1
|
Malhotra A, Heilmann CR, Banerjee KK, Dunn JP, Bunck MC, Bednarik J. Weight reduction and the impact on apnea-hypopnea index: A systematic meta-analysis. Sleep Med 2024; 121:26-31. [PMID: 38908268 PMCID: PMC11330732 DOI: 10.1016/j.sleep.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/13/2024] [Accepted: 06/13/2024] [Indexed: 06/24/2024]
Abstract
Obstructive sleep apnea (OSA) is strongly associated with obesity. While the relationship between weight reduction and apnea-hypopnea index improvement has been documented, to our knowledge, it has not been quantified adequately. Therefore, this study aimed to quantify the relationship between weight reduction and AHI change. METHODS A systematic literature search was performed using meta-analyses (PRISMA) guidelines for studies reporting AHI and weight loss in people with obesity/overweight and OSA between 2000 and 2023. A linear and quadratic model (weighted by treatment arm sample size) predicted percent change from baseline AHI against mean percent change from baseline weight. The quadratic term was statistically significant (P < 0.05), so the quadratic model (with 95 % prediction interval) was used. RESULTS The literature search identified 27 studies/32 treatment arms: 15 using bariatric surgery and lifestyle intervention each and 2 using pharmacological interventions. Included studies were ≥3 months with weight intervention and participants had AHI ≥15/h. Weight reduction in people with OSA and obesity was associated with improvements in the severity of OSA. BMI reduction of 20 % was associated with AHI reduction of 57 %, while further weight reduction beyond 20 % in BMI was associated with a smaller effect on AHI. As the prediction intervals are relatively wide, a precise relationship could not be conclusively established. CONCLUSION The degree of AHI index improvement was associated with the magnitude of weight reduction. The model suggests that with progress in weight reduction beyond 20 %, the incremental decrease in BMI appeared to translate to a smaller additional effect on AHI.
Collapse
|
2
|
McCarthy CE, McAteer CA, Murphy R, McDermott C, Costello M, O'Donnell M. Behavioral Sleep Interventions and Cardiovascular Risk Factors: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Cardiovasc Nurs 2024; 39:E158-E171. [PMID: 37556345 DOI: 10.1097/jcn.0000000000001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
BACKGROUND/OBJECTIVES Chronic sleep disturbance has been consistently associated with cardiovascular disease. We sought to determine whether behavioral interventions to improve sleep have been associated with improvements in 4 common cardiovascular disease risk factors: hypertension, diabetes mellitus (DM), obesity, and smoking. METHODS Randomized controlled trials evaluating the prospective effect of behavioral sleep interventions on ( a ) blood pressure in participants with hypertension/prehypertension, ( b ) glycemic control in participants with DM/pre-DM, ( c ) anthropometrics in participants who were overweight/obese, and ( d ) smoking status in smokers were eligible. Where feasible, we undertook random-effects meta-analyses of standardized mean differences in cardiovascular disease risk factor change. RESULTS Overall, 3 trials met the inclusion criteria for blood pressure, 4 for glycemic control, 9 for overweight/obesity, and 2 for smoking. On meta-analysis, interventions with sleep as the sole behavioral target were associated with a significant reduction in hemoglobin A 1c % (-0.84; 95% confidence interval [CI], -1.34 to -0.34), but not a significant reduction in systolic blood pressure (-0.18; 95% CI, -0.55 to 0.20) versus controls. In addition, any interventions with sleep as a behavioral target were associated with significant reductions in hemoglobin A 1c % (-0.71; 95% CI, -1.01 to -0.42) and weight (-0.78; 95% CI, -1.11 to -0.45), but not systolic blood pressure (-0.72; 95% CI, -1.82 to 0.37). Trials evaluating smoking status were not amenable to meta-analysis. CONCLUSION Behavioral interventions to improve sleep were associated with improved glycemic control in patients with DM. It is also possible that these interventions improve weight in individuals who were overweight/obese. A low number of trials and small sample sizes indicate that further large, well-designed randomized controlled trials of interventions are warranted.
Collapse
|
3
|
Meyer EJ, Wittert GA. Approach the Patient With Obstructive Sleep Apnea and Obesity. J Clin Endocrinol Metab 2024; 109:e1267-e1279. [PMID: 37758218 PMCID: PMC10876414 DOI: 10.1210/clinem/dgad572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/31/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
Obstructive sleep apnea (OSA) and obesity are highly prevalent and bidirectionally associated. OSA is underrecognized, however, particularly in women. By mechanisms that overlap with those of obesity, OSA increases the risk of developing, or having poor outcomes from, comorbid chronic disorders and impairs quality of life. Using 2 illustrative cases, we discuss the relationships between OSA and obesity with type 2 diabetes, dyslipidemia, cardiovascular disease, cognitive disturbance, mood disorders, lower urinary tract symptoms, sexual function, and reproductive disorders. The differences in OSA between men and women, the phenotypic variability of OSA, and comorbid sleep disorders are highlighted. When the probability of OSA is high due to consistent symptoms, comorbidities, or both, a diagnostic sleep study is advisable. Continuous positive airway pressure or mandibular advancement splints improve symptoms. Benefits for comorbidities are variable depending on nightly duration of use. By contrast, weight loss and optimization of lifestyle behaviors are consistently beneficial.
Collapse
Affiliation(s)
- Emily Jane Meyer
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Endocrine and Diabetes Services, The Queen Elizabeth Hospital, Woodville South, SA 5011, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5000, Australia
| | - Gary Allen Wittert
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA 5000, Australia
- Freemasons Centre for Male Health and Wellbeing, South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| |
Collapse
|
4
|
Godos J, Ferri R, Lanza G, Caraci F, Vistorte AOR, Yelamos Torres V, Grosso G, Castellano S. Mediterranean Diet and Sleep Features: A Systematic Review of Current Evidence. Nutrients 2024; 16:282. [PMID: 38257175 PMCID: PMC10821402 DOI: 10.3390/nu16020282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
The prevalence of sleep disorders, characterized by issues with quality, timing, and sleep duration is increasing globally. Among modifiable risk factors, diet quality has been suggested to influence sleep features. The Mediterranean diet is considered a landmark dietary pattern in terms of quality and effects on human health. However, dietary habits characterized by this cultural heritage should also be considered in the context of overall lifestyle behaviors, including sleep habits. This study aimed to systematically revise the literature relating to adherence to the Mediterranean diet and sleep features in observational studies. The systematic review comprised 23 reports describing the relation between adherence to the Mediterranean diet and different sleep features, including sleep quality, sleep duration, daytime sleepiness, and insomnia symptoms. The majority of the included studies were conducted in the Mediterranean basin and reported a significant association between a higher adherence to the Mediterranean diet and a lower likelihood of having poor sleep quality, inadequate sleep duration, excessive daytime sleepiness or symptoms of insomnia. Interestingly, additional studies conducted outside the Mediterranean basin showed a relationship between the adoption of a Mediterranean-type diet and sleep quality, suggesting that biological mechanisms sustaining such an association may exist. In conclusion, current evidence suggests a relationship between adhering to the Mediterranean diet and overall sleep quality and different sleep parameters. The plausible bidirectional association should be further investigated to understand whether the promotion of a healthy diet could be used as a tool to improve sleep quality.
