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Deyang T, Baig MAI, Dolkar P, Hediyal TA, Rathipriya AG, Bhaskaran M, PandiPerumal SR, Monaghan TM, Mahalakshmi AM, Chidambaram SB. Sleep apnoea, gut dysbiosis and cognitive dysfunction. FEBS J 2024; 291:2519-2544. [PMID: 37712936 DOI: 10.1111/febs.16960] [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: 05/26/2023] [Revised: 08/14/2023] [Accepted: 09/13/2023] [Indexed: 09/16/2023]
Abstract
Sleep disorders are becoming increasingly common, and their distinct effects on physical and mental health require elaborate investigation. Gut dysbiosis (GD) has been reported in sleep-related disorders, but sleep apnoea is of particular significance because of its higher prevalence and chronicity. Cumulative evidence has suggested a link between sleep apnoea and GD. This review highlights the gut-brain communication axis that is mediated via commensal microbes and various microbiota-derived metabolites (e.g. short-chain fatty acids, lipopolysaccharide and trimethyl amine N-oxide), neurotransmitters (e.g. γ-aminobutyric acid, serotonin, glutamate and dopamine), immune cells and inflammatory mediators, as well as the vagus nerve and hypothalamic-pituitary-adrenal axis. This review also discusses the pathological role underpinning GD and altered gut bacterial populations in sleep apnoea and its related comorbid conditions, particularly cognitive dysfunction. In addition, the review examines the preclinical and clinical evidence, which suggests that prebiotics and probiotics may potentially be beneficial in sleep apnoea and its comorbidities through restoration of eubiosis or gut microbial homeostasis that regulates neural, metabolic and immune responses, as well as physiological barrier integrity via the gut-brain axis.
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Affiliation(s)
- Tenzin Deyang
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, India
| | - Md Awaise Iqbal Baig
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, India
| | - Phurbu Dolkar
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, India
| | - Tousif Ahmed Hediyal
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, India
- Centre for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education & Research, Mysuru, India
| | | | - Mahendran Bhaskaran
- College of Pharmacy and Pharmaceutical Sciences, Frederic and Mary Wolf Center, University of Toledo Health Science Campus, OH, USA
| | - Seithikuruppu R PandiPerumal
- Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Division of Research and Development, Lovely Professional University, Phagwara, India
| | - Tanya M Monaghan
- National Institute for Health Research Nottingham Biomedical Research Centre, University of Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, UK
| | - Arehally M Mahalakshmi
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, India
- Centre for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education & Research, Mysuru, India
- SIG-Brain, Behaviour and Cognitive Neurosciences Research (BBRC), JSS Academy of Higher Education & Research, Mysuru, India
| | - Saravana Babu Chidambaram
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, India
- Centre for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education & Research, Mysuru, India
- SIG-Brain, Behaviour and Cognitive Neurosciences Research (BBRC), JSS Academy of Higher Education & Research, Mysuru, India
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Bloomgarden Z. Obstructive sleep apnea and diabetes. J Diabetes 2023; 15:916-919. [PMID: 37926432 PMCID: PMC10667637 DOI: 10.1111/1753-0407.13494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- Zachary Bloomgarden
- Department of Medicine, Division of Endocrinology, Diabetes and Bone DiseaseIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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3
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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.
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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.
