and anthropometric measures following positive airway pressure treatment in a large clinical cohort. Patients with obstructive sleep apnea with positive airway pressure treatment from the European Sleep Apnea Database registry (n = 1,415, 77% male, age 54 ± 11 [mean ± SD] years, body mass index 31.7 ± 6.4 kg/m , apnea-hypopnea index 37 ± 24 n per hr, Epworth Sleepiness Scale 10.2 ± 5.0) were selected. Changes in body mass index and neck/waist/hip circumferences at baseline and at follow-up visit were analysed. Overall, body mass index (0.0 [95% confidence interval, -0.1 to 0.2] kg/m ) and neck circumference (0.0 (95% confidence interval, -0.1 to 0.1] cm) were unchanged after positive airway pressure treatment compared with baseline (follow-up duration 1.1 ± 1.0 years and compliance 5.2 ± 2.1 hr per day). However, in non-obese (body mass index <30 kg/m ) patients, positive airway pressure treatment was associated with an increased body mass index and waist circumference (0.4 [0.3-0.5] kg/m and 0.8 [0.4-1.2] cm, respectively, all p < 0.05), and weight gain was significantly associated with higher positive airway pressure compliance and longer positive airway pressure treatment duration. In the obese subgroup, body mass index was reduced after positive airway pressure treatment (-0.3 [-0.5 to -0.1] kg/m , p < 0.05) mainly in patients with a strong reduction in Epworth Sleepiness Scale. In conclusion, positive airway pressure therapy was not found to systematically change body mass index in the European Sleep Apnea Database cohort, but the response was heterogeneous. Our findings suggest that weight gain may be restricted to an obstructive sleep apnea phenotype without established obesity. Lifestyle intervention needs to be considered in both lean and obese patients with obstructive sleep apnea receiving positive airway pressure treatment.
气道正压治疗对阻塞性睡眠呼吸暂停患者体重和中心性肥胖标志物的影响仍不清楚。我们在一个大型临床队列中研究了气道正压治疗后体重和人体测量学指标的变化。从欧洲睡眠呼吸暂停数据库登记处（n=1415，77%为男性，年龄 54±11[均值±标准差]岁，体重指数 31.7±6.4kg/m2，呼吸暂停低通气指数 37±24 次/小时，Epworth 睡眠量表 10.2±5.0）中选择接受气道正压治疗的阻塞性睡眠呼吸暂停患者。分析了基线和随访时体重指数和颈围/腰围/臀围的变化。总体而言，与基线相比，气道正压治疗后体重指数（0.0[95%置信区间，-0.1 至 0.2]kg/m2）和颈围（0.0[95%置信区间，-0.1 至 0.1]cm）无变化治疗随访时间为 1.1±1.0 年，顺应性为 5.2±2.1 小时/天）。然而，在非肥胖（体重指数<30kg/m2）患者中，气道正压治疗与体重指数和腰围增加相关（分别为 0.4[0.3-0.5]kg/m2和 0.8[0.4-1.2]cm，均 p<0.05），体重增加与较高的气道正压顺应性和较长的气道正压治疗时间显著相关。在肥胖亚组中，气道正压治疗后体重指数降低（-0.3[-0.5 至-0.1]kg/m2，p<0.05），主要发生在 Epworth 睡眠量表明显降低的患者中。总之，在欧洲睡眠呼吸暂停数据库队列中，气道正压治疗并未发现系统地改变体重指数，但反应存在异质性。我们的发现表明，体重增加可能仅限于没有明确肥胖的阻塞性睡眠呼吸暂停表型。在接受气道正压治疗的阻塞性睡眠呼吸暂停患者中，无论肥胖程度如何，都需要考虑生活方式干预。
