1. In this study, comprehensive lifestyle interventions significantly decreased severity of obstructive sleep apnea at end of intervention up to 6 months after.

2. More than 50% of patients in the intervention group no longer required continuous positive airway pressure therapy both at end of intervention and 6 months after.

Evidence Rating Level: 1 (Excellent)

Obesity is a rising public health crisis and is a risk factor for multiple medical conditions. Specifically, it is the leading cause of obstructive sleep apnea (OSA), which affects up to 936 million adults. However, whether strategies targeting obesity such as weight loss and lifestyle interventions can directly improve OSA severity has not been well-studied.

This randomized control trial was conducted in Granada, Spain, from April 1st, 2019, to October 23rd 2020. The study looked at the effect of multi-faceted weight loss and lifestyle intervention on OSA severity and associated morbidity in 89 obese (BMI>25), Spanish men aged 18 to 65 years with moderate to severe OSA receiving continuous positive airway pressure (CPAP) therapy. 40 participants were randomized to receive usual care (CPAP therapy alone) and 49 to receive usual care along with 8-week lifestyle interventions such as nutritional behavior counseling, aerobic exercise, sleep, and alcohol and tobacco cessation. Patients enrolled in weight loss programs or with any psychological/psychiatric disorder were excluded. The primary outcome was changes in OSA severity as measured by apnea-hypopnea index (AHI) at end of intervention and 6 months after intervention. Secondary outcomes were changes in sleep-related outcomes, body weight, cardiometabolic risk, and health-related quality of life.

Results demonstrated that compared to the control group, patients in the intervention group had greater decrease in AHI (51% reduction) at the end of intervention and sustained decrease (57%) at 6 months after intervention. A proportion of patients in the intervention group were able to stop using CPAP therapy at end of intervention (45%) and an even higher proportion by 6 months after intervention (61.8%). Patients in the intervention group also had improved secondary outcomes including weight loss (mean difference between group of -6.8kg) and improved blood pressure (mean different between group of -6.4mmHg). However, this study was limited by homogeneity of patient population, making generalization to female or non-Spanish patients difficult. However, the results strongly support the inclusion of lifestyle interventions as future therapeutic strategy for OSA.

 Click to read the study in JAMA Network Open

Image: PD

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