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Obstructive sleep apnoea and calorie restriction. Clincial studies: Longer term effects of very low energy diet on obstructive sleep apnoea in cohort derived from randomised controlled trial: prospective observational follow-up study. Johansson K1, Hemmingsson E, Harlid R, Trolle Lagerros Y, Granath F, Rössner S, Neovius M. BMJ. 2011 Jun 1;342:d3017. doi: 10.1136/bmj.d3017. To determine whether initial improvements in obstructive sleep apnoea after a very low energy diet were maintained after one year in patients with moderate to severe obstructive sleep apnoea. DESIGN: Single centre, prospective observational follow-up study. SETTING: Outpatient obesity clinic in a university hospital in Stockholm, Sweden. PARTICIPANTS: 63 men aged 30-65 with body mass index (BMI) 30-40 and moderate to severe obstructive sleep apnoea defined as an apnoea-hypopnoea index ≥ 15 (events/hour), all treated with continuous positive airway pressure. INTERVENTION: A one year weight loss programme, consisting of an initial very low energy diet for nine weeks (seven weeks of 2.3 MJ/day and two weeks of gradual introduction of normal food) followed by a weight loss maintenance programme. MAIN OUTCOME MEASURE: Apnoea-hypopnoea index, the main index for severity of obstructive sleep apnoea. Data from all patients were analysed (baseline carried forward for missing data). RESULTS: Of 63 eligible patients, 58 completed the very low energy diet period and started the weight maintenance programme and 44 completed the full programme; 49 had complete measurements at one year. At baseline the mean apnoea-hypopnoea index was 36 events/hour. After the very low energy diet period, apnoea-hypopnoea index was improved by -21 events/hour (95% confidence interval -17 to -25) and weight by -18 kg (-16 to -19; both P<0.001). After one year the apnoea-hypopnoea index had improved by -17 events/hour (-13 to -21) and body weight by -12 kg (-10 to -14) compared with baseline (both P<0.001). Patients with severe obstructive sleep apnoea at baseline had greater improvements in apnoea-hypopnoea index (-25 events/hour) compared with patients with moderate disease (-7 events/hour, P<0.001). At one year, 30/63 (48%, 95% confidence interval 35% to 60%) no longer required continuous positive airway pressure and 6/63 (10%, 2% to 17%) had total remission of obstructive sleep apnoea (apnoea-hypopnoea index <5 events/hour). There was a dose-response association between weight loss and apnoea-hypopnoea index at follow-up (β = 0.50 events/kg, 0.11 to 0.88; P = 0.013). CONCLUSION: Initial improvements in obstructive sleep apnoea after treatment with a very low energy diet can be maintained after one year in obese men with moderate to severe disease. Those who lose the most weight or have severe sleep apnoea at baseline benefit most. Trial registration Current Controlled Trials 70090382. Effect of a very low energy diet on moderate and severe obstructive sleep apnoea in obese men: a randomised controlled trial BMJ. 2009; 339: b4609. Published online Dec 3, 2009. doi: 10.1136/bmj.b4609 PMCID: PMC2788899 Kari Johansson, PhD student,corresponding author1 Martin Neovius, postdoctoral research fellow,1,2 Ylva Trolle Lagerros, physician,1,2 Richard Harlid, physician,3 Stephan Rössner, professor,1 Fredrik Granath, statistican,2 and Erik Hemmingsson, postdoctoral research fellow1 Objective To assess the effect of weight loss induced by a very low energy diet on moderate and severe obstructive sleep apnoea in obese men. Design Single centre, two arm, parallel, randomised, controlled, open label trial. Blocked randomisation procedure used for treatment allocation. Setting Outpatient obesity clinic in a university hospital in Stockholm, Sweden. Participants 63 obese men (body mass index 30-40, age 30-65 years) with moderate to severe obstructive sleep apnoea (apnoea-hypopnoea index (AHI) ≥15), treated with continuous positive airway pressure. Interventions The intervention group received a liquid very low energy diet (2.3 MJ/day) for seven weeks to promote weight loss, followed by two weeks of gradual introduction of normal food, reaching 6.3 MJ/day at week 9. The control group adhered to their usual diet during the nine weeks of follow-up. Main outcome measure AHI, the major disease severity index for obstructive sleep apnoea. Data from all randomised patients were included in an intention to treat analysis (baseline carried forward for missing data). Results Of the 63 eligible patients, 30 were randomised to intervention and 33 to control. Two patients in the control group were dissatisfied with allocation and immediately discontinued. All other patients completed the trial. Both groups had a