Collapse
Affiliation(s)
- Justyna Godos
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy;
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute-IRCCS, 94018 Troina, Italy;
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, 95123 Catania, Italy;
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, 94018 Troina, Italy
| | - Filippo Caraci
- Department of Drug and Health Sciences, University of Catania, 95125 Catania, Italy;
- Neuropharmacology and Translational Neurosciences Research Unit, Oasi Research Institute-IRCCS, 94018 Troina, Italy
| | - Angel Olider Rojas Vistorte
- Research Group on Food, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain; (A.O.R.V.); (V.Y.T.)
- Universidad Internacional Iberoamericana, Arecibo, PR 00613, USA
- Universidade Internacional do Cuanza, Cuito EN250, Angola
| | - Vanessa Yelamos Torres
- Research Group on Food, Nutritional Biochemistry and Health, Universidad Europea del Atlántico, Isabel Torres 21, 39011 Santander, Spain; (A.O.R.V.); (V.Y.T.)
- Universidad Internacional Iberoamericana, Campeche 24560, Mexico
- Universidad de La Romana, La Romana 22000, Dominican Republic
| | - Giuseppe Grosso
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95123 Catania, Italy;
- Center for Human Nutrition and Mediterranean Foods (NUTREA), University of Catania, 95123 Catania, Italy
| | - Sabrina Castellano
- Department of Educational Sciences, University of Catania, 95124 Catania, Italy;
| |
Collapse
|
5
|
Hnatiak J, Galkova LZ, Winnige P, Batalik L, Dosbaba F, Ludka O, Krejci J. Comprehensive home-based telerehabilitation in a morbidly obese male patient with severe obstructive sleep apnea. A case report. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023; 167:390-394. [PMID: 37313735 DOI: 10.5507/bp.2023.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/19/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Rehabilitation may be an effective additional treatment method in patients with obstructive sleep apnea (OSA). Physical exercise, weight reduction, pulmonary rehabilitation, and myofunctional therapy (MT) represent beneficial components of rehabilitation recommended as a possible adjunct to standard OSA treatment. METHODS AND RESULTS A 54-year-old man with morbid obesity, long-lasting snoring, breathing pauses, frequent waking, as well as persistent drowsiness and fatigue during the day underwent polysomnography (PSG) to investigate suspected OSA. Severe OSA was confirmed by PSG and a 12-week comprehensive, home-based telerehabilitation program (tele-RHB program) along with continuous positive airway pressure (CPAP) therapy was implemented. The tele-RHB program included regular teleconsultations, aerobic-endurance training, MT, inspiratory and expiratory muscle training, as well as recommendations on proper nutrition, a healthy lifestyle, and behavioral changes. Following the treatment, the patient's quality of life (QoL), exercise capacity, lung function, and OSA severity significantly improved. The patient achieved an overall 19.9 kg reduction in weight, of which 16.2 kg was body fat, and his apnea-hypopnea index decreased by 42.6 episodes/hour. CONCLUSION Our case report suggests that the comprehensive home-based tele-RHB program adjunct to CPAP therapy may be a novel approach for improving OSA severity, a patient's QoL, exercise capacity, lung function and body composition. It is important to note that such a program should be optional, however it may be needed to achieve the highest possible overall improvement in a patient's life. Further clinical investigations are needed to determine the therapeutic efficacy and clinical potential of this tele-RHB program.
Collapse
Affiliation(s)
- Jakub Hnatiak
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- 1st Department of Internal Medicine - Cardioangiology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Lujza Zikmund Galkova
- 1st Department of Internal Medicine - Cardioangiology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Cardiovascular Sleep Center, 1st Department of Internal Medicine - Cardioangiology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Winnige
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ladislav Batalik
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Filip Dosbaba
- Department of Rehabilitation, University Hospital Brno, Brno, Czech Republic
| | - Ondrej Ludka
- Department of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno, Brno, Czech Republic
| | - Jan Krejci
- 1st Department of Internal Medicine - Cardioangiology, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| |
Collapse
|
6
|
DeVettori G, Troxel WM, Duff K, Baron KG. Positive airway pressure adherence among patients with obstructive sleep apnea and cognitive impairment: A narrative review. Sleep Med 2023; 111:28-35. [PMID: 37716335 PMCID: PMC10613340 DOI: 10.1016/j.sleep.2023.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/19/2023] [Accepted: 08/29/2023] [Indexed: 09/18/2023]
Abstract
Adults with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) have increased rates of Obstructive Sleep Apnea (OSA). Positive Airway Pressure (PAP) is the first-line treatment for OSA and may have potential benefits for slowing cognitive decline in these individuals. However, adherence is low in PAP users overall and those with cognitive impairment may have unique challenges. Furthermore, there has been little systematic study of the use of PAP or strategies to enhance PAP adherence among those with AD or MCI. The aim of this review is to examine existing observational, quasi-experimental and experimental studies of the effects of PAP on cognitive function. In addition, our goal was to gather evidence about the adherence rates, and support for PAP among adults with MCI and mild to moderate AD. Through searches of electronic databases (University of Utah Library, SAGE Publishing, PubMed, Wiley, EBSCO, Science Direct, ProQuest, and NCBI), we identified 11 articles that fit our study inclusion criteria. Synthesis of data was performed with a focus on cognitive outcomes of PAP interventions and adherence. Findings from the studies showed that multiple indices of memory improved with PAP use. Adherence in MCI and AD populations was largely comparable to adherence reported in general adult populations, but more research is needed to optimize systems for providing support for PAP users and caregivers. Results support PAP as a promising intervention in this population but more research is needed to make definitive conclusions about the relationship between PAP use and improved cognitive function. Furthermore, research is needed to determine if additional interventions are needed to support patients and caregivers.
Collapse
Affiliation(s)
- Giulia DeVettori
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Wendy M Troxel
- Rand Corporation, Division of Behavior and Policy Sciences, Pittsburgh, PA, USA
| | - Kevin Duff
- Department of Neurology, University of Utah, Salt Lake City, UT, USA; Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Kelly G Baron
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA.