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Gupta A, Kaur J, Shukla G, Bhullar KK, Lamo P, Kc B, Agarwal A, Srivastava AK, Sharma G. Effect of yoga-based lifestyle and dietary modification in overweight individuals with sleep apnea: A randomized controlled trial (ELISA). Sleep Med 2023; 107:149-156. [PMID: 37178546 DOI: 10.1016/j.sleep.2023.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Obesity is recognised as an important risk factor for obstructive sleep apnea (OSA), with obese individuals at a four times higher risk of being diagnosed with the syndrome. Treating obesity with lifestyle modification is associated with a reduction in the severity of obstructive sleep apnea. Yoga comprises lifestyle modification that includes asana (postures), pranayama (breathing techniques), dhyana (meditation) and guideline principles for healthy living (Yama and Niyama). There is a scarcity of data to evaluate the effect of yoga on OSA. This study was conducted to evaluate the efficacy of Yoga based lifestyle modification on OSA. METHODS Consenting obese patients (BMI >23) diagnosed with obstructive sleep apnea (OSA) (AHI>5) on Polysomnography (PSG) were enrolled. Eligible patients were randomized into two groups. The control group received counselling for dietary modification (staple Indian) with regular exercise and the active intervention group received Yoga intervention as treatment (OSA module) in addition to similar dietary modification and regular exercise counselling. Polysomnography (PSG) was conducted at baseline and one year follow-up. All patients were evaluated at baseline, six months, and one year for compliance and anthropometric parameters. Additional assessment with Hamilton scales for depression and anxiety, SF-36, and the Pittsburgh sleep quality index was also conducted. RESULTS A total of 37 eligible patients (19 in the control group and 18 in the yoga group) were recruited for the study. The age [45.73 ± 10.71 vs. 46.22 ± 9.39 years, p = 0.88] and gender [15(78.95%) vs. 12(66.67%), p = 0.48 (males)] distribution was similar in both groups. After adjusting for age and gender, the percentage reduction in weight between the two groups did not reach statistical significance at one year. There was no significant difference in mean AHI between the two groups at one year. However, the number of patients with more than 40% AHI reduction [2/19 (10.52%) vs 8/18 (44.44%), p = 0.02] was significantly higher in the yoga group. Additionally, within the groups, the mean AHI at one year was significantly reduced in the yoga group [51.2 ± 28.0 to 36.8 ± 21.0/hour, p = 0.003], while no significant change was found in the control group [47.2 ± 23 to 38.8 ± 19.9/hour, p = 0.08]. CONCLUSIONS Lifestyle alteration using Yoga intervention and modification of staple Indian diet may be effective in reducing OSA severity among obese patients. CTRI NUMBER CTRI/2017/05/008462.
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Affiliation(s)
- Anupama Gupta
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Jasmin Kaur
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India; Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Shukla
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India; Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Khushpreet Kaur Bhullar
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Pasang Lamo
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Biju Kc
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Aman Agarwal
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India
| | | | - Gautam Sharma
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, New Delhi, India; Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
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Melaku YA, Reynolds AC, Appleton S, Sweetman A, Shi Z, Vakulin A, Catcheside P, Eckert DJ, Adams R. High quality and anti-inflammatory diets and a healthy lifestyle are associated with lower sleep apnea risk. J Clin Sleep Med 2022; 18:1667-1679. [PMID: 35232539 DOI: 10.5664/jcsm.9950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Most studies on diet and sleep apnea focus on calorie restriction. Here we investigate potential associations between dietary quality [healthy eating index (HEI), dietary inflammatory index (DII)] and overall healthy lifestyle with sleep apnea risk. METHODS National Health and Nutrition Examination Survey data (waves 2005-2008, and 2015-2018; N=14,210) were used to determine HEI, DII and their quintiles, with the fifth quintile indicating highest adherence to each dietary construct. A healthy lifestyle score was determined using diet, smoking, alcohol intake and physical activity level. STOP-BANG questionnaire was used to define sleep apnea risk. Generalized linear regression models with binomial family and logit link were used to investigate potential associations. The models were adjusted for socioeconomic status, lifestyle factors and chronic conditions. RESULTS Prevalence of high sleep apnea risk was 25.1%. Higher DII was positively associated with sleep apnea (odds ratio (OR)Q5 vs. Q1=1.55; 95% CI: 1.24-1.94; p for trend <0.001) whereas higher HEI was associated with reduced sleep apnea risk (ORQ5 VS. Q1=0.72: 0.59-0.88; p for trend=0.007). Higher healthy lifestyle score was also associated with decreased odds of sleep apnea (p for trend <0.001). There was a significant interaction between healthy lifestyle and sex with sleep apnea risk (p for interaction=0.049) whereby females with higher healthy lifestyle scores had lower risk of sleep apnea versus males. CONCLUSIONS Higher quality and anti-inflammatory diets and a healthier overall lifestyle are associated with lower sleep apnea risk. These findings underline the importance of strategies to improve overall diet quality and promote healthy behavior, not just calorie restriction, to reduce sleep apnea risk.
