CLINICAL REVIEW ARTICLE: Weight loss as a treatment for obstructive sleep apnoea

doi:10.1053/smrv.2000.0114

Sleep Medicine Reviews

Volume 4, Issue 5, October 2000, Pages 435-452

https://doi.org/10.1053/smrv.2000.0114 Get rights and content

Abstract

Obesity is a major health problem in well-developed societies. It is frequently associated with metabolic, cardiovascular and psychological comorbid conditions. Besides, it is known that obesity constitutes a risk factor for obstructive sleep apnoea (OSA). Weight loss has been evaluated as a treatment for OSA. We reviewed the nature of the link between obesity and OSA as well as the conservative and surgical therapeutic approaches of obesity. We consider the effectiveness of weight loss alone or combined with other modalities of treatment in OSA. We conclude that although weight loss is important and can facilitate the treatment of OSA, it can rarely cure it without being associated to classical techniques, such as nasal continuous positive airway pressure (nCPAP).

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Cited by (45)

Obesity and obstructive sleep apnea - Clinical significance of weight loss
2013, Sleep Medicine Reviews
Citation Excerpt :
Moreover, many studies have been conducted with small selected subgroups, e.g., severely obese patients usually with severe or at least heterogeneous severity of OSA. The previous studies examining the effect of weight loss as a treatment of OSA have been meticulously reviewed by Barvaux et al., and this review concluded that weight loss may reduce the severity of OSA, but that it is not a curative treatment option for most patients.49 Accumulating and improving knowledge of weight loss programs have demonstrated that if they are to be successful, additional changes in lifestyles in conjunction with energy restriction per se, are essential.
Obesity is a major health burden that contributes to increased morbidity and mortality. Obesity is also the most important risk factor for obstructive sleep apnea (OSA); at least 70% of patients are obese. OSA as such, has been linked with increased cardiovascular morbidity and mortality, and OSA patients often display metabolic syndrome. The exact underlying mechanisms behind these associations are complex and not fully understood. In obese individuals, weight reduction and increased physical activity form cornerstones for the prevention and treatment of metabolic syndrome, and recent controlled intervention trials strongly suggest that weight reduction together with a healthy diet and increased physical activity may correct or at least improve the symptoms of OSA. However, regardless of promising results in terms of symptoms of OSA and the undoubted metabolic benefits of changing lifestyles, weight reduction as a treatment of OSA is still underrated by many clinicians. Based on the current knowledge, clinicians should revise their previous attitudes, including suspicions about weight reduction as an effective treatment for OSA patients. Nevertheless, we also need large well-controlled trials on the effects of different weight reduction programs among OSA patients to determine the overall efficacy of different treatment modalities and their long-term success.
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Obstructive Sleep Apnea: Evaluation and Treatment Planning
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Weight reduction improves sleep, sleepiness and metabolic status in obese sleep apnoea patients
2008, Obesity Research and Clinical Practice
Citation Excerpt :
In particular, focus is on the amount of deep sleep because it is considered to have an important restorative function [38]. For example, in a review article from 2000 Barvaux et al. [39] put the relationship between weight loss and sleep architecture in OSAS patients on the research agenda. This issue has previously been investigated by Noseda et al. [24], who evaluated patients treated with either dietary or surgical methods.
In this prospective intervention study, 33 obese patients with obstructive sleep apnoea syndrome (OSAS) (24 men, 9 women) were consecutively enrolled for a weight reduction program at the Obesity Unit, Karolinska University Hospital. 23 of 33 patients used OSAS-device, 19 with Continuous Positive Airway Pressure and 4 with Mandibular Retaining Device. The patients were investigated with questionnaires, blood tests and ambulant nocturnal polysomnography before and after a 6-month program. Patients with OSAS-device slept without it during the sleep studies. The intervention consisted of 8 weeks low calorie diet and group meetings, followed by a day-care program of behaviour change support.
27 of 33 patients (82%, 21 men and 6 women) completed the study. After the intervention there were highly significant decreases (p < 0.001) in Body Mass Index from mean(S.D.) 40(5) to 34(3), apnoea–hypopnoea index from 43(24) to 26(20) and Epworth Sleepiness Scale (ESS)-score from 9(4) to 6(4). Sleep quality (arousal index, sleep efficiency, percentage deep sleep) and metabolic status (blood pressure, blood glucose levels, lipidemia) were also significantly improved. There was a significant correlation between increased percentage deep sleep and reduced ESS-score. There were no differences due to gender or use/no use of OSAS-device.
The results suggest that weight loss, induced by low calorie diet and behaviour change support, significantly improves nocturnal respiratory parameters, sleep quality, daytime sleepiness and metabolic status in obese OSAS patients after 6 months.
The evaluation of serum tryptophan and kynurenine levels in patients with obstructive sleep apnea syndrome
2021, Sleep and Breathing
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^f1: Correspondence to be addressed to: D. O. Rodenstein, Pneumology Unit, Cliniques Universitaires St Luc, Avenue Hippocrate, 10, 1200 Brussels, Belgium. Fax: 32-2-7643703; Email: [email protected]

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Clinical Review ArticleCLINICAL REVIEW ARTICLE: Weight loss as a treatment for obstructive sleep apnoea

Abstract

Clin Chest Med

Chest

Chest

J Clin Epidemiol

Am J Orthod Dentofacial Orthop

Chest

Chest

Chest

Chest

Chest

Am J Clin Nutr

Chest

Chest

Chest

Chest

Chest

Sleep Medicine Reviews

Consensus development panel on the health implications of obesity

Ann Intern Med

Current views on obesity

Am J Med

Descriptive epidemiology of body weight and weight change in US adults

Ann Intern Med

Actual causes of death in the United States

JAMA

Medical hazards of obesity

Ann Intern Med

Periodic breathing and hypoxia in snorers and controls

Acta Neurol Scand

Prevalence of every-night snoring and obstructive sleep apnoea among 30- to 69-year-old men in Bologna, Italy

Acta Neurol Scand

Predictors and prevalence of Obstructive Sleep Apnoea and snoring in 1001 middle aged men

Thorax

The occurrence of sleep-disordered breathing among middle-aged adults

N Engl J Med

A community study of snoring and sleep-disordered breathing: prevalence

Am J Respir Crit Care Med

Snoring and sleep apnoea: a population study in Australian men

Am J Respir Crit Care Med

Effects of age on sleep apnoea in men: I. Prevalence and severity

Am J Respir Crit Care Med

Predictive value of clinical features in diagnosing OSA

Sleep

The prevalence of obstructive sleep apnoea in an obese female population

Int J Obes Relat Metab Disord

The relationship between obstructive sleep apnoea and body mass index

Clin Otolaryngol

Dtsch Med Wochenschr

Predictive value of clinical features for obstructive sleep apnoea syndrome

Eur Respir J

Sleep apnoea in acute cerebrovascular disease: final report on 128 patients

Sleep

Cephalometric abnormalities in non-obese and obese patients with obstructive sleep apnoea

Eur Respir J

Clinical Review Article
CLINICAL REVIEW ARTICLE: Weight loss as a treatment for obstructive sleep apnoea