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Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes.

ABSTRACT: To examine whether the initial benefit of weight loss on obstructive sleep apnea (OSA) severity at 1 year is maintained at 4 years.Randomized controlled trial with follow-up at 1, 2, and 4 years.4 Look AHEAD clinical centers.Two hundred sixty-four obese adults with type 2 diabetes and OSA.Intensive lifestyle intervention with a behavioral weight loss program or diabetes support and education.Change in apnea-hypopnea index on polysomnogram.The intensive lifestyle intervention group's mean weight loss was 10.7 ± 0.7 (standard error), 7.4 ± 0.7, and 5.2 ± 0.7 kg at 1, 2, and 4 years respectively, compared to a less than 1-kg weight loss for the control group at each time (P < 0.001). Apnea-hypopnea index difference between groups was 9.7 ± 2.0, 8.0 ± 2.0, and 7.7 ± 2.3 events/h at 1, 2 and 4 years respectively (P < 0.001). Change in apnea-hypopnea index over time was related to the amount of weight loss (P < 0.0001) and intervention, independent of weight loss (P = 0.001). Remission of OSA at 4 years was 5 times more common with intensive lifestyle intervention (20.7%) than diabetes support and education (3.6%).Among obese adults with type 2 diabetes and OSA, intensive lifestyle intervention produced greater reductions in weight and apnea-hypopnea index over a 4 year period than did diabetes support and education. Beneficial effects of intensive lifestyle intervention on apneahypopnea index at 1 year persisted at 4 years, despite an almost 50% weight regain. Effect of intensive lifestyle intervention on apnea-hypopnea index was largely, but not entirely, due to weight loss.

SUBMITTER: Kuna ST

PROVIDER: S-EPMC3624818 | biostudies-literature | 2013 May

REPOSITORIES: biostudies-literature

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Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes.

Kuna Samuel T ST Reboussin David M DM Borradaile Kelley E KE Sanders Mark H MH Millman Richard P RP Zammit Gary G Newman Anne B AB Wadden Thomas A TA Jakicic John M JM Wing Rena R RR Pi-Sunyer F Xavier FX Foster Gary D GD

Sleep 20130501 5

<h4>Study objectives</h4>To examine whether the initial benefit of weight loss on obstructive sleep apnea (OSA) severity at 1 year is maintained at 4 years.<h4>Design</h4>Randomized controlled trial with follow-up at 1, 2, and 4 years.<h4>Setting</h4>4 Look AHEAD clinical centers.<h4>Participants</h4>Two hundred sixty-four obese adults with type 2 diabetes and OSA.<h4>Interventions</h4>Intensive lifestyle intervention with a behavioral weight loss program or diabetes support and education.<h4>Me ...[more]

PMID: 23633746

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Project description:Obesity and obstructive sleep apnea tend to coexist and are associated with inflammation, insulin resistance, dyslipidemia, and high blood pressure, but their causal relation to these abnormalities is unclear.We randomly assigned 181 patients with obesity, moderate-to-severe obstructive sleep apnea, and serum levels of C-reactive protein (CRP) greater than 1.0 mg per liter to receive treatment with continuous positive airway pressure (CPAP), a weight-loss intervention, or CPAP plus a weight-loss intervention for 24 weeks. We assessed the incremental effect of the combined interventions over each one alone on the CRP level (the primary end point), insulin sensitivity, lipid levels, and blood pressure.Among the 146 participants for whom there were follow-up data, those assigned to weight loss only and those assigned to the combined interventions had reductions in CRP levels, insulin resistance, and serum triglyceride levels. None of these changes were observed in the group receiving CPAP alone. Blood pressure was reduced in all three groups. No significant incremental effect on CRP levels was found for the combined interventions as compared with either weight loss or CPAP alone. Reductions in insulin resistance and serum triglyceride levels were greater in the combined-intervention group than in the group receiving CPAP only, but there were no significant differences in these values between the combined-intervention group and the weight-loss group. In per-protocol analyses, which included 90 participants who met prespecified criteria for adherence, the combined interventions resulted in a larger reduction in systolic blood pressure and mean arterial pressure than did either CPAP or weight loss alone.In adults with obesity and obstructive sleep apnea, CPAP combined with a weight-loss intervention did not reduce CRP levels more than either intervention alone. In secondary analyses, weight loss provided an incremental reduction in insulin resistance and serum triglyceride levels when combined with CPAP. In addition, adherence to a regimen of weight loss and CPAP may result in incremental reductions in blood pressure as compared with either intervention alone. (Funded by the National Heart, Lung, and Blood Institute; ClinicalTrials.gov number, NCT0371293 .).

Dataset Information

Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes.

Publications

Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes.

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