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Affiliation(s)
- Yohannes Adama Melaku
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Sarah Appleton
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Alexander Sweetman
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Zumin Shi
- Human Nutrition Department, College of Health Sciences, QU Health, Qatar University, Doha Qatar
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Peter Catcheside
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Danny J Eckert
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Robert Adams
- Flinders Health and Medical Research Institute (Sleep Health)/Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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Liu Y, Yang L, Stampfer MJ, Redline S, Tworoger SS, Huang T. Physical activity, sedentary behaviour and incidence of obstructive sleep apnoea in three prospective US cohorts. Eur Respir J 2022; 59:13993003.00606-2021. [PMID: 34289976 PMCID: PMC8933852 DOI: 10.1183/13993003.00606-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/10/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Reduced physical activity and increased sedentary behaviour may independently contribute to the development of obstructive sleep apnoea (OSA) through increased adiposity, inflammation, insulin resistance and body fluid retention. However, epidemiological evidence remains sparse and is primarily limited to cross-sectional studies. METHODS We prospectively followed 50 332 women from the Nurses' Health Study (2002-2012), 68 265 women from the Nurses' Health Study II (1995-2013) and 19 320 men from the Health Professionals Follow-up Study (1996-2012). Recreational physical activity (quantified by metabolic equivalent of task (MET)-h per week) and sitting time spent watching TV and at work/away from home were assessed by questionnaires every 2-4 years. Physician-diagnosed OSA was identified by validated self-report. Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals for OSA incidence associated with physical activity and sedentary behaviour. RESULTS During 2 004 663 person-years of follow-up, we documented 8733 incident OSA cases. After adjusting for potential confounders, the pooled HR for OSA comparing participants with ≥36.0 versus <6.0 MET-h per week of physical activity was 0.46 (95% CI 0.43-0.50; ptrend<0.001). Compared with participants spending <4.0 h per week sitting watching TV, the multivariable-adjusted HR was 1.78 (95% CI 1.60-1.98) for participants spending ≥28.0 h per week (ptrend<0.001). The comparable HR was 1.49 (95% CI 1.38-1.62) for sitting hours at work/away from home (ptrend<0.001). With additional adjustment for several metabolic factors, including body mass index and waist circumference, the associations with physical activity and sitting hours at work/away from home were attenuated but remained significant (ptrend<0.001), whereas the association with sitting hours watching TV was no longer statistically significant (ptrend=0.18). CONCLUSIONS Higher levels of physical activity and fewer sedentary hours were associated with lower OSA incidence. The potential mediating role of metabolic factors in the association between sedentary behaviour and OSA incidence may depend on the type of sedentary behaviour. Our results suggest that promoting an active lifestyle may reduce OSA incidence.
