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Meta-Analysis
. 2013 Oct 1;36(10):1553-62, 1562A-1562E.
doi: 10.5665/sleep.3056.

Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): systematic review and meta-analysis

Marzieh Hosseini Araghi  1 , Yen-Fu Chen, Alison Jagielski, Sopna Choudhury, Dev Banerjee, Shakir Hussain, G Neil Thomas, Shahrad Taheri
Affiliations
Meta-Analysis

Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): systematic review and meta-analysis

Marzieh Hosseini Araghi et al. Sleep. .

Abstract

Background: Obstructive sleep apnea (OSA) is a common sleep disorder associated with several adverse health outcomes. Given the close association between OSA and obesity, lifestyle and dietary interventions are commonly recommended to patients, but the evidence for their impact on OSA has not been systematically examined.

Objectives: To conduct a systematic review and meta-analysis to assess the impact of weight loss through diet and physical activity on measures of OSA: apnea-hypopnea index (AHI) and oxygen desaturation index of 4% (ODI4).

Methods: A systematic search was performed to identify publications using Medline (1948-2011 week 40), EMBASE (from 1988-2011 week 40), and CINAHL (from 1982-2011 week 40). The inverse variance method was used to weight studies and the random effects model was used to analyze data.

Results: Seven randomized controlled trials (519 participants) showed that weight reduction programs were associated with a decrease in AHI (-6.04 events/h [95% confidence interval -11.18, -0.90]) with substantial heterogeneity between studies (I(2) = 86%). Nine uncontrolled before-after studies (250 participants) showed a significant decrease in AHI (-12.26 events/h [95% confidence interval -18.51, -6.02]). Four uncontrolled before-after studies (97 participants) with ODI4 as outcome also showed a significant decrease in ODI4 (-18.91 episodes/h [95% confidence interval -23.40, -14.43]).

Conclusions: Published evidence suggests that weight loss through lifestyle and dietary interventions results in improvements in obstructive sleep apnea parameters, but is insufficient to normalize them. The changes in obstructive sleep apnea parameters could, however, be clinically relevant in some patients by reducing obstructive sleep apnea severity. These promising preliminary results need confirmation through larger randomized studies including more intensive weight loss approaches.

Keywords: Lifestyle Intervention; meta-analysis; obesity; obstructive sleep apnea; systematic review.

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Figures

Figure 1
Figure 1
Flowchart of study selection.
Figure 2
Figure 2
Forest plot of differences in AHI (events/h) changes between intervention and control groups after intervention in randomized controlled studies. IV, inverse varience method; Random, random effects model; CI, confidence intervals.
Figure 3
Figure 3
Forest plot of AHI (events/h) changes after intervention in uncontrolled before-after studies. IV, inverse varience method; Random, random effects model; CI, confidence intervals.
Figure 4
Figure 4
Forest plot of ODI4 (episodes/h) changes after intervention in uncontrolled before-and-after studies. IV, inverse varience method; Random, random effects model; CI, confidence intervals.
Figure 5
Figure 5
Forest plot of differences in BMI (kg/m2) changes between intervention and control groups after intervention in randomized controlled studies. IV, inverse varience method; Random, random effects model; CI, confidence intervals.
Figure 6
Figure 6
Forest plot of BMI (kg/m2) changes after intervention in uncontrolled before-and-after studies. IV, inverse varience method; Random, random effects model; CI, confidence intervals.
Figure 7
Figure 7
Meta-regression of baseline AHI against reduction AHI (the shaded area represents the 95% confidence intervals).
Figure 8
Figure 8
Meta-regression of reduction in weight against reduction in AHI (the shaded area represent the 95% confidence intervals).
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