Effectiveness of Lifestyle Interventions on Obstructive Sleep Apnea (OSA): Systematic Review and Meta-Analysis

Oct 2, 2013Sleep

How well lifestyle changes work for obstructive sleep apnea: a combined review and analysis

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Abstract

Weight reduction programs were associated with a decrease in the apnea-hypopnea index (AHI) by 6.04 events/h.

Seven randomized controlled trials with 519 participants indicated that weight loss can reduce AHI.
Uncontrolled before-after studies with 250 participants demonstrated a significant decrease in AHI by -12.26 events/h.
Four uncontrolled before-after studies involving 97 participants found a significant decrease in the oxygen desaturation index of 4% (ODI4) by -18.91 episodes/h.
The evidence suggests that while weight loss improves obstructive sleep apnea parameters, it may not fully normalize them.
The observed changes in obstructive sleep apnea severity could be clinically relevant for some patients.

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BACKGROUND: Obstructive sleep apnea (OSA) is a common sleep disorder associated with several adverse health outcomes. Given the close association between OSA and obesity, lifestyle and dietary interventions are commonly recommended to patients, but the evidence for their impact on OSA has not been systematically examined.

OBJECTIVES: To conduct a systematic review and meta-analysis to assess the impact of weight loss through diet and physical activity on measures of OSA: apnea-hypopnea index (AHI) and oxygen desaturation index of 4% (ODI4).

METHODS: A systematic search was performed to identify publications using Medline (1948-2011 week 40), EMBASE (from 1988-2011 week 40), and CINAHL (from 1982-2011 week 40). The inverse variance method was used to weight studies and the random effects model was used to analyze data.

RESULTS: Seven randomized controlled trials (519 participants) showed that weight reduction programs were associated with a decrease in AHI (-6.04 events/h [95% confidence interval -11.18, -0.90]) with substantial heterogeneity between studies (I(2) = 86%). Nine uncontrolled before-after studies (250 participants) showed a significant decrease in AHI (-12.26 events/h [95% confidence interval -18.51, -6.02]). Four uncontrolled before-after studies (97 participants) with ODI4 as outcome also showed a significant decrease in ODI4 (-18.91 episodes/h [95% confidence interval -23.40, -14.43]).

CONCLUSIONS: Published evidence suggests that weight loss through lifestyle and dietary interventions results in improvements in obstructive sleep apnea parameters, but is insufficient to normalize them. The changes in obstructive sleep apnea parameters could, however, be clinically relevant in some patients by reducing obstructive sleep apnea severity. These promising preliminary results need confirmation through larger randomized studies including more intensive weight loss approaches.

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Effectiveness of Lifestyle Interventions on Obstructive Sleep Apnea (OSA): Systematic Review and Meta-Analysis

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