Effects of dietary weight loss on obstructive sleep apnea: a meta-analysis

Purpose

Clinical and epidemiologic investigations suggest a strong association between obesity and obstructive sleep apnea (OSA). The purpose of this study is to evaluate the currently available literature reporting on the effectiveness of dietary weight loss in treating OSA among obese patients.

Methods

Relevant studies were identified by computerized searches of PubMed, EMBASE, CINAHL, Web of Science, and The Cochrane Central Register of Controlled Trials through September 2011 as well as the reference lists of all obtained articles. Information on study design, patient characteristics, pre- and post-dietary weight loss measures of OSA and body mass index (BMI), and study quality was obtained. Data were extracted by two independent analysts. Weighted averages using a random-effects model are reported with 95 % confidence intervals.

Results

Nine articles representing 577 patients were selected. Dietary weight loss program resulted in a pooled mean BMI reduction of 4.8 kg/m² (95 % confidence interval [CI] 3.8-5.9). The random-effects pooled apnea hypopnea (AHI) indices at pre- and post-dietary intervention were 52.5 (range 10.0–91.0) and 28.3 events/h (range 5.4–64.5), respectively (p?<?0.001). Compared to control, the weighted mean difference of AHI was decreased by ?14.3 events/h (95 % CI ?23.5 to ?5.1; p?=?0.002) in favor of the dietary weight loss programs.

Conclusions

Dietary weight loss programs are effective in reducing the severity of OSA but not adequate in relieving all respiratory events. Weight reduction programs should be considered as adjunct rather than curative therapy.     

降低体质量对阻塞性睡眠呼吸暂停低通气综合征治疗的研究

目的探讨降低体质量对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）伴超重或肥胖者治疗的影响及临床意义。方法采用低热量饮食（84～105kJ／kg）和（或）运动减重后，观察治疗组与对照组自体症状、睡眠监测及血液生化等各项指标的变化情况，并对年龄、性别、治疗前体质量指数（BMI）、呼吸暂停低通气指数（AHI）、吸烟、高血压、糖尿病、高血脂、脑梗死、服药多因素进行Logistic回归分析。结果治疗组与对照组前后差值比较，鼾声、嗜睡评分、憋气、憋醒、记忆力下降、全身不适、胸闷、心悸症状均有改善；颈围、腰围、臀围较对照组有明显差异；呼吸暂停次数、AHI、呼吸暂停指数（AI）也较对照组有明显差异；低通气次数及低通气指数（Hl）无明显差异。血氧饱和度（SaO2低于95％、低于85％及低于80％所占的时间百分比较对照组有明显差异；最低血氧饱和度（LSaO2）及最长呼吸暂停时间较对照组有显著性差异。红细胞（RBC）、血红蛋白（Hb）、红细胞压积（HCT）也有明显差异。Logistic回归分析表明BMI、体质量减少、脑梗死、高脂血症影响OSAHS伴超重或肥胖者的治疗效果。结论减重对OSAHS伴超重或肥胖者的治疗是有效的，可使OSAHS者的严重程度得到改善，并使部分轻度OSAHS者治愈。减重后缺氧、RBC的改善对预防心脑血管病有着重要的意义。     

Effect of weight loss on inflammation in patients with mild obstructive sleep apnea

Background and aimsInflammation may be one mediating mechanism for cardiovascular diseases in obstructive sleep apnea (OSA). However, little is known about subclinical inflammation or the effect of lifestyle intervention on inflammation in early stages of OSA. The aim of this substudy of an existing randomized controlled trial, with post hoc analyses, was to determine the impact of lifestyle changes aimed at weight reduction on inflammatory biomarkers in overweight patients with mild OSA.Methods and resultsPatients were randomized to supervised intensive lifestyle intervention group (N = 28) or to control group (N = 31), which received routine lifestyle advices. Circulating concentrations of pro- and anti-inflammatory mediators were measured before and after the 1-year intervention. The concentrations of two pro-inflammatory mediators, high-sensitivity C-reactive protein (hsCRP) and interleukin (IL)-6, decreased significantly in both groups. Although the changes in inflammatory biomarkers favored the supervised lifestyle intervention, the only significant reduction observed between the groups was for the anti-inflammatory IL-1 receptor antagonist (IL-1RA). The change in hsCRP was associated with apnea–hypopnea index, and improving night-time oxygen saturation was related to tumor necrosis factor alpha. IL-1RA and IL-6 were associated with insulin metabolism.ConclusionWeight loss resulted in reductions in concentrations of some pro- and anti-inflammatory mediators in overweight patients with mild OSA, overall favoring the supervised lifestyle intervention. These findings suggest that more intensive treatment of obesity in OSA patients might be well-justified. Trial Registration clinicaltrials.gov ID: NCT00486746, June 7th 2007.     

