Contact: Keely Savoie
American Thoracic Society
Losing weight can cure obstructive sleep apnea in overweight patients
For sufferers of obstructive sleep apnea (OSA), a new study shows that
losing weight is perhaps the single most effective way to reduce OSA
symptoms and associated disorders, according to a new study in the
American Journal of Respiratory and Critical Care Medicine, one of the American Thoracic Society's three peer-reviewed journals.
loss may not be a new miracle pill or a fancy high-tech treatment, but
it is an exciting therapy for sufferers of OSA both because of its
short- and long-term effectiveness and for its relatively modest price
tag. Surgery doesn't last, continuous positive airway pressure (CPAP)
machines are only as effective as the patient's adherence, and most
other devices have had disappointing outcomes, in addition to being
expensive, unwieldy and having poor patient compliance. Furthermore,
OSA is generally only treated when it has progressed to a moderate to
"Very low calorie diet (VLCD) combined with
active lifestyle counseling resulting in marked weight reduction is a
feasible and effective treatment for the majority of patients with mild
OSA, and the achieved beneficial outcomes are maintained at 1-year
follow-up," wrote Henri P.I. Tuomilehto, M.D., Ph.D., of the department
of Otorhinolaryngology at the Kuopio University Hospital in Finland.
prospective, randomized trial found that, in 81 patients with mild OSA,
the 40 patients who were in the intervention arm underwent a diet that
strictly limited caloric intake combined with lifestyle counseling lost
more than 20 pounds on average in a year—and kept it off, resulting in
markedly lower symptoms of OSA. The 41 patients in the control arm, who
only received lifestyle counseling and lost on average less than 6
pounds, and were much less likely to see improvements in their OSA.
not only does sustained weight loss improve OSA, it also improves the
many other independently linked co-morbidities such as hypertension,
high cholesterol, and diabetes.
"This is emphasized by our
findings that, in conjunction with the improvement in AHI, significant
improvements were also found in symptoms related to OSA, insulin
resistance, lipids, and cardiorespiratory variables, such as arterial
oxygen saturation, in patients belonging to the intervention group,"
wrote Dr. Tuomilehto.
Furthermore, Dr. Tuomilehto observed,
"The greater the change in body weight or waist circumference, the
greater was the improvement in OSA." In fact, mild OSA was objectively
cured in 88 percent of the patients who lost more than 33 pounds, a
statistic that declined with the amount of weight lost. Only in 62
percent of those who lost between 11 and 33 pounds were objectively
cured of their OSA, as were 38 percent of those who lost between zero
and 11 pounds, and only 11 percent of those who had not lost weight or
who had gained weight.
"Witnessed apneas," i.e., those loud or
disturbing enough to have wakened the bedfellows of study participants,
"totally vanished" in 26 percent of those patients, but in only three
percent of the control group.
"This appears to be a fairly
straightforward relationship, and while we would not necessarily
recommend the severe caloric restriction used in our study to every
patient, one of the first treatment for OSA that should be considered
in the overweight patient is clearly weight loss," said Dr. Tuomilehto.
more aggressive treatment of obesity in patients with OSA is
well-founded. Lifestyle intervention with an early VLCD is a feasible,
low-cost, and curative treatment for the vast majority of patients with
mild OSA and it can be implemented in a primary care setting after
diagnosis of OSA. Weight reduction also results in an improvement of
obesity-related risk factors for cardiovascular diseases."