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Randomized Controlled Trial
. 2009 Sep 28;169(17):1619-26.
doi: 10.1001/archinternmed.2009.266.

A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study

Gary D Foster  1 , Kelley E Borradaile, Mark H Sanders, Richard Millman, Gary Zammit, Anne B Newman, Thomas A Wadden, David Kelley, Rena R Wing, F Xavier Pi-Sunyer, David Reboussin, Samuel T Kuna; Sleep AHEAD Research Group of Look AHEAD Research Group
Collaborators, Affiliations
Randomized Controlled Trial

A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study

Gary D Foster et al. Arch Intern Med. .

Abstract

Background: The belief that weight loss improves obstructive sleep apnea (OSA) has limited empirical support. The purpose of this 4-center study was to assess the effects of weight loss on OSA over a 1-year period.

Methods: The study included 264 participants with type 2 diabetes and a mean (SD) age of 61.2 (6.5) years, weight of 102.4 (18.3) kg, body mass index (BMI) (calculated as weight in kilograms divided by height in meters squared) of 36.7 (5.7), and an apnea-hypopnea index (AHI) of 23.2 (16.5) events per hour. The participants were randomly assigned to either a behavioral weight loss program developed specifically for obese patients with type 2 diabetes (intensive lifestyle intervention [ILI]) or 3 group sessions related to effective diabetes management (diabetes support and education [DSE]).

Results: The ILI participants lost more weight at 1 year than did DSE participants (10.8 kg vs 0.6 kg; P < .001). Relative to the DSE group, the ILI intervention was associated with an adjusted (SE) decrease in AHI of 9.7 (2.0) events per hour (P < .001). At 1 year, more than 3 times as many participants in the ILI group than in the DSE group had total remission of their OSA, and the prevalence of severe OSA among ILI participants was half that of the DSE group. Initial AHI and weight loss were the strongest predictors of changes in AHI at 1 year (P < .01). Participants with a weight loss of 10 kg or more had the greatest reductions in AHI.

Conclusions: Physicians and their patients can expect that weight loss will result in significant and clinically relevant improvements in OSA among obese patients with type 2 diabetes. Trial Registration clinicaltrials.gov Identifier: NCT00194259.

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Figures

Figure 1
Figure 1
Participant flow diagram. DSE indicates diabetes support and education; ILI, intensive lifestyle intervention; and OSA, obstructive sleep apnea.
Figure 2
Figure 2
Changes in weight and apnea-hypopnea index (AHI) over 1 year by treatment condition (diabetes support and education [DSE] and intensive lifestyle intervention [ILI]). Data are from all 264 participants. The between-group differences were significant for changes in weight (P<.001) and AHI (P<.001). Means are adjusted by research site. Error bars indicate 95% confidence intervals.
Figure 3
Figure 3
Percentage of participants in diabetes support and education (DSE) and intensive lifestyle intervention (ILI) whose obstructive sleep apnea (OSA) category improved (≥1 category change), worsened (≤1 category Change), or stayed the same (no change in category). Data are from the 219 participants who had baseline and 1-year data.
Figure 4
Figure 4
Changes in apnea-hypopnea index (AHI) by category of weight change over 1 year. Data are from the 219 participants who had baseline and 1-year data. The asterisk indicates that, after multiple comparisons were controlled for, participants who lost 10 kg or more had significantly greater reductions in AHI than all other groups (P<.01 for all); error bars indicate 95% confidence intervals.
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Comment in

References

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