Lojander J, Mustajoki P, Rönkä S, Mecklin P, Maasilta P
Department of Medicine, Helsinki University Central Hospital, Finland.
J Intern Med. 1998 Sep;244(3):251-5. doi: 10.1046/j.1365-2796.1998.00387.x.
This longitudinal, clinical intervention study was designed to investigate whether pulmonary departments can set up a cost-effective weight and lifestyle programme as primary treatment of obstructive sleep apnoea syndrome (OSAS).
A weight reduction programme (1 year) in a pulmonary department for outpatients in Helsinki University Central Hospital.
A total of 24 (23 men) moderately obese (body mass index [BMI], 30-40 kg m(-2)) patients with newly diagnosed OSAS. Interventions. The first 6 weeks consisted of a very low-calorie diet (VLCD, 500 kcal day(-1)) and thereafter normal food low in calories. There were altogether 12 group meetings for behavioural management.
Daytime somnolence, BMI and oxygen desaturation index of 4% (ODI4) were measured prior to the programme, at the end of the VLCD phase and at 1 year.
The programme was easy to administer without any serious side-effects. At 1 year, patients had lost a mean of 33% of their overweight (mean weight at baseline 110 kg, after 99 kg) and their ODI4 indexes improved significantly (P < 0.005). There was no correlation between the amount of weight loss and improvement in ODI4 indexes. The cost per patient was about half the cost of treatment with nCPAP (nasal continuous positive airway pressure) for 1 year at our hospital.
A nurse-managed programme with VLCD and behavioural management is safe and effective on an outpatient basis. Weight loss should be encouraged in OSAS in patients with moderate overweight. The amount of weight loss needed for improvement of OSAS is unique to each individual.
本纵向临床干预研究旨在调查肺科能否设立一项具有成本效益的体重及生活方式计划，作为阻塞性睡眠呼吸暂停综合征（OSAS）的主要治疗方法。
在赫尔辛基大学中心医院肺科为门诊患者开展一项为期1年的减重计划。
共有24名（23名男性）新诊断为OSAS的中度肥胖患者（体重指数[BMI]，30 - 40 kg/m²）。干预措施。前6周采用极低热量饮食（VLCD，500千卡/天），之后为低热量正常饮食。共召开12次行为管理小组会议。
在计划开始前、VLCD阶段结束时及1年时测量日间嗜睡情况、BMI和4%氧饱和度下降指数（ODI4）。
该计划易于实施，无任何严重副作用。1年时，患者平均减重33%（基线平均体重110 kg，之后为99 kg），且ODI4指数显著改善（P < 0.005）。体重减轻量与ODI4指数改善之间无相关性。每位患者的成本约为我院nCPAP（鼻持续气道正压通气）治疗1年成本的一半。
由护士管理的VLCD及行为管理计划在门诊实施安全有效。对于中度超重的OSAS患者，应鼓励其减重。改善OSAS所需的减重量因人而异。