| |
Collapse
|
7
|
Kechribari I, Kontogianni MD, Fragopoulou E, Tenta R, Georgoulis M, Lamprou K, Vagiakis E, Yiannakouris N. Adherence to a "Western-type" dietary pattern is positively associated with the Apnea-Hypopnea Index in adults with obstructive sleep apnea. Nutr Res 2023; 117:56-65. [PMID: 37480783 DOI: 10.1016/j.nutres.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/24/2023] [Accepted: 06/24/2023] [Indexed: 07/24/2023]
Abstract
Dietary habits have been associated with obstructive sleep apnea (OSA); however, the underlying mechanisms remain unclear. We hypothesized that adherence to dietary patterns may be associated with Apnea-Hypopnea Index (AHI) and OSA severity and that insulin resistance, oxidative stress, and inflammation may act as potential mediators of these associations. This was a cross-sectional study among 269 adult participants with polysomnography-diagnosed moderate-to-severe OSA. Dietary and physical activity habits were assessed through validated questionnaires, and biochemical, inflammatory, and oxidative stress markers were measured for all volunteers. Dietary patterns were identified using principal component analysis, and mediation analyses was also performed. A "Western-type" dietary pattern (characterized by high intakes of full-fat dairy, refined grains, potatoes, red meat, sweets, salty snacks, and soft drinks and low intakes of low-fat dairy and whole grains) was positively associated with AHI. Mediation analyses also revealed that insulin resistance partially explained this association. In multivariable models controlling for age, sex, smoking, socioeconomic status, obesity presence, energy intake, and physical activity level, participants in the highest quartile of adherence to the Western-type dietary pattern had ∼3.5 times higher likelihood of suffering from severe OSA, compared with participants in the lowest quartile of adherence (odds ratio [95% confidence interval]: 3.45 [1.21-9.94], P trend across quartiles: 0.024). After further adjustment for Homeostasis Model of Assessment-Insulin Resistance and high-sensitivity C-reactive protein, this association lost significance. Higher adherence to a less healthy, Western-type dietary pattern is positively associated with AHI and OSA severity, which may partially be mediated through insulin resistance.
Collapse
Affiliation(s)
- Ioanna Kechribari
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece.
| | - Meropi D Kontogianni
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Elizabeth Fragopoulou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Roxane Tenta
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Michael Georgoulis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Kallirroi Lamprou
- Center of Sleep Disorders, 1st Department of Critical Care, "Evangelismos" General Hospital, Athens, Greece
| | - Emmanouil Vagiakis
- Center of Sleep Disorders, 1st Department of Critical Care, "Evangelismos" General Hospital, Athens, Greece
| | - Nikos Yiannakouris
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| |
Collapse
|
8
|
Bouloukaki I, Daskalaki E, Mavroudi E, Moniaki V, Schiza SE, Tsiligianni I. A Dietary and Lifestyle Intervention Improves Treatment Adherence and Clinical Outcomes in Overweight and Obese Patients with Obstructive Sleep Apnea: A Randomized, Controlled Trial. Life (Basel) 2023; 13:1755. [PMID: 37629612 PMCID: PMC10456081 DOI: 10.3390/life13081755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
The study's objective was to assess the impact of Mediterranean diet/lifestyle interventions for weight loss on positive airway pressure (PAP) adherence, body mass index (ΒΜΙ), sleepiness, and blood pressure measurements (BP) in patients with obstructive sleep apnea (OSA). We designed a randomized, controlled trial, including overweight and obese patients with moderate to severe OSA, randomized to standard care (SCG, n = 37) or a Mediterranean diet group (MDG, n = 37). The SCG received healthy lifestyle advice, while the MDG underwent a 6-month behavioral intervention aiming to enhance weight loss and adherence to a Mediterranean diet. PAP adherence, BMI, Epworth Sleepiness Scale (ESS), and BP measurements were evaluated pre- and post-intervention. Post-intervention PAP use was higher in the MDG compared to the SCG (6.1 vs. 5.4, p = 0.02). Diet/lifestyle intervention was one of the most significant predictive factors for PAP adherence (OR = 5.458, 95% CI = 1.144-26.036, p = 0.03). The SCG demonstrated a rise in BMI, while the MDG displayed a decline (0.41 vs. -0.75, p = 0.02). The MDG also demonstrated a substantial reduction in adjusted SBP (-5.5 vs. 2.8, p = 0.014) and DBP (-4.0 vs. 2.5, p = 0.01). Ultimately, incorporating a dietary/lifestyle intervention with standard care yields superior PAP adherence, BMI, and BP measurements in contrast to standard care alone, emphasizing the advantages of dedicating more time and support within the MDG.
Collapse
Affiliation(s)
- Izolde Bouloukaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, 71500 Heraklion, Greece; (E.D.); (I.T.)
- Sleep Disorders Center, Department of Respiratory Medicine, Medical School, University of Crete, 71500 Heraklion, Greece; (E.M.); (V.M.); (S.E.S.)
| | - Eleni Daskalaki
- Department of Social Medicine, Faculty of Medicine, University of Crete, 71500 Heraklion, Greece; (E.D.); (I.T.)
| | - Eleni Mavroudi
- Sleep Disorders Center, Department of Respiratory Medicine, Medical School, University of Crete, 71500 Heraklion, Greece; (E.M.); (V.M.); (S.E.S.)
| | - Violeta Moniaki
- Sleep Disorders Center, Department of Respiratory Medicine, Medical School, University of Crete, 71500 Heraklion, Greece; (E.M.); (V.M.); (S.E.S.)
| | - Sophia E. Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, Medical School, University of Crete, 71500 Heraklion, Greece; (E.M.); (V.M.); (S.E.S.)
| | - Ioanna Tsiligianni
- Department of Social Medicine, Faculty of Medicine, University of Crete, 71500 Heraklion, Greece; (E.D.); (I.T.)
| |
Collapse
|
9
|
Georgoulis M, Yiannakouris N, Kechribari I, Lamprou K, Perraki E, Vagiakis E, Kontogianni MD. Sustained improvements in the cardiometabolic profile of patients with obstructive sleep apnea after a weight-loss Mediterranean diet/lifestyle intervention: 12-month follow-up (6 months post-intervention) of the "MIMOSA" randomized clinical trial. Nutr Metab Cardiovasc Dis 2023; 33:1019-1028. [PMID: 36958969 DOI: 10.1016/j.numecd.2023.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND AND AIMS Obstructive sleep apnea (OSA) and the metabolic syndrome (MS) frequently coexist and lead to increased cardiometabolic morbidity. We aimed to explore the long-term cardiometabolic benefits of a weight-loss Mediterranean diet/lifestyle intervention in OSA. METHODS AND RESULTS As many as 180 adults with overweight/obesity and polysomnography-diagnosed moderate-to-severe OSA were randomized to a standard care (SCG, n = 62), a Mediterranean diet (MDG, n = 59) or a Mediterranean lifestyle group (MLG, n = 59). All groups were prescribed with continuous positive airway pressure (CPAP), while intervention arms (MDG/MLG) additionally participated in a 6-month weight-loss intervention based on the Mediterranean diet/lifestyle. Cardiometabolic parameters were evaluated at baseline and 12 months (6 months post-intervention). Data were analyzed using the intention-to-treat method, and 12-month between-group differences were explored while adjusting for age, sex, baseline status and CPAP use. Compared to the SCG, intervention arms exhibited lower insulin, triglycerides and high-sensitivity C-reactive protein, and higher high-density lipoprotein cholesterol; the MDG also exhibited lower diastolic blood pressure, while the MLG exhibited lower glucose and systolic blood pressure (all P < 0.050). The relative risk (95% confidence interval) of MS was 0.60 (0.36, 0.99) in the MDG versus the SCG, 0.33 (0.20, 0.55) in the MLG versus the SCG and 0.55 (0.32, 0.93) in the MLG versus the MDG. The risk of MS remained lower in the MLG versus the other study groups (both P < 0.050) after additional adjustment for body weight change. CONCLUSION Cardiometabolic benefits of a 6-month healthy dietary/lifestyle intervention are sustainable 6 months post-intervention in OSA. TRIAL REGISTRATION ClinicalTrials.gov, NCT02515357, August 4, 2015.
