A weight loss and lifestyle intervention alleviates the need for CPAP in obstructive sleep apnea

Obstructive sleep apnea (OSA), characterized by recurrent sleep state–dependent upper airway collapse, is a globally recognized major public health problem affecting up to 936 million adults in the general population, with obesity as the leading cause. OSA has been independently associated with substantial increases in the likelihood of hypertension, dyslipidemia, diabetes, life-threatening cardiovascular diseases, and all-cause death. The first-line treatment for OSA is the use of a continuous positive airway pressure (CPAP) device, which maintains upper airway patency through positive pressure applied with a nasal or oronasal interface. Although CPAP therapy is effective in reducing upper airway occlusions when used as prescribed, adherence rates are suboptimal, and long-term benefits remain uncertain. Weight loss attained through alternative or combined behavioral interventions appears to substantially improve OSA and coexisting conditions among adults. However, previous clinical trials of alternative and behavioral interventions, although enlightening, have had limitations inherent to study design or methods. Furthermore, weight loss has only been addressed through restricted diets or exercise, without using either a combination of both components, and the interventions did not include alcohol avoidance and smoking cessation, which are well-established behavioral risk factors associated with the occurrence and worsening of OSA. The Interdisciplinary Weight Loss and Lifestyle Intervention for OSA (INTERAPNEA) randomized clinical trial evaluating a novel interdisciplinary weight loss and lifestyle intervention sought to overcome these limitations of previous research. The results were published online in JAMA Network Open on April 22, 2022.

This parallel-group open-label randomized trial was conducted at a hospital-based referral center in Granada, Spain. The study enrolled 89 men aged 18 to 65 years with moderate to severe OSA and a body mass index of 25 or greater who were receiving CPAP therapy. The sole inclusion of men was based on the higher incidence and prevalence of OSA in this population, the differences in OSA phenotypes between men and women, and the known effectiveness of weight loss interventions among men vs women. Participants were randomized to receive usual care (CPAP therapy) or an 8-week weight loss and lifestyle intervention involving nutritional behavior change, aerobic exercise, sleep hygiene, and alcohol and tobacco cessation combined with usual care. The primary end point was the change in the apnea-hypopnea index (AHI) from baseline at the end of the intervention and 6 months after intervention.

Among 89 men (mean [SD] age, 54.1 [8.0] years; mean [SD] AHI, 41.3 [22.2] events/h), 49 were randomized to the control group and 40 were randomized to the intervention group. The intervention group had a greater decrease in AHI (51% reduction; change, –21.2 events/h; 95% CI, –25.4 to –16.9 events/h) than the control group (change, 2.5 events/h; 95% CI, –2.0 to 6.9 events/h) at the intervention end point, with a mean between-group difference of –23.6 events/h (95% CI, –28.7 to –18.5 events/h). At 6 months after intervention, the reduction in AHI was 57% in the intervention group, with a mean between-group difference of –23.8 events/h (95% CI, –28.3 to –19.3 events/h). Moreover, at 6 months after intervention, 21 of 34 participants (61.8%) no longer required CPAP therapy, and complete remission of OSA was attained by 10 of 34 participants (29.4%). Not surprisingly, the intervention group had greater improvements in body weight ( –7.1 kg [95% CI, −8.6 to −5.5 kg] vs control (−0.3 kg [95% CI, −1.9 to 1.4 kg]).


Back to the list