Changes in regional adiposity and cardio-metabolic function following a weight loss program with sibutramine in obese men with obstructive sleep apnea.

Dec 8, 2009Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine

Changes in body fat distribution and heart-metabolism health after weight loss with sibutramine in obese men with sleep apnea

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Abstract

After 6 months, weight loss in 93 men with moderate-severe obstructive sleep apnea resulted in improved insulin resistance and changes in body fat composition.

Weight loss led to reduced liver fat and improved insulin resistance, as measured by HOMA.
Increased HDL cholesterol and a reduced total cholesterol/HDL ratio were observed after the weight loss program.
Visceral and subcutaneous abdominal fat decreased alongside improvements in metabolic health.
No significant changes were noted in blood pressure, arterial stiffness, or heart rate despite weight loss.
Improvements in insulin resistance were partly associated with reductions in liver fat and lower oxygen saturation during sleep.

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BACKGROUND: Although obstructive sleep apnea (OSA) is strongly linked with obesity, both conditions have been associated with increased cardiovascular risk including glucose intolerance, dyslipidemia, and hypertension independent of one another. Weight loss is known to improve both cardiovascular risk and OSA severity. The aim of this study was to evaluate cardiovascular and metabolic changes, including compartment-specific fat loss in obese OSA subjects undergoing a weight loss program.

DESIGN: Observational study.

PARTICIPANTS: 93 men with moderate-severe OSA.

INTERVENTIONS: 6-month open-label weight loss trial combining sibutramine (a serotonin and noradrenaline reuptake inhibitor) with a 600-kcal deficit diet and exercise.

MEASUREMENTS AND RESULTS: At baseline and following 6 months of weight loss, OSA was assessed together with CT-quantified intraabdominal and liver fat and markers of metabolic and cardiovascular function. At 6 months, weight loss and improvements in OSA were accompanied by improved insulin resistance (HOMA), increased HDL cholesterol, and reduced total cholesterol/HDL ratio. There were also reductions in measures of visceral and subcutaneous abdominal fat and liver fat. Reductions in liver fat and sleep time spent below 90% oxyhemoglobin saturation partly explained the improvement in HOMA (R2 = 0.18). In contrast, arterial stiffness (aortic augmentation index), heart rate, blood pressure, and total cholesterol did not change.

CONCLUSIONS: Weight loss with sibutramine was associated with improvements in metabolic and body composition risk factors but not blood pressure or arterial stiffness. Improved insulin resistance was partly associated with reductions in liver fat and hypoxemia associated with sleep apnea.

Changes in regional adiposity and cardio-metabolic function following a weight loss program with sibutramine in obese men with obstructive sleep apnea.

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