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Affiliation(s)
- Yue Liu
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, Canada,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Meir J. Stampfer
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Susan Redline
- Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA,Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Shelley S. Tworoger
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA,Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Tianyi Huang
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA,Division of Sleep Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Guimarães TM, Poyares D, Oliveira E Silva L, Luz G, Coelho G, Dal Fabbro C, Tufik S, Bittencourt L. The treatment of mild OSA with CPAP or mandibular advancement device and the effect on blood pressure and endothelial function after one year of treatment. J Clin Sleep Med 2021; 17:149-158. [PMID: 32964829 DOI: 10.5664/jcsm.8822] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVES To evaluate and compare the effects of continuous positive airway pressure (CPAP), use of a mandibular advancement device (MAD), and no treatment on 24-hour ambulatory blood pressure monitoring and peripheral arterial tonometry at 6 and 12 months follow-up in individuals with mild obstructive sleep apnea (OSA), and in a subgroup who had an apnea-hypopnea index of < 5 events/h and adherence of ≥ 4 hours per night (effective-treatment subgroups). METHODS The inclusion criteria were individuals with mild obstructive sleep apnea, any sex, age between 18 and 65 years, and a body mass index of ≤ 35 kg/m². Patients were randomized into CPAP, MAD, and no-treatment groups. The evaluations included physical examination, full polysomnography, 24-hour ambulatory blood pressure monitoring, and peripheral arterial tonometry at baseline and after 6 and 12 months. A generalized linear mixed model was used for comparisons. RESULTS The CPAP and MAD groups had lower apnea-hypopnea indexes than the control group at 6 and 12 months, and the CPAP group had higher blood oxygen levels (SpO₂) than the MAD group. The MAD group had more hours of treatment per night and better adaptation to treatment than the CPAP group (MAD: 5.7 ± 2.7 h/night; CPAP: 3.8 ± 3.4 h/night; MAD: 16% did not adapt; CPAP: 42% did not adapt). No differences were found in the total sample and effective treatment in relation to peripheral arterial tonometry or 24-hour ambulatory blood pressure monitoring outcomes. CONCLUSIONS Treatment of mild obstructive sleep apnea with CPAP or MAD did not improve blood pressure or endothelial function after 1 year, even in patients with effective treatment. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Continuous Positive Airway Pressure and Oral Appliances Treatments in Mild Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT01461486; Identifier: NCT01461486.
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Affiliation(s)
| | - Dalva Poyares
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, São Paulo, Brasil
| | | | - Gabriela Luz
- Departamento de Pneumologia, Universidade Federal de Sao Paulo, São Paulo, Brasil
| | - Glaury Coelho
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, São Paulo, Brasil
| | - Cibele Dal Fabbro
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, São Paulo, Brasil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, São Paulo, Brasil
| | - Lia Bittencourt
- Departamento de Psicobiologia, Universidade Federal de Sao Paulo, São Paulo, Brasil
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Toy Ş, Çiftçi R, Şenol D, Kizilay F, Ermiş H. Comparison of the Effects of the Somatotype on the Physical Activity, Kinesiophobia, and Fatigue Levels of Obstructive Sleep Apnea Syndrome Patients and Healthy Individuals. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:919-926. [PMID: 34183950 PMCID: PMC8223555 DOI: 10.18502/ijph.v50i5.6109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: We aimed to compare the physical activity, kinesiophobia, and fatigue levels of obstructive sleep apnea syndrome (OSAS) patients and healthy individuals in terms their somatotypes. Methods: A total of 165 individuals were enrolled referred to the Department of Chest Diseases Sleep Disorders Center Outpatient Clinic of Inonu University, Malatya, Turkey in 2018. The somatotype analysis was conducted using the Heath-Carter method, the fatigue level was assessed using the Functional Assessment of Chronic Illness Therapy (FACIT) fatigue scale, the kinesiophobia level was assessed using the Tampa Scale for Kinesiophobia (TSK), and the physical activity level was assessed using the International Physical Activity Questionnaire (IPAQ). Results: The results of the somatotype analysis revealed 3 different somatotypes in the healthy individuals and the OSAS patients’ mesomorph endomorph, endomorphic mesomorph, and mesomorphic endomorph. When comparing the somatotypes of the healthy individuals and the OSAS patients, statistically significant differences were found in the FACIT scores of the mesomorph endomorphs, the IPAQ and FACIT scores of the endomorphic mesomorphs, and the TSK and FACIT scores of the mesomorphic endomorphs (P<0.05). Conclusion: In all three somatotypes of the OSAS patients, the fatigue index scores were higher when compared to those of the healthy individuals. Moreover, when compared with the healthy individuals, the physical activity levels of the endomorphic mesomorphs with OSAS were low, while the kinesiophobia scores of the mesomorphic endomorphs with OSAS were high. Based on the results of this study, in OSAS patients, the endomorphic mesomorph somatotype could be a risk factor for reduced physical activity, while the mesomorphic endomorph somatotype could be a risk factor for increased kinesiophobia.
