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Predictors of weight loss in obese patients with obstructive sleep apnea

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Consistent predictors of weight loss outcomes with very low-energy diets (VLEDs) in obstructive sleep apnea (OSA) have not been identified. This study aimed to identify variables predictive of weight loss success in obese patients with OSA undertaking an intensive weight loss programme.

Methods

We analysed biological, psychological, and behavioural variables as potential predictors of weight loss in obese patients with OSA after a 2-month VLED followed by one of two 10-month weight loss maintenance diets. Actigraphy, in-lab polysomnography, urinary catecholamines, and various psychological and behavioural variables were measured at baseline, 2, and 12 months. Spearman’s correlations analysed baseline variables with 2-month weight loss, and 2-month variables with 2–12 month-weight change.

Results

Forty-two patients completed the VLED and thirty-eight completed the maintenance diets. Actigraphy data revealed that late bedtime (rs =  − 0.45, p =  < 0.01) was correlated with 2-month weight loss. The change in the time that participants got out of bed (rise-time) from baseline to two months was also correlated with 2-month weight loss (rs = 0.36, p = 0.03). The Impact of Weight on Quality of Life-Lite questionnaire (IWQOL) Public Distress domain (rs =  − 0.54, p =  < 0.01) and total (rs =  − 0.38, p = 0.02) scores were correlated with weight loss maintenance from 2 to 12 months.

Conclusions

Results from this small patient sample reveal correlations between actigraphy characteristics and weight loss in obese patients with OSA. We suggest the IWQOL may also be a useful clinical tool to identify OSA patients at risk of weight regain after initial weight loss.

Clinical trial registration

This clinical trial was prospectively registered on 18/02/2013 with the Australia and New Zealand Clinical Trials Registry (ACTRN12613000191796).

Public Registry Title

Sleep, Lifestyle, Energy, Eating, Exercise Program for the management of sleep apnea patients indicated for weight loss treatment: A randomised, controlled pilot study.

URL

https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363680

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Data availability

Ethical approval was not granted to release participants’ raw data to third parties. We are happy to provide summaries of data collected in the trial upon request.

Code availability

No custom code was created for the analysis of this trial’s data. Statistical analysis was performed with standard medical statistics software (see ‘Methods’).

Abbreviations

AGHE:

Australian Guide to Healthy Eating

AHI:

Apnea-hypopnea index

AUSNUT:

Australian Food, Supplement and Nutrient Database

BMI:

Body mass index

CPAP:

Continuous positive airway pressure

EAC:

Elizabeth A. Cayanan

IWQOL:

Impact of Weight on Quality of Life-Lite questionnaire

LGHP:

Low Glycemic Index High-Protein

NC:

North Carolina

OSA:

Obstructive sleep apnea

PA:

Pennsylvania

SAS:

Statistical Analysis Software

USA:

United States of America

VLED:

Very low-energy diet

WASO:

Wake after sleep onset

References

  1. Newman AB, Foster G, Givelber R, Nieto FJ, Redline S, Young T (2005) Progression and regression of sleep-disordered breathing with changes in weight: the Sleep Heart Health Study. Arch Intern Med 165:2408–2413

    Article  PubMed  Google Scholar 

  2. Ford ES, Cooper RS (1991) Risk factors for hypertension in a national cohort study. Hypertension 18:598–606

    Article  CAS  PubMed  Google Scholar 

  3. Rimm EB, Stampfer MJ, Giovannucci E et al (1995) Body size and fat distribution as predictors of coronary heart disease among middle-aged and older US men. Am J Epidemiol 141:1117–1127

    Article  CAS  PubMed  Google Scholar 

  4. Hudgel DW, Patel SR, Ahasic AM et al (2018) The role of weight management in the treatment of adult obstructive sleep apnea. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 198:e70–e87

    Article  PubMed  Google Scholar 

  5. Fernandes JF, Araujo Lda S, Kaiser SE, Sanjuliani AF, Klein MR (2015) The effects of moderate energy restriction on apnoea severity and CVD risk factors in obese patients with obstructive sleep apnoea. Br J Nutr 114:2022–2031