mean AHI of 37 events/h (SD 15) at baseline. At week 9, the intervention group’s mean body weight was 20 kg (95% confidence interval 18 to 21) lower than that of the control group, while its mean AHI was 23 events/h (15 to 30) lower. In the intervention group, five of 30 (17%) were disease free after the energy restricted diet (AHI <5), with 15 of 30 (50%) having mild disease (AHI 5-14.9), whereas the AHI of all patients in the control group except one remained at 15 or higher. In a subgroup analysis of the intervention group, baseline AHI significantly modified the effectiveness of treatment, with a greater improvement in AHI in patients with severe obstructive sleep apnoea (AHI >30) at baseline compared with those with moderate (AHI 15-30) sleep apnoea (AHI −38 v −12, P<0.001), despite similar weight loss (−19.2 v −18.2 kg, P=0.55). Conclusion Treatment with a low energy diet improved obstructive sleep apnoea in obese men, with the greatest effect in patients with severe disease. Long term treatment studies are needed to validate weight loss as a primary treatment strategy for obstructive sleep apnoea. Trial registration Current Controlled Trials ISRCTN70090382. Losing Weight Can Cure Obstructive Sleep Apnoea in Overweight Patients NEW YORK -- February 6, 2009 -- Losing weight is perhaps the single most effective way to reduce symptoms of obstructive sleep apnoea (OSA), according to a study published in the January issue of the American Journal of Respiratory and Critical Care Medicine. "Very low calorie diet (VLCD) combined with active lifestyle counselling 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," said lead author Henri P.I. Tuomilehto, MD, Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland. The prospective, randomised trial included 81 patients with mild OSA. Patients were randomised to either a very low calorie diet combined with lifestyle counselling (n=40) or to lifestyle counselling alone (n=41). Patients in the intervention arm who underwent a strict diet lost more than 10 kg (20 lbs) on average in 1 year and were able to keep the weight off resulting in markedly lower symptoms of OSA. The patients in the control arm lost on average less than 3 kg (6 lbs) and were much less likely to see improvements in their OSA."The greater the change in body weight or waist circumference, the greater was the improvement in OSA," said Dr. Tuomilehto.Mild OSA was objectively cured in 88% of the patients who lost more than 16.5 kg (33 lbs) -- a statistic that declined with the amount of weight lost. Only in 62% of those who lost between 5.5 kg and 16.5 kg (11-33 lbs) were objectively cured of their OSA, as were 38% of those who lost between zero and 5.5 kg (0-11 lbs), and only 11% of those who had not lost weight or who had gained weight. "…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. Tuemilehto. Source: American Thoratic Society. Am J Respir Crit Care Med. 2009 Feb 15;179(4):320-7. Epub 2008 Nov 14. Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea. Tuomilehto HP, Seppä JM, Partinen MM, Peltonen M, Gylling H, Tuomilehto JO, Vanninen EJ, Kokkarinen J, Sahlman JK, Martikainen T, Soini EJ, Randell J, Tukiainen H, Uusitupa M; Kuopio Sleep Apnea Group. Department of Otorhinolaryngology, Institute of Clinical Medicine, University of Kuopio, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio, Finland. Comment in: Am J Respir Crit Care Med. 2009 Jul 15;180(2):190-1; author reply 191. Am J Respir Crit Care Med. 2009 Jul 1;180(1):101; author reply 101-2. Evid Based Nurs. 2009 Oct;12(4):111. RATIONALE: Obesity is the most important risk factor for obstructive sleep apnea (OSA). However, although included in clinical guidelines, no randomized controlled studies have been performed on the effects of weight reduction on mild OSA. OBJECTIVES: The aim of this prospective, randomized controlled parallel-group 1-year follow-up study was to determine whether a very low calorie diet (VLCD) with supervised lifestyle counseling could be an effective treatment for adults with mild OSA. METHODS: Seventy-two consecutive overweight patients (body mass index, 28-40) with mild OSA were recruited. The intervention group (n = 35) completed the VLCD program with supervised lifestyle modification, and the control group (n = 37) received routine lifestyle counseling. The apnea-hypopnea index (AHI) was the main objectively measured outcome variable. Change in symptoms and the 15D-Quality of Life tool were used as subjective measurements. MEASUREMENTS AND MAIN RESULTS: The lifestyle intervention was found to effectively reduce body weight (-10.7 +/- 6.5 kg; body mass index, -3.5 +/- 2.1 mean +/- SD). There was a statistically significant difference in the mean change in AHI between the study groups (P = 0.017). The adjusted odds ratio for having mild OSA was markedly lowered (odds ratio, 0.24 [95% confidence interval, 0.08-0.72]; P = 0.011) in the intervention group. All common symptoms related to OSA, and some features of 15D-Quality of Life improved after the lifestyle intervention. Changes in AHI were strongly associated with changes in weight and waist circumference. CONCLUSIONS: 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. Clin Physiol. 