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Affiliation(s)
- Şeyma Toy
- Department of Anatomy, Faculty of Medicine, Karabük University, Karabük, Turkey
| | - Rukiye Çiftçi
- Department of Anatomy, Faculty of Medicine, Inönü University, Malatya, Turkey
| | - Deniz Şenol
- Department of Anatomy, Faculty of Medicine, Düzce University, Düzce, Turkey
| | - Fatma Kizilay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Malatya, Turkey
| | - Hilal Ermiş
- Department of Chest Diseases, Faculty of Medicine, Inönü University, Malatya, Turkey
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9
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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.
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Kuna ST, Reboussin DM, Strotmeyer ES, Millman RP, Zammit G, Walkup MP, Wadden TA, Wing RR, Pi-Sunyer FX, Spira AP, Foster GD. Effects of Weight Loss on Obstructive Sleep Apnea Severity. Ten-Year Results of the Sleep AHEAD Study. Am J Respir Crit Care Med 2021; 203:221-229. [PMID: 32721163 DOI: 10.1164/rccm.201912-2511oc] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Rationale: Weight loss is recommended to treat obstructive sleep apnea (OSA).Objectives: To determine whether the initial benefit of intensive lifestyle intervention (ILI) for weight loss on OSA severity is maintained at 10 years.Methods: Ten-year follow-up polysomnograms of 134 of 264 adults in Sleep AHEAD (Action for Health in Diabetes) with overweight/obesity, type 2 diabetes mellitus, and OSA were randomized to ILI for weight loss or diabetes support and education (DSE).Measurements and Main Results: Change in apnea-hypopnea index (AHI) was measured. Mean ± SE weight losses of ILI participants of 10.7 ± 0.7, 7.4 ± 0.7, 5.1 ± 0.7, and 7.1 ± 0.8 kg at 1, 2, 4, and 10 years, respectively, were significantly greater than the 1-kg weight loss at 1, 2, and 4 years and 3.5 ± 0.8 kg weight loss at 10 years for the DSE group (P values ≤ 0.0001). AHI was lower with ILI than DSE by 9.7, 8.0, and 7.9 events/h at 1, 2, and 4 years, respectively (P values ≤ 0.0004), and 4.0 events/h at 10 years (P = 0.109). Change in AHI over time was related to amount of weight loss, baseline AHI, visit year (P values < 0.0001), and intervention independent of weight change (P = 0.01). OSA remission at 10 years was more common with ILI (34.4%) than DSE (22.2%).Conclusions: Participants with OSA and type 2 diabetes mellitus receiving ILI for weight loss had reduced OSA severity at 10 years. No difference in OSA severity was present between ILI and DSE groups at 10 years. Improvement in OSA severity over the 10-year period with ILI was related to change in body weight, baseline AHI, and intervention independent of weight change.
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Affiliation(s)
- Samuel T Kuna
- University of Pennsylvania, Philadelphia, Pennsylvania.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | | | | | | | | | | | | | | | | | | | - Gary D Foster
- Temple University, Philadelphia, Pennsylvania; and.,WW (formerly Weight Watchers), New York, New York
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11
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Sleep Disordered Breathing: An Epidemiological Study among Albanian Children and Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228586. [PMID: 33227965 PMCID: PMC7699164 DOI: 10.3390/ijerph17228586] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/10/2020] [Accepted: 11/13/2020] [Indexed: 12/13/2022]
Abstract
Sleep Disordered Breathing (SDB) comprises a group of diseases characterized by alterations in the frequency and/or depth of breathing during sleep. The aim of this study was to investigate the frequency of SDB in a group of Albanian children and adolescents and to describe its social, physiological, psychological, sleep-related, and anthropometric risk factors, in relation to the sociodemographic situation. A total of 6087 participants (mean age: 10.42 years, range: 6 to 15 years, 52.3% females and 47.7% males) attending public schools all over Albania took part in the cross-sectional study. On a sample of 6087 questionnaires distributed, 4702 (77.25% of the original sample) were returned and included in the study. High risk status for SDB was assessed using the Paediatric Sleep Questionnaire (PSQ). The prevalence of SDB was 7.9%. No statistically significant difference was found for gender at high risk for SBD. Compared to participants living in urban aeras (7.3%), participants living in rural areas (10.4%) reported significantly higher SDB prevalence rates. No other significant correlations were detected between the high-risk subjects and the age. The prevalence of the subjects at high risk of SBD obese participants (20.8%) was statistically higher than among nonobese ones (6.3%). SDB is highly prevalent in Albanian growing population and further prevalence studies are recommended.
