身体成分变化及其与阻塞性睡眠呼吸暂停症状、严重程度的关系：睡眠良好试验。

Body composition changes and their relationship with obstructive sleep apnoea symptoms, severity: The Sleeping Well Trial.

机构信息

School of Agriculture, Food and Ecosystem Sciences, Faculty of Science, The University of Melbourne, Australia; Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Australia.

Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Monash University, Australia.

出版信息

Clin Nutr. 2023 Sep;42(9):1661-1670. doi: 10.1016/j.clnu.2023.07.006. Epub 2023 Jul 22.

DOI:10.1016/j.clnu.2023.07.006

PMID:37515844

Abstract

BACKGROUND & AIMS: Obstructive sleep apnoea (OSA) and obesity share a complex bi-directional relationship as location of body fat and changes in regional body composition may be more important for OSA improvement than changes in total body weight only. The aim of this study was to evaluate the impact of a 6-month weight loss intervention for adults newly diagnosed with moderate-severe OSA and obesity on regional body composition. The secondary aims evaluated the relationship between changes in OSA symptoms and severity and anthropometry and regional body composition during the first 12-months after commencing CPAP and explored differences in outcomes between males and females.

METHODS

Participants (n = 59) received CPAP overnight at home alongside a 6-month modified fasting intervention with 12-months follow up. Regional body composition was measured by Dual X-ray absorptiometry, (DXA) and anthropometry before and after the lifestyle intervention. OSA severity was measured using the apnoea hypopnea index via overnight polysomnography and OSA symptoms were measured using the Epworth Sleepiness scale.

RESULTS

Forty-seven adults (74% male) had complete measures available with a mean age of 50.0 y (SD 11.0) and BMI 34.1 kg/m (SD 5.0). Following the intervention average fat mass changed by -5.27 kg (5.36), p < 0.001) and visceral adipose tissue (-0.63 kg (0.67), p < 0.001) significantly decreased in males only with a maintenance of fat-free mass (mean -0.41 kg (1.80), p = 0.18). Females (n = 12) had significant decreases in waist circumference (mean -3.36 cm (3.18) p < 0.01), android lean (-0.12 kg (0.04), p < 0.05) and android total mass (-0.28 kg (0.39), p < 0.05) only. Regional body composition changes in males were positively associated with improvements in OSA severity (p < 0.01) but not OSA symptoms.

CONCLUSION

Improvements in regional body composition were seen in males only which were related to improvements in OSA severity but not OSA symptoms. Females may exhibit different OSA pathophysiology and may require different treatment approaches.

TRIAL REGISTRATION

https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369975&isReview=trueAACTRN12616000203459 ACTRN12616000203459.

摘要

背景与目的

阻塞性睡眠呼吸暂停（OSA）和肥胖之间存在复杂的双向关系，因为身体脂肪的位置和区域身体成分的变化可能比体重的总体变化对 OSA 的改善更为重要。本研究的目的是评估 6 个月的减肥干预对新诊断为中重度 OSA 和肥胖的成年人的区域身体成分的影响。次要目的评估在开始 CPAP 后的前 12 个月中，OSA 症状和严重程度与人体测量学和区域身体成分之间的变化关系，并探讨男女之间结局的差异。

方法

参与者（n=59）在家中接受 CPAP 治疗，并进行为期 6 个月的改良禁食干预，随访 12 个月。在生活方式干预前后，通过双能 X 线吸收法（DXA）和人体测量法测量区域身体成分。通过整夜多导睡眠图测量睡眠呼吸暂停低通气指数来测量 OSA 严重程度，通过 Epworth 嗜睡量表测量 OSA 症状。

结果

47 名成年人（74%为男性）具有完整的测量值，平均年龄为 50.0 岁（SD 11.0），BMI 为 34.1kg/m（SD 5.0）。干预后，男性的平均脂肪量减少了 5.27kg（5.36，p<0.001），内脏脂肪组织减少了 0.63kg（0.67，p<0.001），而脂肪量没有变化（平均减少了 0.41kg（1.80），p=0.18）。女性（n=12）腰围明显减小（平均减少 3.36cm（3.18），p<0.01），腹部瘦体重减少（减少 0.12kg（0.04），p<0.05），腹部总质量减少（减少 0.28kg（0.39），p<0.05）。男性的区域身体成分变化与 OSA 严重程度的改善呈正相关（p<0.01），但与 OSA 症状无关。