Collapse
Affiliation(s)
- Michael Georgoulis
- Department of Nutrition & Dietetics, School of Health Sciences & Education, Harokopio University, 70 Eleftheriou Venizelou Str., 17676 Athens, Greece
| | - Nikos Yiannakouris
- Department of Nutrition & Dietetics, School of Health Sciences & Education, Harokopio University, 70 Eleftheriou Venizelou Str., 17676 Athens, Greece
| | - Ioanna Kechribari
- Department of Nutrition & Dietetics, School of Health Sciences & Education, Harokopio University, 70 Eleftheriou Venizelou Str., 17676 Athens, Greece
| | - Kallirroi Lamprou
- Center of Sleep Disorders, 1st Department of Critical Care and Pulmonary Services, Evangelismos Hospital, 45-47 Ipsilantou Str., 10676 Athens, Greece
| | - Eleni Perraki
- Center of Sleep Disorders, 1st Department of Critical Care and Pulmonary Services, Evangelismos Hospital, 45-47 Ipsilantou Str., 10676 Athens, Greece
| | - Emmanοuil Vagiakis
- Center of Sleep Disorders, 1st Department of Critical Care and Pulmonary Services, Evangelismos Hospital, 45-47 Ipsilantou Str., 10676 Athens, Greece
| | - Meropi D Kontogianni
- Department of Nutrition & Dietetics, School of Health Sciences & Education, Harokopio University, 70 Eleftheriou Venizelou Str., 17676 Athens, Greece.
| |
Collapse
|
10
|
Rokou A, Eleftheriou A, Tsigalou C, Apessos I, Nena E, Dalamaga M, Voulgaris A, Steiropoulos P. Effect of the Implementation of a Structured Diet Management Plan on the Severity of Obstructive Sleep Apnea: A Systematic Review. Curr Nutr Rep 2023; 12:26-38. [PMID: 36435894 PMCID: PMC9974698 DOI: 10.1007/s13668-022-00445-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The prevalence of obstructive sleep apnea (OSA) is increasing worldwide, in line with the increase in obesity prevalence. Taken into consideration the low compliance rates to continuous positive airway pressure (CPAP) treatment, and since obesity is a risk factor for OSA, these patients should receive additional counseling for weight loss through a diet plan. The aim of this review is to examine the role of a structured diet management plan on OSA severity, nocturnal oxygen indices, and subjective sleep parameters. RECENT FINDINGS Τhis systematic review of the literature resulted in four studies and demonstrated that severity of OSA, assessed by the apnea-hypopnea index, is reduced by a dietary management plan when delivered through an educational program. Moreover, nocturnal oxygenation is improved, as well as subjective sleep parameters, when initiating a diet on top of CPAP use. In summary, the present systematic review reports on the beneficial effects of a structured diet management plan in patients with OSA. Although CPAP remains the gold standard of OSA treatment, a specific dietary plan should be sought when managing patients with OSA. Nevertheless, still the evidence is low, and further research on this field is needed to reduce the burden of OSA.
Collapse
Affiliation(s)
- Aikaterini Rokou
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Anna Eleftheriou
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Christina Tsigalou
- Laboratory of Microbiology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ioulianos Apessos
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| | - Evangelia Nena
- Laboratory of Social Medicine, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Voulgaris
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece.
| | - Paschalis Steiropoulos
- Department of Pneumonology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
- MSc Program in Sleep Medicine, Medical School, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
| |
Collapse
|
11
|
Efficacy of lifestyle medicine on sleep quality: A meta-analysis of randomized controlled trials. J Affect Disord 2023; 330:125-138. [PMID: 36863476 DOI: 10.1016/j.jad.2023.02.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVES Randomized controlled trials (RCTs) on the efficacy of multicomponent lifestyle medicine (LM) interventions for improving sleep quality have yielded inconsistent findings. This study marks the first meta-analysis to evaluate the efficacy of multicomponent LM interventions in improving sleep quality. METHODS We searched six online databases for RCTs that compared multicomponent LM interventions to an active or inactive control group in an adult population and assessed subjective sleep quality as a primary or secondary outcome using validated sleep measures at any post-intervention time-point. RESULTS A total of 23 RCTs with 26 comparisons involving 2534 participants were included in the meta-analysis. After excluding outliers, the analysis revealed that multicomponent LM interventions significantly improved sleep quality at immediate post-intervention (d = 0.45) and at short-term follow-up (i.e., <three months) (d = 0.50) relative to an inactive control group. Regarding the comparison with active control, no significant between-group difference was found at any time-point. No meta-analysis was conducted at the medium- and long-term follow-up due to insufficient data. Subgroup analyses supported that multicomponent LM interventions had a more clinically relevant effect on improving sleep quality in participants with clinical levels of sleep disturbance (d = 1.02) relative to an inactive control at immediate post-intervention assessment. There was no evidence of publication bias. CONCLUSION Our findings provided preliminary evidence that multicomponent LM interventions were efficacious in improving sleep quality relative to an inactive control at immediate post-intervention and at short-term follow-up. Additional high-quality RCTs targeting individuals with clinically significant sleep disturbance and long-term follow-up are warranted.
Collapse
|
12
|
Palomo JM, Piccoli VD, Menezes LMD. Obstructive sleep apnea: a review for the orthodontist. Dental Press J Orthod 2023; 28:e23spe1. [PMID: 37075419 PMCID: PMC10108585 DOI: 10.1590/2177-6709.28.1.e23spe1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/02/2023] [Indexed: 04/21/2023] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) affects an important part of the population and is characterized by recurrent total or partial obstruction of the upper airway (UA) during sleep, negatively affecting the quality of life of patients in the short and long terms, and constituting an important public health problem for the society. The field of expertise of orthodontists is closely related to the UA, placing them in a strategic position to diagnose air passage failures and intervene when necessary. Orthodontists, as health professionals, must know how to recognize respiratory problems and manage them appropriately, when indicated. OBJECTIVE Thus, this paper aims to review and critically evaluate the related literature, to provide orthodontists with updated knowledge on the diagnosis and therapy related to OSA. Science and technology are constantly evolving; thus, the literature was also reviewed considering new technologies available in consumer-targeted applications and devices for the diagnosis, monitoring, and treatment of sleep-disordered breathing.
