American journal of respiratory and critical care medicineJul 30, 2020

How Weight Loss Affects Obstructive Sleep Apnea Severity: Ten-Year Results from the Sleep AHEAD Study

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Updated Apr 1, 2026

Abstract

Mean weight losses of 10.7 kg at 1 year and 7.1 kg at 10 years were observed in participants receiving intensive lifestyle intervention (ILI) for obstructive sleep apnea (OSA).

Change in apnea-hypopnea index (AHI) was significantly lower in the ILI group compared to the diabetes support and education (DSE) group at 1, 2, and 4 years, with a difference of 9.7, 8.0, and 7.9 events/hour respectively.
At 10 years, the difference in AHI between ILI and DSE was 4.0 events/hour, which was not statistically significant.
OSA remission at 10 years was more common in the ILI group (34.4%) compared to the DSE group (22.2%).
Change in AHI over time was associated with the amount of weight loss, baseline AHI, and the intervention itself, independent of weight change.

Simplified

Weight loss is recommended to treat obstructive sleep apnea (OSA).To determine whether the initial benefit of intensive lifestyle intervention (ILI) for weight loss on OSA severity is maintained at 10 years.Ten-year follow-up polysomnograms of 134 of 264 adults in Sleep AHEAD (Action for Health in Diabetes) with overweight/obesity, type 2 diabetes mellitus, and OSA were randomized to ILI for weight loss or diabetes support and education (DSE).Change in apnea-hypopnea index (AHI) was measured. Mean ± SE weight losses of ILI participants of 10.7 ± 0.7, 7.4 ± 0.7, 5.1 ± 0.7, and 7.1 ± 0.8 kg at 1, 2, 4, and 10 years, respectively, were significantly greater than the 1-kg weight loss at 1, 2, and 4 years and 3.5 ± 0.8 kg weight loss at 10 years for the DSE group (values ≤ 0.0001). AHI was lower with ILI than DSE by 9.7, 8.0, and 7.9 events/h at 1, 2, and 4 years, respectively (values ≤ 0.0004), and 4.0 events/h at 10 years ( = 0.109). Change in AHI over time was related to amount of weight loss, baseline AHI, visit year (values < 0.0001), and intervention independent of weight change ( = 0.01). OSA remission at 10 years was more common with ILI (34.4%) than DSE (22.2%).Participants with OSA and type 2 diabetes mellitus receiving ILI for weight loss had reduced OSA severity at 10 years. No difference in OSA severity was present between ILI and DSE groups at 10 years. Improvement in OSA severity over the 10-year period with ILI was related to change in body weight, baseline AHI, and intervention independent of weight change. Rationale: Objectives: Methods: Measurements and Main Results: Conclusions: P P P P P

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How Weight Loss Affects Obstructive Sleep Apnea Severity: Ten-Year Results from the Sleep AHEAD Study

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