Changes in breathing and the pharynx after weight loss in obstructive sleep apnea

The effect of weight loss following dietary restriction on disordered breathing on the pharyngeal airway is controversial in patients with obstructive sleep apnea (OSA). We therefore prospectively studied eight patients before and after dietary-induced weight loss. Mean weight loss was 20.6 kg +/- 12.8 SD. After weight loss there were significant improvements in PO2 and PCO2 measured during wakefulness, and in the number of desaturation episodes per hour of sleep, average desaturation per episode, and number of movement arousals. The number of apneas and hypopneas significantly decreased in six of eight patients. There was a significant correlation between body mass index and number of disordered breathing events. Nasopharyngeal collapsibility and pulse flow resistance decreased in awake patients after weight loss. We conclude that moderate weight loss in obese patients with OSA improves oxygenation during both sleep and wakefulness, decreases the number of disordered breathing events in many patients, decreases the collapsibility of the nasopharyngeal airway.     

Improvement in upper airway function after weight loss in patients with obstructive sleep apnea

Overweight patients with obstructive sleep apnea (OSA) are improved by weight reduction, although the underlying mechanisms are not clear. We tested the hypothesis that improvement in OSA after weight loss is associated with improvement in pharyngeal function. Consequently, we measured pharyngeal area at functional residual capacity (AFRC) and at residual volume (ARV), the percent change in pharyngeal area between FRC and RV (delta Aph%) defined as (AFRC - ARV)/AFRC x 100, and lung volume dependence of pharyngeal area (LVD) defined as the difference between AFRC and ARV normalized for the expiratory reserve volume (ERV)--in 12 overweight apneic patients before and after weight loss. We found that after a 26 +/- 18 kg weight loss, there was a significant reduction in the apnea/hypopnea index from 57 +/- 29 to 14 +/- 10 (p less than 0.0005) and increase in the lowest nocturnal oxygen saturation from 54 +/- 20% to 80 +/- 8% (p less than 0.001). This improvement was associated with a significant reduction in delta Aph% from 25 +/- 15% to 9 +/- 18% (p less than 0.05) and a significant decrease in LVD from 1.98 +/- 1.52 cm2/L to 0.16 +/- 0.88 cm2/L (p less than 0.005). There were four patients in whom baseline LVD was low and relatively unchanged after weight loss. Three of these patients exhibited paradoxical inspiratory narrowing of the glottis, which reversed after weight loss; these glottic abnormalities were not present in the rest of the patients with OSA. We conclude that improvement in obstructive sleep apnea after weight loss may be related to improvement in pharyngeal and glottic function.     

阻塞性睡眠呼吸暂停低通气综合征超重者减重前后分析

目的探讨降低体质量对阻塞性睡眠呼吸暂停低通气综合征（OSAHS）伴超重或肥胖者的影响及临床意义。方法采用低热量饮食（84～150kJ／kg）和（或）运动减重后，观察52例OSAHS伴超重或肥胖者减重前后自体症状、睡眠监测及血液生化等各项指标的变化情况。结果52例患者减重后鼾声、嗜睡评分、憋气、憋醒、记忆力下降、全身不适、胸闷、心悸症状均有改善。颈围、腰围、臀围明显缩小；呼吸暂停次数、呼吸暂停低通气指数（AHl）、呼吸暂停指数（AI）明显减少（P〈0．01）。低通气指数（HI）无明显变化。血氧饱和度（SaO2）〈95％及〈85％所占的时间百分比明显减少，最低血氧饱和度（LSaO2）明显升高。最长呼吸暂停时间明显缩短．红细胞计数（RBC）、血红蛋白（HB）、红细胞压积（HCT）、三酰甘油（TG）、总胆固醇（TC）、血尿酸（uA）明显降低。结论减重对OSAHS伴超重或肥胖者的治疗是有效的，可使OSAHS者的严重程度得到改善，并使部分轻度OSAHS治愈。减重后缺氧、RBC、血脂的改善对预防心脑血管疾病非常有益。     

阻塞性睡眠呼吸暂停综合征术前评估方法的研究进展

阻塞性睡眠呼吸暂停综合征(obstructive sleep apnea syndrome,OSAS)是一种常见的因郡分或全部上呼吸道反复阻塞引起的睡眠障碍,其特征是睡眠时呼吸气流暂停超过10 s.手术患者合并OSAS可使患者更易发生围手术期并发症.目前OSAS诊断的金标准是多导睡眠图,其术前评估方法有量表法和便携式仪器诊断等多种方法.     

Individualized therapy for treating obstructive sleep apnea in pediatric Crouzon syndrome patients

Sleep and Breathing - Pediatric patients with Crouzon syndrome have great possibilities of suffering from obstructive sleep apnea (OSA), which is mainly due to midfacial hypoplasia and facial...     