    Article  CAS  PubMed  Google Scholar 

  6. Smith PL, Gold AR, Meyers DA, Haponik EF, Bleecker ER (1985) Weight loss in mildly to moderately obese patients with obstructive sleep apnea. Ann Intern Med 103:850–855

    Article  CAS  PubMed  Google Scholar 

  7. Tuomilehto HP, Seppa JM, Partinen MM et al (2009) Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea. Am J Respir Crit Care Med 179:320–327

    Article  PubMed  Google Scholar 

  8. Pasman WJ, Saris WH, Westerterp-Plantenga MS (1999) Predictors of weight maintenance. Obes Res 7:43–50

    Article  CAS  PubMed  Google Scholar 

  9. Sumithran P, Purcell K, Kuyruk S, Proietto J, Prendergast LA (2018) Combining biological and psychosocial baseline variables did not improve prediction of outcome of a very-low-energy diet in a clinic referral population. Clin Obes 8:30–38

    Article  CAS  PubMed  Google Scholar 

  10. Handjieva-Darlenska T, Handjiev S, Larsen TM et al (2010) Initial weight loss on an 800-kcal diet as a predictor of weight loss success after 8 weeks: the Diogenes study. Eur J Clin Nutr 64:994–999

    Article  CAS  PubMed  Google Scholar 

  11. Linde JA, Jeffery RW, Finch EA, Ng DM, Rothman AJ (2004) Are unrealistic weight loss goals associated with outcomes for overweight women? Obes Res 12:569–576

    Article  PubMed  Google Scholar 

  12. Fabricatore AN, Wadden TA, Moore RH, Butryn ML, Heymsfield SB, Nguyen AM (2009) Predictors of attrition and weight loss success: results from a randomized controlled trial. Behav Res Ther 47:685–691

    Article  PubMed  PubMed Central  Google Scholar 

  13. Vogels N, Diepvens K, Westerterp-Plantenga MS (2005) Predictors of long-term weight maintenance. Obes Res 13:2162–2168

    Article  PubMed  Google Scholar 

  14. Teixeira PJ, Going SB, Sardinha LB, Lohman TG (2005) A review of psychosocial pre-treatment predictors of weight control. Obes Rev 6:43–65

    Article  CAS  PubMed  Google Scholar 

  15. Zhu B, Shi C, Park CG, Zhao X, Reutrakul S (2019) Effects of sleep restriction on metabolism-related parameters in healthy adults: a comprehensive review and meta-analysis of randomized controlled trials. Sleep Med Rev 45:18–30

    Article  CAS  PubMed  Google Scholar 

  16. Ogilvie RP, Patel SR (2017) The epidemiology of sleep and obesity. Sleep Health 3:383–388

    Article  PubMed  PubMed Central  Google Scholar 

  17. Shechter A (2017) Obstructive sleep apnea and energy balance regulation: a systematic review. Sleep Med Rev 34:59–69

    Article  PubMed  Google Scholar 

  18. Kline CE, Chasens ER, Bizhanova Z et al (2021) The association between sleep health and weight change during a 12-month behavioral weight loss intervention. Int J Obes (Lond) 45:639–649

    Article  Google Scholar 

  19. Simpson SJ, Raubenheimer D (2005) Obesity: the protein leverage hypothesis. Obes Rev 6:133–142

    Article  CAS  PubMed  Google Scholar 

  20. Cayanan EA, Marshall NS, Hoyos CM et al (2018) Maintenance diets following rapid weight loss in obstructive sleep apnea: a pilot 1-year clinical trial. J Sleep Res 27:244–251

    Article  PubMed  Google Scholar 

  21. Moroshko I, Brennan L, O’Brien P (2011) Predictors of dropout in weight loss interventions: a systematic review of the literature. Obes Rev 12:912–934

    Article  CAS  PubMed  Google Scholar 

  22. Sasaki N, Fujiwara S, Yamashita H et al (2018) Association between obesity and self-reported sleep duration variability, sleep timing, and age in the Japanese population. Obes Res Clin Pract 12:187–194

