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Randomized Controlled Trial
. 2024 May-Jun;18(3):238-241.
doi: 10.1016/j.orcp.2024.06.003. Epub 2024 Jul 2.

Cardio-metabolic health effects of CPAP treatment for sleep apnoea during weight loss: A randomised controlled pilot trial

Camilla M Hoyos  1 , Elizabeth A Machan  2 , Brendon J Yee  3 , Svetlana Postnova  4 , Nathaniel S Marshall  1 , Tania Markovic  5 , Stephen M Twigg  5 , Ronald R Grunstein  6 , Craig L Phillips  7
Affiliations
Randomized Controlled Trial

Cardio-metabolic health effects of CPAP treatment for sleep apnoea during weight loss: A randomised controlled pilot trial

Camilla M Hoyos et al. Obes Res Clin Pract. 2024 May-Jun.

Abstract

Background and aims: This study assessed whether the addition of continuous positive airway pressure (CPAP) during weight loss would enhance cardiometabolic health improvements in patients with obesity and Obstructive Sleep Apnoea (OSA).

Methods and results: Patients with overweight or obesity, pre-diabetes and moderatesevere OSA were randomised to receive CPAP therapy with a weight loss programme (CPAP+WL) or a weight loss programme alone (WL alone).

Primary outcome: 2-hour glucose assessed by an oral glucose tolerance test.

Secondary outcomes: 24 hr blood pressure, body composition (DEXA) and fasting blood markers. 17 patients completed 3-month follow-up assessments (8 CPAP+WL and 9 WL alone). Overall, participants in both groups lost ∼12 kg which reduced polysomnography determined OSA severity by ∼45 %. In the CPAP+WL group, CPAP use (compliance 5.29 hrs/night) did not improve any outcome above WL alone. There was no improvement in 2-hour glucose in either group. However, in the pooled (n = 17) analysis there were overall improvements in most outcomes including insulin sensitivity (.000965 units, p = .008), sleep systolic BP (- 16.2 mmHg, p = .0003), sleep diastolic BP (-9.8 mmHg, p = 0.02), wake diastolic BP (- 4.3 mmHg, p = .03) and sleepiness (Epworth Sleepiness Score -3.2, p = .0003). In addition, there were reductions in glucose area under the curve (-230 units, p = .009), total (-0.86 mmol/L, p = 0.006) and LDL cholesterol (-0.58 mmol/L, p = 0.007), triglycerides (-0.75 mmol/L, p = 0.004), fat mass (-7.6 kg, p < .0001) and abdominal fat (-310 cm3, p < .0001).

Conclusion: Weight loss reduced OSA and improved sleepiness and cardiometabolic health. These improvements were not further enhanced by using CPAP. Results suggest weight loss should be the primary focus of treatment for patients with OSA and obesity.

Keywords: Continuous positive airway pressure; Obesity; Obstructive sleep apnoea; Weight loss.

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Conflict of interest statement

Declaration of Competing Interest S. Postnova reports grants unrelated to the manuscript from NHMRC and ARC. T. Markovich reports grants unrelated to the manuscript from NHMRC and advisory board participation with Nestle Health Science and Eli Lilly. S. Twigg reports advisory board participation with Abbott Diabetes care and Nevro Inc and payments from Nevro Inc and Astra Zeneca Inc for presentations. R. Grunstein reports advisory board participation and payments from Eli Lilly for SURMOUNT OSA weight loss trial. All other authors have no conflict of interest to declare.

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