Collapse
Affiliation(s)
- Juan Martin Palomo
- Case Western Reserve University, School of Dental Medicine, Department of Orthodontics (Cleveland/OH, USA)
| | - Vicente Dias Piccoli
- Pontifícia Universidade Católica do Estado do Rio Grande do Sul, Faculdade de Odontologia (Porto Alegre/RS, Brazil)
| | - Luciane Macedo de Menezes
- Case Western Reserve University, School of Dental Medicine, Department of Orthodontics (Cleveland/OH, USA)
- Pontifícia Universidade Católica do Estado do Rio Grande do Sul, Faculdade de Odontologia (Porto Alegre/RS, Brazil)
| |
Collapse
|
13
|
Adherence to the Mediterranean lifestyle pattern is associated with favorable weight loss outcomes: the MedWeight study. Nutr Res 2022; 108:73-81. [PMID: 36403536 DOI: 10.1016/j.nutres.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 09/22/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
Individual lifestyle targets have been associated with weight loss outcomes, yet few studies have examined associations of one's total lifestyle with weight loss maintenance. We aimed to examine the relationship between lifestyle patterns and weight loss outcomes in weight loss maintainers and regainers. We hypothesized that higher adherence to a broader healthy lifestyle favors maintenance (over regain). This is a cross-sectional analysis of 470 adults (62% women) with a history of overweight/obesity and significant weight loss 12 months before study entry. Participants were classified as maintainers (current weight ≤90% maximum weight) or regainers. They were asked to fill in a series of questionnaires on demographics and lifestyle habits (dietary intake and eating behaviors through two 24-hour recalls, physical activity, and sleep). A total Mediterranean Lifestyle Index (total-MLI, range 0-13) was generated by summing up ratings in the lifestyle domain quartiles (diet quality, physical activity, and sleep habits) and dietary behaviors (seasonal food and vegetable intake, intake of traditional foods, responsibility for food preparation, conviviality). Maintainers scored higher in the total-MLI than regainers (6.93 ± 2.31 vs 5.78 ± 2.49, P < .001). Adherence to the total-MLI was associated with 28% higher odds for weight loss maintenance (per unit increment) in linear analyses. Being in the highest total-MLI quartile was associated with 5.27 (95% CI, 2.77-10.02) odds for maintenance. Higher adherence to a comprehensive Mediterranean lifestyle pattern was associated with higher odds for weight loss maintenance. Our findings suggest that even modest shifts toward a healthier living may contribute to favorable weight loss outcomes.
Collapse
|
14
|
Montero-Sandiego E, Ferrer-Cascales R, Ruiz-Robledillo N, Costa-López B, Alcocer-Bruno C, Albaladejo-Blázquez N. Assessment Strategies to Evaluate the Mediterranean Lifestyle: A Systematic Review. Nutrients 2022; 14:nu14194179. [PMID: 36235832 PMCID: PMC9571868 DOI: 10.3390/nu14194179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022] Open
Abstract
The Mediterranean Lifestyle (MLS) has been related to better health and quality of life. However, there is no consensus on how to assess this lifestyle. The main objective of this work was to systematically review the methodology used in different studies on the evaluation of the MLS. The specific objectives were (1) to analyze the MLS components evaluated in previous studies, (2) to explore the assessment instruments available for the analysis of the MLS, and (3) to identify the psychometric properties of these instruments. The search was carried out using the PubMed, Scopus, Web of Science, and ScienceDirect databases with the purpose of identifying those published articles in which the MLS was assessed. The review included 26 studies linked to the assessment of the MLS. Of these studies, only four exclusively used a tool to analyze MLS components globally. These studies included two questionnaires and three different indexes. None of them, however, evaluated all of the recognized MLS components, and food preparation was the least frequently evaluated component. Given the clear importance of analyzing MLS adherence and the lack of consensus in previous research, an evaluation tool needs to be created to comprehensively assess all of the MLS dimensions by means of appropriate psychometric properties.
Collapse
|
15
|
Improvements in Plasma Tumor Necrosis Factor-Alpha Levels after a Weight-Loss Lifestyle Intervention in Patients with Obstructive Sleep Apnea. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081252. [PMID: 36013431 PMCID: PMC9410143 DOI: 10.3390/life12081252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/07/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022]
Abstract
Obstructive sleep apnea (OSA) and systemic inflammation typically coexist within a vicious cycle. This study aimed at exploring the effectiveness of a weight-loss lifestyle intervention in reducing plasma tumor necrosis factor-alpha (TNF-a), a well-established modulator of systematic inflammation in OSA. Eighty-four adult, overweight patients with a diagnosis of moderate-to-severe OSA were randomized to a standard care (SCG, n = 42) or a Mediterranean lifestyle group (MLG, n = 42). Both groups were prescribed continuous positive airway pressure (CPAP), while the MLG additionally participated in a 6-month behavioral intervention aiming at healthier weight and lifestyle habits according to the Mediterranean pattern. Plasma TNF-a was measured by an immunoenzymatic method both pre- and post-intervention. Drop-out rates were 33% (n = 14) for the SCG and 24% (n = 10) for the MLG. Intention-to-treat analysis (n = 84) revealed a significant decrease in median TNF-a only in the MLG (from 2.92 to 2.00 pg/mL, p = 0.001). Compared to the SCG, the MLG exhibited lower follow-up TNF-a levels (mean difference adjusted for age, sex, baseline TNF-a and CPAP use: −0.97 pg/mL, p = 0.014), and further controlling for weight loss did not attenuate this difference (p = 0.020). Per protocol analyses (n = 60) revealed similar results. In conclusion, a healthy lifestyle intervention can lower plasma TNF-a levels in patients with OSA.
Collapse
|
16
|
Effects of a palaeolithic diet on obstructive sleep apnoea occurring in females who are overweight after menopause—a randomised controlled trial. Int J Obes (Lond) 2022; 46:1833-1839. [PMID: 35879528 PMCID: PMC9492533 DOI: 10.1038/s41366-022-01182-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/20/2022] [Accepted: 06/29/2022] [Indexed: 11/08/2022]
Abstract
Abstract
Background/Objectives
Obesity is the main risk factor for obstructive sleep apnoea, commonly occurring in females who are overweight after menopause. We aimed to study the effect of a palaeolithic diet on sleep apnoea in females with overweight after menopause from the population.
Methods
Seventy healthy, non-smoking females with a mean age of 60 years and a mean BMI of 33 kg/m2 were randomised to a palaeolithic diet or to a control low-fat diet according to Nordic Nutritional Recommendations, for 2 years. The apnoea-hypopnoea index was measured and daytime sleepiness was estimated during the intervention.
Results
The mean apnoea-hypopnoea index at baseline was 11.6 (95% CI 8.6–14.5). The mean weight loss was 7.2 kg (95% CI 5.3–9.2 kg) in the palaeolithic diet group and 3.9 kg in the control group (95% CI 1.9–5.9 kg); p < 0.021 for the group difference. The reduction in weight corresponded to a reduction in the apnoea-hypopnoea index in the palaeolithic diet group (r = 0.38, p = 0.034) but not in the control group (r = 0.08, p = 0.69). The apnoea-hypopnoea index was reduced in the palaeolithic diet group when the weight was reduced by more than 8 kg. Daytime sleepiness according to the Epworth Sleepiness Scale score and the Karolinska Sleepiness Scale score was unaffected by dietary group allocation.
Conclusions
A substantial decrease in body weight of 8 kg was needed to achieve a reduction in sleep apnoea in this small trial of women who are overweight after menopause. The palaeolithic diet was more effective for weight reduction than a control low-fat diet and the reduction in sleep apnoea was related to the degree of weight decrement within this diet group.
Trial registration
Clinicaltrials.gov: NCT00692536.
