Effects of Weight Loss on Obstructive Sleep Apnea Severity. Ten-Year Results of the Sleep AHEAD Study

Abstract

Rationale: Weight loss is recommended to treat obstructive sleep apnea (OSA).Objectives: To determine whether the initial benefit of intensive lifestyle intervention (ILI) for weight loss on OSA severity is maintained at 10 years.Methods: Ten-year follow-up polysomnograms of 134 of 264 adults in Sleep AHEAD (Action for Health in Diabetes) with overweight/obesity, type 2 diabetes mellitus, and OSA were randomized to ILI for weight loss or diabetes support and education (DSE).Measurements and Main Results: Change in apnea-hypopnea index (AHI) was measured. Mean ± SE weight losses of ILI participants of 10.7 ± 0.7, 7.4 ± 0.7, 5.1 ± 0.7, and 7.1 ± 0.8 kg at 1, 2, 4, and 10 years, respectively, were significantly greater than the 1-kg weight loss at 1, 2, and 4 years and 3.5 ± 0.8 kg weight loss at 10 years for the DSE group (P values ≤ 0.0001). AHI was lower with ILI than DSE by 9.7, 8.0, and 7.9 events/h at 1, 2, and 4 years, respectively (P values ≤ 0.0004), and 4.0 events/h at 10 years (P = 0.109). Change in AHI over time was related to amount of weight loss, baseline AHI, visit year (P values < 0.0001), and intervention independent of weight change (P = 0.01). OSA remission at 10 years was more common with ILI (34.4%) than DSE (22.2%).Conclusions: Participants with OSA and type 2 diabetes mellitus receiving ILI for weight loss had reduced OSA severity at 10 years. No difference in OSA severity was present between ILI and DSE groups at 10 years. Improvement in OSA severity over the 10-year period with ILI was related to change in body weight, baseline AHI, and intervention independent of weight change.

Keywords: apnea–hypopnea index; obstructive sleep apnea; lifestyle modification; polysomnogram.

Figure 1.

Diagram showing the number of Sleep AHEAD (Action for Health in Diabetes) participants in the ILI and DSE groups who completed assessments over time. DSE = diabetes support and education; FU = follow-up; ILI = intensive lifestyle intervention; OSA = obstructive sleep apnea; PSG = polysomnogram.

Figure 2.

Estimated mean (SE) changes in body weight (kg) and AHI at Years 1, 2, 4, and 10. The dashed line indicates the diabetes support and education group; the solid line indicates the intensive lifestyle intervention group. AHI = apnea–hypopnea index.

Figure 3.

Percentage of participants in ILI (solid bars, n = 90) and DSE (open bars, n = 97) whose OSA category improved (≥1 category change), worsened (≥1 category change), or was unchanged from baseline to Year 10. Data are from the participants who had baseline and Year-10 data. DSE = diabetes support and education; ILI = intensive lifestyle intervention; OSA = obstructive sleep apnea.

Figure 4.

Percentage of ILI (solid bars) and DSE (open bars) participants without OSA and with mild, moderate, and severe OSA at 10 years compared with their OSA severity at baseline. For definition of abbreviations, see Figure 3.