Weight loss in patients with obstructive sleep apnea: an interventional procedure
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EPIDEMIOLOGY • LETTER TO THE EDITORS
Weight loss in patients with obstructive sleep apnea: an interventional procedure Tomoyuki Kawada 1 Received: 15 June 2020 / Accepted: 17 July 2020 # Springer Nature Switzerland AG 2020
Dear Editor, I read with interest a paper by Tsuyumu et al. who evaluated the 10-year adherence to continuous positive airway pressure (CPAP) treatment in patients with moderate-to-severe obstructive sleep apnea (OSA) [1]. Among a total of 181 patients, 56 patients dropped out of the treatment. Among the 56 patients who dropped out, approximately a half of the patients dropped out within a year, and all dropped out within 76 months. In addition, body mass index (BMI) and the first-month utilization were significantly associated with continuation of the treatment. The authors clarified that higher BMI was closely related to lowering of discontinuation of CPAP treatment; I think that BMI intervention for patients with OSA is also important for the treatment. Namely, lifestyle interventions addressing obesity-related dietary control and exercise, improvement of sleep with device and positioning, and alcohol cessation are recommended in the management of OSA. Carneiro-Barrera et al. conducted a meta-analysis to understand the effectiveness of lifestyle interventions on apnea-hypopnea index (AHI), oxygen desaturation index (ODI), excessive daytime sleepiness (EDS), and secondary obstructive sleep apnea (OSA) measures among adults [2]. In addition, they compared the superiority of each intervention for the greatest improvements. The metaanalyses of 13 randomized controlled trials (RCTs) and 22 uncontrolled studies revealed significant reductions on AHI (d = − 0.61 and − 0.46), ODI (d = − 0.61 and − 0.46), and EDS (d = − 0.41 and − 0.49), respectively. Secondary OSA outcomes were also improved by the
* Tomoyuki Kawada [email protected]
interventions. They concluded that weight loss was the most effective interventions for male patients with moderate-to-severe OSA, although effectiveness of interventions differed depending on their components, OSA severity, and gender. Regarding OSA severity, Mitchell et al. also conducted a meta-analysis regarding the effect of weight loss via lifestyle interventions on OSA using two systematic reviews and eight randomized RCTs [3]. The overall weighted mean differences (95% confidence interval) for weight change, change in AHI, and change in ODI of ≥ 4% were as follows: − 13.76 kg (− 19.21, − 8.32), − 16.09 (− 25.64, − 6.54), and − 14.18 (− 24.23, − 4.13), respectively. They concluded that intensive lifestyle interventions with weight loss were effective for mild-to-moderate OSA and its severity. OSA treatment by continuous positive airway pressure is not a fundamental procedure for the improvement of OSA, and weight control has been recommended to improve pathophysiology of OSA. I think that weight control intervention has a difficulty in its continuity, and combination of CPAP treatment and weight control intervention might be needed. As a meta-analysis of RCTs in
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