Collapse
|
17
|
Effect of a Weight Loss and Lifestyle Intervention on Dietary Behavior in Men with Obstructive Sleep Apnea: The INTERAPNEA Trial. Nutrients 2022; 14:nu14132731. [PMID: 35807913 PMCID: PMC9268365 DOI: 10.3390/nu14132731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 01/27/2023] Open
Abstract
This study investigated the effects of an eight-week interdisciplinary weight loss and lifestyle intervention on dietary behavior in men who were overweight/had obesity and moderate-to-severe obstructive sleep apnea (OSA). It was based on data from INTERAPNEA (ClinicalTrials.gov ID: NCT03851653); a randomized clinical trial conducted from April 2019 to April 2020. Men aged 18–65 years with moderate-to-severe OSA and a body mass index ≥25 kg/m2 were randomly assigned to a usual-care group or an eight-week interdisciplinary weight loss and lifestyle intervention combined with usual-care. Dietary behavior was assessed through the Food Behavior Checklist (FBC) and the Mediterranean Diet Adherence Screener (MEDAS). Of the 89 participants who underwent randomization, 75 completed the intervention endpoint assessment, 89 participants being therefore included in the intention-to-treat analyses, and 75 in the per-protocol approach. As compared with usual-care, the intervention group had greater improvements at intervention endpoint in dietary behavior, as measured by the FBC total score (20% increase in FBC total score, mean between-group difference, 8.7; 95% confidence interval, 5.7 to 11.7), and MEDAS total score (33% increase in MEDAS total score, mean between-group difference, 2.1; 95% CI 1.3 to 2.9). At 6 months after intervention, the intervention group also had greater improvements in both the FBC total score (15% increase) and MEDAS total score (25% increase), with mean between-group differences of 7.7 (CI 95%, 4.4 to 10.9) and 1.7 (CI 95%, 0.9 to 2.6), respectively. An eight-week interdisciplinary weight loss and lifestyle intervention resulted in meaningful and sustainable improvements in dietary behavior, including adherence to the Mediterranean diet in men who were overweight/ had obesity and CPAP-treated moderate-to-severe OSA.
Collapse
|
18
|
Pataka A. ‘One Size Doesn’t Fit for All’: There Is a Need for Targeted Personalized Therapy in Obstructive Sleep Apnea Syndrome. J Clin Med 2022; 11:jcm11133595. [PMID: 35806879 PMCID: PMC9267363 DOI: 10.3390/jcm11133595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/20/2022] [Indexed: 12/10/2022] Open
Affiliation(s)
- Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| |
Collapse
|
19
|
Georgoulis M, Yiannakouris N, Kechribari I, Lamprou K, Perraki E, Vagiakis E, Kontogianni MD. Dose-response relationship between weight loss and improvements in obstructive sleep apnea severity after a diet/lifestyle interventions: secondary analyses of the "MIMOSA" randomized clinical trial. J Clin Sleep Med 2022; 18:1251-1261. [PMID: 34915980 PMCID: PMC9059581 DOI: 10.5664/jcsm.9834] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Lifestyle-induced weight loss is a complementary therapeutic approach for obstructive sleep apnea (OSA). We aimed at identifying the dose-response relationship between weight loss and OSA severity improvement. METHODS This is a secondary analysis of a 6-month clinical trial in 180 adult, overweight/obese moderate-to-severe OSA patients. Participants were randomized to a standard care, a Mediterranean diet, or a Mediterranean lifestyle arm. All patients were prescribed with continuous positive airway pressure (CPAP), while intervention arms additionally participated in a weight-loss dietary/lifestyle intervention. Based on percent change in weight at 6 months, participants were categorized into a weight-stable/gain (WS/GG) group or 3 weight-loss groups (WLG): < 5%WLG, 5%-10%WLG, and ≥ 10%WLG. Polysomnographic data and OSA symptoms were evaluated preintervention and postintervention. RESULTS Respiratory events and oximetry indices improved only in patients who lost weight and improvements were proportional to the degree of weight loss. Median percent change in apnea-hypopnea index (AHI) was -11.7%, - 37.9%, and - 49.3% in the < 5%WLG, 5%-10%WLG, and ≥ 10%WLG, respectively (P < .001). Compared to the WS/GG, the age-, sex-, baseline-, and CPAP use-adjusted relative risk (95% confidence interval) of severe OSA (AHI ≥ 30 events/h) was 0.45 (0.23-0.87) in the 5%-10%WLG and 0.32 (0.17-0.64) in the ≥ 10%WLG; the risk was also lower in the ≥ 10%WLG vs the < 5%WLG (0.42 [0.22-0.82]). Insomnia and daytime sleepiness also improved more in participants exhibiting ≥ 5% weight loss. CONCLUSIONS Even a < 5% weight loss can reduce respiratory events, but a ≥ 5% and ideally ≥ 10% weight loss is necessary for reducing the prevalence of severe OSA. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Mediterranean Diet/Lifestyle Intervention in Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT02515357; Identifier: NCT02515357. CITATION Georgoulis M, Yiannakouris N, Kechribari I, et al. Dose-response relationship between weight loss and improvements in obstructive sleep apnea severity after a diet/lifestyle intervention: secondary analyses of the "MIMOSA" randomized clinical trial. J Clin Sleep Med. 2022;18(5):1251-1261.
Collapse
Affiliation(s)
- Michael Georgoulis
- Department of Nutrition & Dietetics, School of Health Sciences & Education, Harokopio University, Athens, Greece
| | - Nikos Yiannakouris
- Department of Nutrition & Dietetics, School of Health Sciences & Education, Harokopio University, Athens, Greece
| | - Ioanna Kechribari
- Department of Nutrition & Dietetics, School of Health Sciences & Education, Harokopio University, Athens, Greece
| | - Kallirroi Lamprou
- Center of Sleep Disorders, 1st Department of Critical Care and Pulmonary Services, Medical School of Athens University, Evangelismos Hospital, Athens, Greece
| | - Eleni Perraki
- Center of Sleep Disorders, 1st Department of Critical Care and Pulmonary Services, Medical School of Athens University, Evangelismos Hospital, Athens, Greece
| | - Emmanouil Vagiakis
- Center of Sleep Disorders, 1st Department of Critical Care and Pulmonary Services, Medical School of Athens University, Evangelismos Hospital, Athens, Greece
| | - Meropi D. Kontogianni
- Department of Nutrition & Dietetics, School of Health Sciences & Education, Harokopio University, Athens, Greece
| |
Collapse
|
20
|
Duan X, Huang J, Zheng M, Zhao W, Lao L, Li H, Wang Z, Lu J, Chen W, Deng H, Liu X. Association of healthy lifestyle with risk of obstructive sleep apnea: a cross-sectional study. BMC Pulm Med 2022; 22:33. [PMID: 35016643 PMCID: PMC8751297 DOI: 10.1186/s12890-021-01818-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/31/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND No studies investigated the whole effect of modifiable lifestyle factors on OSA risk. This study aimed to examine the individual and combined effects of lifestyle factors on OSA risk among Chinese adults. METHODS This cross-sectional study included 9733 participants aged 35 to 74 years from the baseline survey of Guangzhou Heart Study. OSA was evaluated by Berlin Questionnaire. The healthy lifestyle score (HLS), representing the overall effect of lifestyles, was derived from seven lifestyle factors: active smoking, passive smoking, alcohol, diet, waist-hip ratio, leisure-time physical activity, and mental status. Odds ratio (OR) with 95% confidence interval (CI) was calculated using the multivariate logistic regression model. RESULTS 8107 participants were divided into the non-OSA group and 1626 participants into the OSA group. No passive smoking (OR 0.83, 95% CI 0.74-0.94), healthy waist-hip ratio (OR 0.67, 95% CI 0.58-0.77) and healthy mental status (OR 0.45, 95% CI 0. 29-0.73) were associated with a reduced risk of OSA after adjusting for confounders, while others not. Participants with higher HLS were negatively associated with OSA risk (P-trend < 0.001). In comparison to the participants with 0-3 HLS, the OR for participants with 4, 5, 6, and 7 HLS was 0.68 (95% CI 0.56-0.84), 0.71 (95% CI 0.59-0.86), 0.62 (95% CI 0.51-0.76) and 0.49 (95% CI 0.37-0.65) after adjusting for confounders. Every 1-score increment of HLS was associated with a 13% lower risk of OSA. CONCLUSIONS The results suggest that HLS reflecting the combined effect of multiple-dimensional lifestyle factors was inversely associated with OSA risk. Preventive strategies integrating multiple lifestyle factors may provide a more feasible approach for OSA prevention.