    Article  PubMed  Google Scholar 

  23. Asarnow LD, McGlinchey E, Harvey AG (2015) Evidence for a possible link between bedtime and change in body mass index. Sleep 38:1523–1527

    Article  PubMed  PubMed Central  Google Scholar 

  24. Baron KG, Reid KJ, Kern AS, Zee PC (2011) Role of sleep timing in caloric intake and BMI. Obesity 19:1374–1381

    Article  PubMed  Google Scholar 

  25. Teixeira PJ, Going SB, Houtkooper LB et al (2004) Pretreatment predictors of attrition and successful weight management in women. Int J Obes Relat Metab Disord 28:1124–1133

    Article  CAS  PubMed  Google Scholar 

  26. Teixeira PJ, Going SB, Houtkooper LB et al (2002) Weight loss readiness in middle-aged women: psychosocial predictors of success for behavioral weight reduction. J Behav Med 25:499–523

    Article  PubMed  Google Scholar 

  27. Shechter A, St-Onge M-P, Kuna ST et al (2014) Sleep architecture following a weight loss intervention in overweight and obese patients with obstructive sleep apnea and type 2 diabetes: relationship to apnea-hypopnea index. J Clin Sleep Med 10:1205–1211

    Article  PubMed  PubMed Central  Google Scholar 

  28. Koolhaas CM, Kocevska D, Te Lindert BHW et al (2019) Objectively measured sleep and body mass index: a prospective bidirectional study in middle-aged and older adults. Sleep Med 57:43–50

    Article  PubMed  Google Scholar 

  29. Carlson JT, Hedner J, Elam M, Ejnell H, Sellgren J, Wallin BG (1993) Augmented resting sympathetic activity in awake patients with obstructive sleep apnea. Chest 103:1763–1768

    Article  CAS  PubMed  Google Scholar 

  30. Coy TV, Dimsdale JE, Ancoli-Israel S, Clausen J (1996) Sleep apnoea and sympathetic nervous system activity: a review. J Sleep Res 5:42–50

    Article  CAS  PubMed  Google Scholar 

  31. Marrone O, Salvaggio A, Bue AL et al (2011) Blood pressure changes after automatic and fixed CPAP in obstructive sleep apnea: relationship with nocturnal sympathetic activity. Clin Exp Hypertens 33:373–380

    Article  CAS  PubMed  Google Scholar 

  32. Carraça EV, Santos I, Mata J, Teixeira PJ (2018) Psychosocial pretreatment predictors of weight control: a systematic review update. Obes Facts 11:67–82

    Article  PubMed  PubMed Central  Google Scholar 

  33. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    Article  PubMed  Google Scholar 

  34. Weaver TE, Laizner AM, Evans LK et al (1997) An instrument to measure functional status outcomes for disorders of excessive sleepiness. Sleep 20:835–843

    Article  CAS  PubMed  Google Scholar 

  35. Kolotkin RL, Crosby RD (2002) Psychometric evaluation of the impact of weight on quality of life-lite questionnaire (IWQOL-lite) in a community sample. Qual Life Res 11:157–171

    Article  PubMed  Google Scholar 

  36. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545

    Article  CAS  PubMed  Google Scholar 

  37. Lovibond SH, Lovibond PF (1995) Manual for the depression anxiety stress scales. Psychology Foundation of Australia, Sydney

    Google Scholar 

  38. Schwarzer R, Jerusalem M (1995) Generalized self-efficacy scale. In: Weinman J, Wright S, Johnston M (eds) Measures in health psychology: a user’s portfolio. Causal and control beliefs. NFER-NELSON, Windsor, pp 35–77

    Google Scholar 

  39. Bandura A (1986) The explanatory and predictive scope of self-efficacy theory. J Soc Clin Psychol 4:359–373

    Article  Google Scholar 

  40. Brown J, Miller W, Lawendowski L (1999) Innovations in clinical practice: a source book. Professional Resource Press/Professional Resource Exchange, Sarasota

    Google Scholar 

  41. Baer RA, Smith GT, Allen KB (2004) Assessment of mindfulness by self-report: the Kentucky inventory of mindfulness skills. Assessment 11:191–206

    Article  PubMed  Google Scholar 

Download references

Funding

This trial was funded through the National Health and Medical Research Council (NHMRC) Centre for Integrated Research and Understanding of Sleep (CIRUS) Centre of Research Excellence (571421). Dr Camilla Hoyos is funded by a NHMRC-ARC Dementia Research Development Fellowship (APP1104003).

