The impact of diet and lifestyle management strategies for obstructive sleep apnoea in adults: a systematic review and meta-analysis of randomised controlled trials
- 1.5k Downloads
To systematically evaluate the impact of diet, exercise and lifestyle modification programmes on indices of obesity, Obstructive Sleep Apnoea (OSA) parameters and quality of life (QoL) in adults with OSA.
Electronic databases were searched to identify randomised controlled trials published in English with an intervention based on dietary weight loss, exercise and/or lifestyle programme in adults with OSA. Meta-analyses were conducted using random-effects models.
Twelve studies met the inclusion criteria with nine comparing similar interventions. Diet and diet plus continuous positive airway pressure (CPAP) therapy were compared in three studies (n = 261), and intensive lifestyle programmes and routine care were compared in six studies (n = 483). Diet with CPAP therapy reduced weight by −2.64 kg (95 % Confidence Interval (CI) −3.98, −1.30, I 2 = 0 %) compared with diet alone. No differences were observed for QoL or Epworth Sleepiness Scale. A significant reduction in weight was seen in participants receiving an intensive lifestyle intervention of −5.65 kg (95 % CI −10.91, −0.40, I 2 = 95.7 %) compared with controls. Reductions were also observed for waist circumference (−5.80 cm, 95 % CI −8.64, −2.96, I2 = 77.7 %), body mass index (BMI) (−2.33 kg/m2, 95 % CI −3.41, −1.24, I2 = 78.8 %) and the Apnoea Hypopnoea Index (AHI) (−4.55 events/h, 95 % CI −7.12, −1.98, I 2 = 54.4 %) but with high levels of heterogeneity.
Intensive lifestyle management can significantly reduce obesity indices and improve AHI. Future research is required to investigate this effect due to a limited number of studies identified.
KeywordsObstructive sleep apnoea Diet Lifestyle Randomised controlled trial Meta-analysis
Funding was provided by the Leicester Diabetes Centre and the Hanning Sleep Laboratory.
The corresponding author and co-authors listed on this manuscript have no financial conflict of interest, and this research does not include off-label or investigational use of drugs or devices.
- 9.Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, Jones DW, Materson BJ, Oparil S, Wright JT, Roccella EJ, The National High Blood Pressure Education Program Coordinating Committee (2003) JNC:7 complete report: seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 42:1206–1252CrossRefPubMedGoogle Scholar
- 15.Foster GD, Sanders MH, Millman R, Zammit G, Borradaile KE, Newman AB, Wadden TA, Kelley D, Wing RR, Xavier Pi Sunyer F, Darcey V, Kuna ST, for the Sleep AHEAD Research Group (2009) Obstructive sleep apnoea among obese patients with type 2 diabetes. Diabetes Care 32:1017–1019CrossRefPubMedGoogle Scholar
- 20.Montserrat MJ, Ferrer M, Hernandez L, Farré R, Vilagut G, Navajas D, Badia RJ, Carrasco E, De Pablo J, Ballester E (2001) Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome—a randomized controlled study with an optimized placebo. Am J Respir Crit Care Med 164:608–613CrossRefPubMedGoogle Scholar
- 24.Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD, Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine (2009) Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5:263–76PubMedGoogle Scholar
- 28.Monasterio C, Vidal S, Duran J, Ferrer M, Carmona C, Barbé F, Mavos M, Gonzalez-Mangado N, Juncadella M, Navarro A, Barreira A, Capote F, Mayoralas LR, Peces-Barba G, Alonso J, Montserrat JM (2001) Effectiveness of continuous positive airway pressure in mild sleep apnea–hypopnea syndrome. Am J Respir Crit Care Med 164:939–943CrossRefPubMedGoogle Scholar
- 34.Foster GD, Borradaile KE, Sanders MH, Milman R, Zammit G, Newman AB, Wadden TE, Kelley D, Wing RR, Pi-Sunyer FX, Reboussin D, Kuna ST (2009) Sleep AHEAD Research Group of Look AHEA. A randomized study on the effect of weight loss on obstructive sleep apnea among obese patients with type 2 diabetes: the Sleep AHEAD study. Arch Intern Med 169:1619–1626CrossRefPubMedGoogle Scholar
- 35.Tuomilehto HP, Seppa JM, Partinen MM, Peltonen M, Gylling H, Tuomilehto JOI, Vanninen EJ, Kokkarinen J, Sahlman JK, Martikainen T, Soini EJO, Randell J, Tukiainen H, Uusitupa M (2009) Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea. Am J Respir Crit Care Med 179:320–327CrossRefPubMedGoogle Scholar
- 37.Ackel-D’Elia C, Carlos da Silva A, Santos Silva R, Truksinas E, Saldanha Sousa B, Tufik S, Túlio de Mello M, Azeredo Bittencourt L (2012) Effects of exercise training associated with continuous positive airway pressure treatment in patients with obstructive sleep apnea syndrome. Sleep Breath 16:723–735CrossRefPubMedGoogle Scholar
- 38.Papandreou C, Ssciza S, Tzatzarakis M, Kavalakis M, Hatzis C, Tsatsakis A, Kafatos A, Siafakas N, Tzanakis N (2012) Effects of Mediterranean diet on lipid peroxidation marker TBARS in obese patients with OSAHS under CPAP treatment: a randomised trial. Sleep Breath 16:873–879CrossRefPubMedGoogle Scholar
- 39.Kline CE, Crowley EP, Ewing GB, Burch JB, Blair SN, Durstine JL, Davis JM, Youngstedt SD (2011) The effect of exercise training on obstructive sleep apnea and sleep quality: a randomized controlled trial. Sleep 12:1631–1640Google Scholar
- 40.Tuomilehto HP, Gylling H, Peltonen M, Martikainen T, Sahlman JK, Kokkarinen J, Randel J, Tukiainen H, Vanninen EJ, Partinen MM, Tuomilehto J, Uusitupa M, Seppá J (2010) Sustained improvement in mild obstructive sleep apnea after a diet and physical activity-based lifestyle intervention: post interventional follow-up. Am J Clin Nutr 92:688–696CrossRefPubMedGoogle Scholar
- 41.Shneerson J, Wright JJ (2001) Lifestyle modification for obstructive sleep apnoea. Cochrane Database Syst. Rev Issue 1; CD002875Google Scholar
- 42.Anandam A, Akinnusi M, Kufel T, Porhomayon J, El-Solh AA (2012) Effects of dietary weight loss on obstructive sleep apnea: a meta-analysis. Sleep Breath. doi: 10.1007/s11325-012-0677-3
- 44.Liberati A, Douglas GA, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JPA, Clarke M, Devereaux PJ, Kleijner J, Mother D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. J Clin Epi 62:e1–e34CrossRefGoogle Scholar
- 52.Kline CE, Crowley EP, Ewing GB, Burch JB, Blair SN, Durstine JL, Davis JM, Youngstedt SD (2012) Exercise training improves selected aspects of daytime functioning in adults with obstructive sleep apnea. J Clin Sleep Med 4:357–365Google Scholar