University of Pennsylvania, Philadelphia, Pennsylvania.
Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
Am J Respir Crit Care Med. 2021 Jan 15;203(2):221-229. doi: 10.1164/rccm.201912-2511OC.
Weight loss is recommended to treat obstructive sleep apnea (OSA). To determine whether the initial benefit of intensive lifestyle intervention (ILI) for weight loss on OSA severity is maintained at 10 years. Ten-year follow-up polysomnograms of 134 of 264 adults in Sleep AHEAD (Action for Health in Diabetes) with overweight/obesity, type 2 diabetes mellitus, and OSA were randomized to ILI for weight loss or diabetes support and education (DSE). Change in apnea-hypopnea index (AHI) was measured. Mean ± SE weight losses of ILI participants of 10.7 ± 0.7, 7.4 ± 0.7, 5.1 ± 0.7, and 7.1 ± 0.8 kg at 1, 2, 4, and 10 years, respectively, were significantly greater than the 1-kg weight loss at 1, 2, and 4 years and 3.5 ± 0.8 kg weight loss at 10 years for the DSE group ( values ≤ 0.0001). AHI was lower with ILI than DSE by 9.7, 8.0, and 7.9 events/h at 1, 2, and 4 years, respectively ( values ≤ 0.0004), and 4.0 events/h at 10 years ( = 0.109). Change in AHI over time was related to amount of weight loss, baseline AHI, visit year ( values < 0.0001), and intervention independent of weight change ( = 0.01). OSA remission at 10 years was more common with ILI (34.4%) than DSE (22.2%). Participants with OSA and type 2 diabetes mellitus receiving ILI for weight loss had reduced OSA severity at 10 years. No difference in OSA severity was present between ILI and DSE groups at 10 years. Improvement in OSA severity over the 10-year period with ILI was related to change in body weight, baseline AHI, and intervention independent of weight change.
减肥被推荐用于治疗阻塞性睡眠呼吸暂停（OSA）。为了确定强化生活方式干预（ILI）最初对减肥治疗 OSA 严重程度的益处是否能维持 10 年。超重/肥胖、2 型糖尿病和 OSA 的睡眠 AHEAD（糖尿病健康行动）264 名成年人中的 134 名在 10 年后进行了多导睡眠图随访，这些参与者被随机分为 ILI 减肥组或糖尿病支持和教育（DSE）组。测量了呼吸暂停低通气指数（AHI）的变化。ILI 组参与者在 1、2、4 和 10 年时分别实现了 10.7±0.7、7.4±0.7、5.1±0.7 和 7.1±0.8kg 的体重减轻，明显大于 DSE 组在 1、2 和 4 年时的 1kg 体重减轻和 10 年时的 3.5±0.8kg 体重减轻（值≤0.0001）。在 1、2 和 4 年时，与 DSE 相比，ILI 的 AHI 分别降低了 9.7、8.0 和 7.9 次/小时（值≤0.0004），在 10 年时降低了 4.0 次/小时（值=0.109）。随着时间的推移，AHI 的变化与体重减轻量、基线 AHI、就诊年份（值<0.0001）以及独立于体重变化的干预措施有关（值=0.01）。ILI 组（34.4%）10 年时 OSA 缓解的比例高于 DSE 组（22.2%）。接受减肥 ILI 的 OSA 和 2 型糖尿病患者在 10 年后 OSA 严重程度降低。在 10 年时，ILI 和 DSE 组之间的 OSA 严重程度没有差异。ILI 组在 10 年期间 OSA 严重程度的改善与体重变化、基线 AHI 以及独立于体重变化的干预措施有关。