1998 Jul;18(4):377-85. The effect of a very low-calorie diet-induced weight loss on the severity of obstructive sleep apnoea and autonomic nervous function in obese patients with obstructive sleep apnoea syndrome. Kansanen M, Vanninen E, Tuunainen A, Pesonen P, Tuononen V, Hartikainen J, Mussalo H, Uusitupa M. Department of Otolaryngology, Kuopio University Hospital, Finland. The aim of this study was to examine the effect of a very low-calorie diet (VLCD)-induced weight loss on the severity of obstructive sleep apnoea (OSA), blood pressure and cardiac autonomic regulation in obese patients with obstructive sleep apnoea syndrome (OSAS). A total of 15 overweight patients (14 men and one woman, body weight 114 +/- 20 kg, age 52 +/- 9 years, range 39-67 years) with OSAS were studied prospectively. They were advised to follow a 2.51-3.35 MJ (600-800 kcal) diet daily for a 3-month period. In the beginning of the study, the patients underwent nocturnal sleep studies, autonomic function tests and 24-h electrocardiograph (ECG) recording. In addition, 15 age-matched, normal-weight subjects were studied. They underwent the Valsalva test, the deep-breathing test and assessment of heart rate variability at rest. The sleep studies and autonomic function tests were repeated after the weight loss period. There was a significant reduction in weight (114 +/- 20 kg to 105 +/- 21 kg, P < 0.001), the weight loss being 9.2 +/- 4.0 kg (range 2.3-19.5 kg). This was associated with a significant improvement in the oxygen desaturation index (ODI4) during sleep (31 +/- 20-19 +/- 18, P < 0.001). Before the weight loss the OSAS patients had significantly higher blood pressure (150 +/- 18 vs. 134 +/- 20, P < 0.05, for systolic blood pressure, 98 +/- 10 vs. 85 +/- 13, P < 0.05, for diastolic blood pressure) and heart rate (67 +/- 10 beats min-1 vs. 60 +/- 13, P < 0.05) at rest than the control group. They had also lower baroreflex sensitivity (4.7 +/- 2.8 ms mmHg-1 vs. 10.8 +/- 7.1 ms mmHg-1, P < 0.01). During the weight reduction, the blood pressure declined significantly, and the baroreflex sensitivity increased by 49%. In conclusion, our experience shows that weight loss with VLCD is an effective treatment for OSAS. Weight loss improved significantly sleep apnoea and had favourable effects on blood pressure and baroreflex sensitivity that may have prognostic implications. Am J Clin Nutr. 1992 Jul;56(1 Suppl):182S-184S. Effect of very-low-calorie diets with weight loss on obstructive sleep apnea. Suratt PM, McTier RF, Findley LJ, Pohl SL, Wilhoit SC. Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville 22908. To determine the effect of very-low-calorie diets (VLCDs) with weight loss on obstructive sleep apnea (OSA), we studied eight obese subjects with OSA, five males and three females. Subjects consumed a VLCD of 1760 kJ (420 kcal) (67% protein 4% fat, 29% carbohydrate) or 3350 kJ (800 cal) (20% protein, 30% fat, 50% carbohydrate) with 100% of the recommended daily allowance of vitamins and minerals. Mean (+/- SD) values of weight and respiration before and after weight loss were, for weight, 153 +/- 37 and 132 +/- 29 kg (P less than 0.05); for BMI (kg/m2), 54 +/- 13 and 46 +/- 10 (P less than 0.05); for desaturations/h sleep, 106 +/- 50 and 52 +/- 45 (P less than 0.05); for apneas + hypopneas/h sleep, 90 +/- 32 and 62 +/- 49; for Pco2, 48 +/- 10 and 42 +/- 4 torr (P less than 0.05). Desaturation episodes/h and apnea + hypopneas/h improved in six patients. The most obese subject (female, BMI 81) who lost the most weight (47 kg) did not improve, nor did the subject who lost the least weight, 7 kg. The number of movements + arousals from sleep decreased in all patients (P less than 0.05). We conclude that VLCD with weight loss can produce improvement in OSA; subjects who lose a small amount of weight or subjects who are extraordinarily obese before and after weight loss may not improve. obstructive sleep apnoea, osa, nervous, fasting, Croatia, Hungary, Budapest, weight loss, juice fasting, water fasting, water fasting weight loss, fasting juice, antiaging, anti-aging, caloric restriction, calorie restriction, calorie restriction society, aging plan, anti aging plan. |
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