Author information

Author notes

  1. Thomas J. Altree

    Present address: Adelaide Institute for Sleep Health, Flinders University, Level 2, Mark Oliphant Building, 5 Laffer Drive, Bedford Park, South Australia, 5049, Australia

Authors and Affiliations

  1. CIRUS, Centre for Sleep and Chronobiology, The Woolcock Institute of Medical Research, The University of Sydney, Sydney, Australia

    Thomas J. Altree, Delwyn J. Bartlett, Nathaniel S. Marshall, Camilla M. Hoyos, Craig L. Phillips, Yasmina Serinel, Keith K. H. Wong, Brendon J. Yee, Ronald R. Grunstein & Elizabeth A. Cayanan

  2. Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia

    Delwyn J. Bartlett, Craig L. Phillips, Aran Kanagaratnam, Keith K. H. Wong, Brendon J. Yee & Ronald R. Grunstein

  3. NeuroSleep, National Health and Medical Research Council Centre of Research Excellence, Sydney, Australia

    Nathaniel S. Marshall, Camilla M. Hoyos, Ronald R. Grunstein & Elizabeth A. Cayanan

  4. Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, Australia

    Nathaniel S. Marshall, Callum Birks & Elizabeth A. Cayanan

  5. Faculty of Science, School of Psychology, The University of Sydney, Sydney, Australia

    Camilla M. Hoyos

  6. Healthy Brain Ageing Program, Brain and Mind Centre, Charles Perkins Centre, The University of Sydney, Sydney, Australia

    Camilla M. Hoyos

  7. Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, Australia

    Craig L. Phillips

  8. Mount Sinai Integrative Sleep Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine, New York, NY, USA

    Anna Mullins

  9. Department of Respiratory and Sleep Medicine, Nepean Hospital, Kingswood, Australia

    Yasmina Serinel

  10. Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia

    Keith K. H. Wong & Brendon J. Yee

Authors
  1. Thomas J. Altree
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  4. Camilla M. Hoyos
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  12. Ronald R. Grunstein
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  13. Elizabeth A. Cayanan
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Contributions

Study design: TJA, NSM, CMH, CLP, BJY, RRG, EAC. Data analysis, interpretation of data, and manuscript preparation: TJA, DJB, NSM, CMH, CLP, CB, AK, AM, YS, KKHW, BJY, RRG, EAC. All authors have seen and approved the manuscript.

Corresponding author

Correspondence to Thomas J. Altree.

Ethics declarations

Ethics approval

Approval was granted by the Sydney Local Health District-Ethics Review Committee (RPAH Zone), Research Development Office, Royal Prince Alfred Hospital, CAMPERDOWN NSW 2050 on 13/12/2012. Ethics approval number: HREC/12/RPAH/533.

Consent to participate

All participants freely gave written informed consent to participate.

Consent for publication

All participants gave informed consent for publication of the results of this trial, and ethics approval included permission to publish in indexed, peer-reviewed medical journals.

Institutions where the work was performed

Woolcock Institute of Medical Research, 431 Glebe Point Rd, Glebe, New South Wales, Australia, 2037.

Royal Prince Alfred Hospital Department of Respiratory and Sleep Medicine, Level 11, Main Building (Building 75), Missenden Road, Camperdown, New South Wales, Australia, 2050.

Conflict of interest

The authors declare no competing interests.

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Altree, T.J., Bartlett, D.J., Marshall, N.S. et al. Predictors of weight loss in obese patients with obstructive sleep apnea. Sleep Breath 26, 753–762 (2022). https://doi.org/10.1007/s11325-021-02455-4

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  • DOI: https://doi.org/10.1007/s11325-021-02455-4

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