Collapse
Affiliation(s)
- Xueru Duan
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 7/F, Public Health Building, No.74, Zhongshan Second Road, Guangzhou, 510080, China
- School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Avenue, Haizhu District, Guangzhou, 510310, China
| | - Jun Huang
- Department of Geriatrics, Institute of Geriatrics, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Murui Zheng
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Wenjing Zhao
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, China
| | - Lixian Lao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Science, 5/F, Ying Tung Building, No.106, Zhongshan Second Road, Guangzhou, 510080, China
| | - Haiyi Li
- Shantou University Medical College, Shantou, China
| | - Zhiwei Wang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Jiahai Lu
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 7/F, Public Health Building, No.74, Zhongshan Second Road, Guangzhou, 510080, China
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 7/F, Public Health Building, No.74, Zhongshan Second Road, Guangzhou, 510080, China.
| | - Hai Deng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Science, 5/F, Ying Tung Building, No.106, Zhongshan Second Road, Guangzhou, 510080, China.
| | - Xudong Liu
- School of Public Health, Guangdong Pharmaceutical University, No. 283 Jianghai Avenue, Haizhu District, Guangzhou, 510310, China.
| |
Collapse
|
21
|
|
22
|
Randerath W, Verbraecken J, de Raaff CAL, Hedner J, Herkenrath S, Hohenhorst W, Jakob T, Marrone O, Marklund M, McNicholas WT, Morgan RL, Pepin JL, Schiza S, Skoetz N, Smyth D, Steier J, Tonia T, Trzepizur W, van Mechelen PH, Wijkstra P. European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea. Eur Respir Rev 2021; 30:30/162/210200. [PMID: 34853097 PMCID: PMC9489103 DOI: 10.1183/16000617.0200-2021] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/01/2021] [Indexed: 12/12/2022] Open
Abstract
Treatment of obstructive sleep apnoea (OSA) in adults is evolving, as new therapies have been explored and introduced in clinical practice, while other approaches have been refined or reconsidered. In this European Respiratory Society (ERS) guideline on non-continuous positive airway pressure (CPAP) therapies for OSA, we present recommendations determined by a systematic review of the literature. It is an update of the 2011 ERS statement on non-CPAP therapies, advanced into a clinical guideline. A multidisciplinary group of experts, including pulmonary, surgical, dentistry and ear–nose–throat specialists, methodologists and patient representatives considered the most relevant clinical questions (for both clinicians and patients) relating to the management of OSA. Eight key clinical questions were generated and a systematic review was conducted to identify published randomised clinical trials that answered these questions. We used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the quality of the evidence and the strength of recommendations. The resulting guideline addresses gastric bypass surgery, custom-made dual-block mandibular advancement devices, hypoglossal nerve stimulation, myofunctional therapy, maxillo-mandibular osteotomy, carbonic anhydrase inhibitors and positional therapy. These recommendations can be used to benchmark quality of care for people with OSA across Europe and to improve outcomes. OSA-patients who refuse/don't adhere to CPAP can profit from established/emerging treatment options. High scientific evidence is lacking. Patients’ values/preference may weigh heavy in the decision for non-CPAP options, while health inequity is a concern.https://bit.ly/3o0tJeP
Collapse
Affiliation(s)
- Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany .,Co-shared first authorship
| | - Johan Verbraecken
- Antwerp University Hospital and University of Antwerp, Edegem (Antwerp), Belgium.,Co-shared first authorship
| | | | - Jan Hedner
- Dept of Sleep Medicine, Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Simon Herkenrath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
| | | | - Tina Jakob
- Evidence-based Oncology, Dept I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Oreste Marrone
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Palermo, Italy
| | - Marie Marklund
- Dept of Odontology, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Walter T McNicholas
- School of Medicine, University College Dublin, Dublin, Ireland.,Dept of Respiratory and Sleep Medicine, St Vincent's Hospital Group, Dublin, Ireland
| | - Rebecca L Morgan
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Sofia Schiza
- Sleep Disorders Unit, Dept of Respiratory Medicine, Medical School, University of Crete, Greece
| | - Nicole Skoetz
- Evidence-based Oncology, Dept I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dan Smyth
- European Lung Foundation, Sheffield, UK.,Sleep Disorder Support Foundation, Dublin, Ireland
| | - Jörg Steier
- Lane Fox Unit and Sleep Disorders Centre at Guy's & St Thomas' NHS Foundation Trust, Centre for Human & Applied Physiological Sciences, King's College London, London, UK
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Wojciech Trzepizur
- Dept of Respiratory and Sleep Medicine, Angers University hospital, Angers, France
| | | | - Peter Wijkstra
- Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
23
|
Georgoulis M, Yiannakouris N, Tenta R, Fragopoulou E, Kechribari I, Lamprou K, Perraki E, Vagiakis E, Kontogianni MD. A weight-loss Mediterranean diet/lifestyle intervention ameliorates inflammation and oxidative stress in patients with obstructive sleep apnea: results of the "MIMOSA" randomized clinical trial. Eur J Nutr 2021; 60:3799-3810. [PMID: 33839919 DOI: 10.1007/s00394-021-02552-w] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/30/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Inflammation and oxidative stress are implicated in obstructive sleep apnea (OSA) pathophysiology. We aimed at exploring whether the combination of a weight-loss Mediterranean diet/lifestyle intervention with OSA standard care, i.e., continuous positive airway pressure (CPAP) prescription, can lead to greater improvements in inflammation and oxidative stress, compared to standard care alone. METHODS This was a randomized controlled clinical trial in 187 adult, overweight patients with moderate-to-severe OSA. Participants were randomized to a standard care (SCG, n = 65), a Mediterranean diet (MDG, n = 62) or a Mediterranean lifestyle group (MLG, n = 60). All groups received OSA standard care. Intervention arms participated in a 6-month behavioral weight-loss intervention based on the Mediterranean diet, while the MLG also received counselling on physical activity and sleep habits. RESULTS Seven patients were excluded and 53/180 were lost to follow-up. In intention to treat analysis (n = 180), the SCG did not exhibit changes in any of the markers assessed. Post-intervention age-, sex-, baseline- and CPAP use-adjusted plasma high sensitivity C-reactive protein levels (mg/L) were lower in the MDG and the MLG compared to the SCG (mean difference - 1.33, P = 0.039 and - 1.68, P = 0.007, respectively). The MLG also exhibited lower urinary 8-iso prostaglandin F2a levels (ng/mg creatinine) compared to the SCG and the MDG (mean difference - 1.10, P < 0.0001 and - 0.80, P = 0.001, respectively). Adiponectin and oxidized guanine levels were not altered in any of the study groups. Results were similar in per protocol analysis (n = 127). CONCLUSION A weight-loss Mediterranean diet/lifestyle intervention on top of CPAP has anti-inflammatory and antioxidant benefits in OSA. REGISTRATION The trial was prospectively registered at ClinicalTrials.gov (NCT02515357) on August 4, 2015.
