apnea ostruttiva nel sonno (OSA)



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L' Apnea ostruttiva nel sonno e la restrizione calorica.

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.
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