Department of Nutrition & Dietetics, School of Health Sciences & Education, Harokopio University, Athens, Greece.
Center of Sleep Disorders, 1st Department of Critical Care and Pulmonary Services, Medical School of Athens University, Evangelismos Hospital, Athens, Greece.
J Clin Sleep Med. 2022 May 1;18(5):1251-1261. doi: 10.5664/jcsm.9834.
Lifestyle-induced weight loss is a complementary therapeutic approach for obstructive sleep apnea (OSA). We aimed at identifying the dose-response relationship between weight loss and OSA severity improvement.
This is a secondary analysis of a 6-month clinical trial in 180 adult, overweight/obese moderate-to-severe OSA patients. Participants were randomized to a standard care, a Mediterranean diet, or a Mediterranean lifestyle arm. All patients were prescribed with continuous positive airway pressure (CPAP), while intervention arms additionally participated in a weight-loss dietary/lifestyle intervention. Based on percent change in weight at 6 months, participants were categorized into a weight-stable/gain (WS/GG) group or 3 weight-loss groups (WLG): < 5%WLG, 5%-10%WLG, and ≥ 10%WLG. Polysomnographic data and OSA symptoms were evaluated preintervention and postintervention.
Respiratory events and oximetry indices improved only in patients who lost weight and improvements were proportional to the degree of weight loss. Median percent change in apnea-hypopnea index (AHI) was -11.7%, - 37.9%, and - 49.3% in the < 5%WLG, 5%-10%WLG, and ≥ 10%WLG, respectively ( < .001). Compared to the WS/GG, the age-, sex-, baseline-, and CPAP use-adjusted relative risk (95% confidence interval) of severe OSA (AHI ≥ 30 events/h) was 0.45 (0.23-0.87) in the 5%-10%WLG and 0.32 (0.17-0.64) in the ≥ 10%WLG; the risk was also lower in the ≥ 10%WLG vs the < 5%WLG (0.42 [0.22-0.82]). Insomnia and daytime sleepiness also improved more in participants exhibiting ≥ 5% weight loss.
Even a < 5% weight loss can reduce respiratory events, but a ≥ 5% and ideally ≥ 10% weight loss is necessary for reducing the prevalence of severe OSA.
Registry: ClinicalTrials.gov; Name: Mediterranean Diet/Lifestyle Intervention in Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT02515357; Identifier: NCT02515357.
Georgoulis M, Yiannakouris N, Kechribari I, et al. Dose-response relationship between weight loss and improvements in obstructive sleep apnea severity after a diet/lifestyle intervention: secondary analyses of the "MIMOSA" randomized clinical trial. . 2022;18(5):1251-1261.
生活方式引起的体重减轻是阻塞性睡眠呼吸暂停（OSA）的一种补充治疗方法。我们旨在确定体重减轻与 OSA 严重程度改善之间的剂量反应关系。
这是对 180 名成年超重/肥胖中重度 OSA 患者进行的为期 6 个月的临床试验的二次分析。参与者被随机分配到标准护理、地中海饮食或地中海生活方式组。所有患者均被处方持续气道正压通气（CPAP），而干预组则另外参加了减肥饮食/生活方式干预。根据 6 个月时体重的百分比变化，参与者被分为体重稳定/增加（WS/GG）组或 3 个体重减轻组（WLG）：<5%WLG、5%-10%WLG 和≥10%WLG。在干预前和干预后评估了多导睡眠图数据和 OSA 症状。
只有体重减轻的患者呼吸事件和血氧饱和度指数得到改善，改善程度与体重减轻程度成正比。<5%WLG、5%-10%WLG 和≥10%WLG 组的呼吸暂停低通气指数（AHI）中位数百分比变化分别为-11.7%、-37.9%和-49.3%（<0.001）。与 WS/GG 相比，5%-10%WLG 和≥10%WLG 的年龄、性别、基线和 CPAP 使用调整后的严重 OSA（AHI≥30 次/小时）的相对风险（95%置信区间）分别为 0.45（0.23-0.87）和 0.32（0.17-0.64）；≥10%WLG 与<5%WLG 相比，风险也较低（0.42[0.22-0.82]）。在表现出≥5%体重减轻的参与者中，失眠和白天嗜睡也得到了更大的改善。
即使体重减轻<5%也可以减少呼吸事件，但需要≥5%，理想情况下≥10%的体重减轻才能降低严重 OSA 的患病率。
ClinicalTrials.gov；名称：地中海饮食/生活方式干预阻塞性睡眠呼吸暂停；网址：https://clinicaltrials.gov/ct2/show/NCT02515357；标识符：NCT02515357。
Georgoulis M, Yiannakouris N, Kechribari I, et al. （2022）。减肥与饮食/生活方式干预后阻塞性睡眠呼吸暂停严重程度改善之间的剂量反应关系：“MIMOSA”随机临床试验的二次分析。睡眠，18（5），1251-1261。