Collapse
Affiliation(s)
- Michael Georgoulis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 70 Eleftheriou Venizelou Str., 17671, Athens, Greece
| | - Nikos Yiannakouris
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 70 Eleftheriou Venizelou Str., 17671, Athens, Greece
| | - Roxane Tenta
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 70 Eleftheriou Venizelou Str., 17671, Athens, Greece
| | - Elizabeth Fragopoulou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 70 Eleftheriou Venizelou Str., 17671, Athens, Greece
| | - Ioanna Kechribari
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 70 Eleftheriou Venizelou Str., 17671, Athens, Greece
| | - Kallirroi Lamprou
- Center of Sleep Disorders, 1st Department of Critical Care and Pulmonary Services, Evangelismos Hospital, Medical School of Athens University, 45-47 Ipsilantou Str., 10676, Athens, Greece
| | - Eleni Perraki
- Center of Sleep Disorders, 1st Department of Critical Care and Pulmonary Services, Evangelismos Hospital, Medical School of Athens University, 45-47 Ipsilantou Str., 10676, Athens, Greece
| | - Emmanοuil Vagiakis
- Center of Sleep Disorders, 1st Department of Critical Care and Pulmonary Services, Evangelismos Hospital, Medical School of Athens University, 45-47 Ipsilantou Str., 10676, Athens, Greece
| | - Meropi D Kontogianni
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 70 Eleftheriou Venizelou Str., 17671, Athens, Greece.
| |
Collapse
|
24
|
Kechribari I, Kontogianni MD, Georgoulis M, Lamprou K, Critselis E, Vagiakis E, Yiannakouris N. Association of adherence to the Mediterranean diet and physical activity habits with the presence of insomnia in patients with obstructive sleep apnea. Sleep Breath 2021; 26:89-97. [PMID: 33813674 DOI: 10.1007/s11325-021-02351-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 01/29/2023]
Abstract
PURPOSE Insomnia and obstructive sleep apnea (OSA) are among the most prevalent sleep disorders and frequently co-occur, defining the sleep apnea-insomnia syndrome. However, data exploring associations between insomnia and lifestyle habits in patients with OSA are lacking. Therefore, the aim of the present study was to investigate potential associations between insomnia presence and individual lifestyle parameters in patients with mild/moderate-to-severe OSA evaluated by attended polysomnography. METHODS These are secondary analyses, using data from a cross-sectional study among 269 Greek patients with OSA. Clinical, anthropometric, socioeconomic, and lifestyle data were collected for all participants. Insomnia presence was evaluated through the validated psychometric instrument "Athens Insomnia Scale" (AIS). Adherence to the Mediterranean diet was estimated with the MedDietScale index and physical activity habits were assessed through a validated questionnaire. Backward stepwise multiple logistic regression analysis was used to estimate the association between lifestyle habits (i.e., adherence to the Mediterranean diet and physical activity) and the likelihood of having insomnia, while adjusting for potential confounders. RESULTS Of 269 patients newly diagnosed with OSA (aged 21-70 years; 73% men), 146 (54%) were categorized as having insomnia. In multivariable models, higher adherence to the Mediterranean diet and engagement in physical activity for ≥ 30 min/day were both associated with a lower likelihood of having insomnia (odds ratio (95% confidence intervals): 0.40 (0.18-0.91) and 0.49 (0.28-0.86), respectively). CONCLUSIONS Results add to the limited data on the role of lifestyle in insomnia and should be further explored both in epidemiological and clinical studies.
Collapse
Affiliation(s)
- Ioanna Kechribari
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 70 El. Venizelou Street, 17671, Athens, Greece.
| | - Meropi D Kontogianni
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 70 El. Venizelou Street, 17671, Athens, Greece
| | - Michael Georgoulis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 70 El. Venizelou Street, 17671, Athens, Greece
| | - Kallirroi Lamprou
- Center of Sleep Disorders, 1st Department of Critical Care, "Evangelismos" General Hospital, Athens, Greece
| | - Elena Critselis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 70 El. Venizelou Street, 17671, Athens, Greece
| | - Emmanouil Vagiakis
- Center of Sleep Disorders, 1st Department of Critical Care, "Evangelismos" General Hospital, Athens, Greece
| | - Nikos Yiannakouris
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 70 El. Venizelou Street, 17671, Athens, Greece.
| |
Collapse
|
25
|
Body Mass Index Reduction and Selected Cardiometabolic Risk Factors in Obstructive Sleep Apnea: Meta-Analysis. J Clin Med 2021; 10:jcm10071485. [PMID: 33918454 PMCID: PMC8038293 DOI: 10.3390/jcm10071485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 01/29/2023] Open
Abstract
Although clinical studies have been carried out on the effects of weight reduction in sleep apnea patients, no direct link has been shown between weight reduction and changes in cardio-metabolic risk factors. We aimed to analyze changes in the apnea–hypopnea index and selected cardio-metabolic parameters (total cholesterol, triglycerides, glucose, insulin, blood pressure) in relation to the reduction in body mass index in obstructive sleep apnea patients. Medline, Web of Science and Cochrane databases were searched to combine results from individual studies in a single meta-analysis. We identified 333 relevant articles, from which 30 papers were assigned for full-text review, and finally 10 (seven randomized controlled trials and three nonrandomized studies) were included for data analysis. One unit of body mass index reduction was found to significantly influence changes in the apnea–hypopnea index (−2.83/h; 95% CI: −4.24, −1.41), total cholesterol (−0.12 mmol/L; 95% CI: −0.22, −0.01), triglycerides (−0.24 mmol/L; 95% CI: −0.46, −0.02), fasting insulin (−7.3 pmol/L; 95% CI: −11.5, −3.1), systolic (−1.86 mmHg; 95% CI: −3.57, −0.15) and diastolic blood pressure (−2.07 mmHg; 95% CI: −3.79, −0.35). Practical application of lifestyle modification resulting in the reduction of one unit of body mass index gives meaningful changes in selected cardio-metabolic risk factors in obstructive sleep apnea patients.
Collapse
|