EFFECTIVENESS OF LIFESTYLE INTERVENTIONS FOR OSA: REVIEW AND META-ANALYSIS
Effectiveness of Lifestyle Interventions on Obstructive Sleep Apnea (OSA): Systematic Review and Meta-Analysis
Marzieh Hosseini Araghi, BSc, MPH1,2; Yen-Fu Chen, PhD1,2; Alison Jagielski, BSc, MSc1,2; Sopna Choudhury, BSc1,2; Dev Banerjee, BSc, MBChB, MD, FRCP1,3,4; Shakir Hussain, PhD5; G. Neil Thomas, PhD1,2,6; Shahrad Taheri, MBBS, PhD, FRCP1,2,7,8
1Birmingham and Black Country NIHR CLAHRC, University of Birmingham, Birmingham, UK; 2School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, UK; 3Academic Unit of Sleep and Ventilation, Heart of England NHS Foundation Trust, Birmingham, UK; 4School of Life and Health Sciences Aston University, Birmingham UK; 5 Department of Economic and Statistics Linnaeus University, Sweden; 6Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany; 7School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK; 8Weight Management Services, Heart of England NHS Foundation Trust, Birmingham, UK
Obstructive sleep apnea (OSA) is a common sleep disorder associated with several adverse health outcomes. Given the close association between OSA and obesity, lifestyle and dietary interventions are commonly recommended to patients, but the evidence for their impact on OSA has not been systematically examined.
To conduct a systematic review and meta-analysis to assess the impact of weight loss through diet and physical activity on measures of OSA: apnea-hypopnea index (AHI) and oxygen desaturation index of 4% (ODI4).
A systematic search was performed to identify publications using Medline (1948-2011 week 40), EMBASE (from 1988-2011 week 40), and CINAHL (from 1982-2011 week 40). The inverse variance method was used to weight studies and the random effects model was used to analyze data.
Seven randomized controlled trials (519 participants) showed that weight reduction programs were associated with a decrease in AHI (-6.04 events/h [95% confidence interval -11.18, -0.90]) with substantial heterogeneity between studies (I2 = 86%). Nine uncontrolled before-after studies (250 participants) showed a significant decrease in AHI (-12.26 events/h [95% confidence interval -18.51, -6.02]). Four uncontrolled before-after studies (97 participants) with ODI4 as outcome also showed a significant decrease in ODI4 (-18.91 episodes/h [95% confidence interval -23.40, -14.43]).
Published evidence suggests that weight loss through lifestyle and dietary interventions results in improvements in obstructive sleep apnea parameters, but is insufficient to normalize them. The changes in obstructive sleep apnea parameters could, however, be clinically relevant in some patients by reducing obstructive sleep apnea severity. These promising preliminary results need confirmation through larger randomized studies including more intensive weight loss approaches.
Araghi MH; Chen YF; Jagielski A; Choudhury S; Banerjee D; Hussain S; Thomas GN; Taheri S. Effectiveness of lifestyle interventions on obstructive sleep apnea (OSA): systematic review and meta-analysis. SLEEP 2013;36(10):1553-1562.