Clinical effects of surgical treatment of obstructive sleep apnea syndrome

Aim of this study was to estimate the efficiency of surgical interventions in the treatment of obstructive sleep apnea (OSAS). Inclusion criteria for treatment were: presence of anatomical abnormalities within upper airways, a will to undergo surgical procedure and no medical contraindication for this treatment. Study group consisted of 43 men at age 42.8 +/- 6.8 year with mean pretreatment value of AHI: 49.5 +/- 21.5. Nasal surgery was performed in 26 cases interventions improving patency of nose were performed, uvulopalatopharyngoplasty in 17 and in two the tonsillectomy. Diagnosis of OSAS was made on the basis of typical complains and symptoms and results of nocturnal polysomnography. During follow-up, subjective improvement was reported by 35 (81%) of patients. Polysomnography revealed a significant decrease of AHI to below 15 in 10 (23%) cases; a lowering over 50% of AHI was obtained in 6 (14%) cases: in another 7 (16%) an increase in post-surgery AHI value was noticed. Efficiency of each intervention is presented as follows: tonsillectomy: 100%, uvulopalatopharyngoplasty: 41% and nasal surgery: 4.2%. Deterioration of OSAS in 7 cases was most probably due to more sleep on back during the follow-up.     

脉冲振荡法在阻塞性睡眠呼吸暂停综合征中的临床意义

脉冲振荡法 (ＩＯＳ)是在强迫振荡技术基础上发展起来的一种测定肺功能的新方法。近年来单频率ＩＯＳ(2 0Ｈｚ)用于睡眠呼吸暂停综合征 (ＳＡＳ)患者夜间呼吸气流的检测以明确上呼吸道阻塞情况[1] 。在气道阻塞的病理情况下 ,呼吸道阻力存在频率依赖性[2 ] 。对阻塞性睡眠呼吸暂停综合征 (ＯＳＡＳ)患者采用多频率ＩＯＳ检测白天的气道阻力 ,并与常规肺功能进行分析 ,以探讨其临床意义。1　对象与方法1.1　研究对象　选择 1999- 0 4～ 0 92 5例经全夜多导睡眠图 (ＰＳＧ)确诊为ＯＳＡＳ的住院患者 (病例来源于德国马克勃兰登堡医院睡眠中心 …     

Dental therapy for obstructive sleep apnea

This article reviews the history of dental therapy as it has led up to currently available options for the treatment of sleep-related breathing disorders with an emphasis on oral appliance therapy. Over the last 20 years and in particular the last 5 to 7 years the contribution as well as the effectiveness of oral appliances has impacted the treatment of sleep apnea and at the same time provides an alternative for many patients. The focus here is to examine oral appliances and the role they have as it may be delivered by the dentist with an interest as well as the expertise in dental sleep medicine.     

睡眠呼吸暂停低通气综合征问卷对阻塞性睡眠呼吸暂停综合征诊断价值

目的 评价阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的流行病学调查表筛查价值.方法 疑似OSAHS的987例患者为研究对象,按照中华医学会呼吸病学分会睡眠学组睡眠呼吸暂停低通气综合征流行病学调查表进行问卷并行多导睡眠监测.将此问卷表进行量化评分,用克隆巴赫信度系数(α系数)进行信度计算,将各相关因素做方差分析及x2检验,筛选出有统计学意义的因素最后做Logistic回归分析.以鼾声中度以上的打鼾及体质量指数≥25 kg/m2为高危,反之为低危,进行敏感性,特异性,假阳性,假阴性,阳性似然比,阴性似然比,阳性预测值等.结果 疑似OSAHS患者987例,其中男800例(81.05％),女187例(18.95％),年龄18～80岁,平均(47±12)岁,平均体质量指数(29±5) kg/m2.＞60岁者156例(15.81％),≤60岁者831例(84.19％).克隆巴赫信度系数(Cronbach'salpha)是0.803,假阳性者20,假阴性者142,真阳性者742,真阴性者83,问卷的敏感性是83.94％,特异性是80.58％,假阳性率19.42％,假阴性率16.06％,阳性似然比4.32,阴性似然比0.20,阳性预测值0.97,阴性预测值0.37,正确率83.59％.结论 该睡眠调查表对OSAHS筛查具有一定意义,可用于临床OSAHS的初筛,尤其适合在社区和基层医院中推广使用.     

关于阻塞性睡眠呼吸暂停治疗方法的新探讨

阻塞性睡眠呼吸暂停(obstructive sleep apnoea,OSA)是临床常见的疾病,主要表现为打鼾,夜间睡眠反复出现呼吸暂停,白天过度嗜睡等症状.目前有许多的临床研究和流行病学的结果都显示了OSA是一种对多器官和多系统都有损害的睡眠呼吸疾病,它是高血压、冠状动脉粥样硬化性心脏病、心律失常、充血性心力衰竭、脑卒中等多种疾病的独立危险因素[1].严重影响着患者的生活质量,其发病率也越来越高.因此,这就使得进一步的研究探讨OSA的治疗方法成为必要.     

Pathogenesis of obstructive sleep apnea

Obstructive sleep apnea is a fairly common disorder with significant adverse health consequences. However, the pathogenetic mechanisms remain incompletely understood. Upper airway (UA) patency is determined by several neuromuscular and nonneuromuscular factors including (1) UA dilating muscle activity, (2) the collapsing transmural pressure generated during inspiration, (3) changes in caudal traction, (4) vasomotor tone, and (5) mucosal adhesive forces. This review addresses the effect of sleep on UA function and how these factors conspire to cause UA obstruction.