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12
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Vuorjoki-Ranta TR, Kämppi A, Aarab G, Tuomilehto H, Pihakari A, Lobbezoo F, Ahlberg J. Mandibular advancement device therapy for obstructive sleep apnea: A longitudinal study among patients treated in community dental care in Finland - Potential for the precision medicine approach. Cranio 2020; 40:268-273. [PMID: 32306855 DOI: 10.1080/08869634.2020.1752431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: Obstructive sleep apnea (OSA) is an increasing health problem worldwide. The aim was to evaluate long-term mandibular advancement device (MAD) therapy outcomes in community dental care among OSA patients in Finland.Methods: In all, 142 (77.2%) respondents of a questionnaire, with recently initiated treatment, were included in the study in 2010. Follow-up questionnaires were mailed in 2012 and 2017.Results: Problems occurred with the device long-term. Orofacial pain was reported more often in 2012 than in 2010 (p < 0.01). Snoring (p < 0.01) and tiredness (p < 0.05) were also significantly increased. In 2017, 50 subjects were still continuing with MAD, 20 of them as a single treatment modality. Treatment modalities in combination with MAD were CPAP, nutrition counseling, and position treatment.Discussion: Long-term MAD treatment may lead to a changing treatment-mix and set-backs. This may not only be a treatment adherence issue but also a lack of precision medicine approach regarding OSA.
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Affiliation(s)
- Tiina-Riitta Vuorjoki-Ranta
- City of Helsinki, Department of Social Services and Health Care, Helsinki, Finland.,Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Antti Kämppi
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Henri Tuomilehto
- Oivauni Sleep Clinic, Kuopio, Finland.,Institute of Public Health and Clinical Nutrition, Department of Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | | | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jari Ahlberg
- Department of Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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13
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López-Padrós C, Salord N, Alves C, Vilarrasa N, Gasa M, Planas R, Montsserrat M, Virgili MN, Rodríguez C, Pérez-Ramos S, López-Cadena E, Ramos MI, Dorca J, Monasterio C. Effectiveness of an intensive weight-loss program for severe OSA in patients undergoing CPAP treatment: a randomized controlled trial. J Clin Sleep Med 2020; 16:503-514. [PMID: 32003737 DOI: 10.5664/jcsm.8252] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
STUDY OBJECTIVES To determine whether an intensive weight-loss program (IWLP) is effective for reducing weight, the severity of obstructive sleep apnea (OSA), and metabolic variables in patients with obesity and severe OSA undergoing continuous positive airway pressure treatment. METHODS Forty-two patients were randomized to the control (CG, n = 20) or the intervention group (IG, n = 22), who followed a 12-month IWLP. The primary outcome was a reduction in the apnea-hypopnea index (AHI) as measured at 3 and 12 months by full polysomnography. Metabolic variables, blood pressure, body fat composition by bioimpedance, carotid intima media thickness, and visceral fat by computed tomography were also assessed. RESULTS Mean age was 49 (6.7) years, body mass index 35 (2.7) kg/m², and AHI 69 (20) events/h. Weight reduction was higher for the IG than the CG at 3 and 12 months, -10.5 versus -2.3 kg (P < .001), and -8.2 versus -0.1 kg (P < .001), respectively, as was loss of visceral fat at 12 months. AHI decreased more in the IG at 3 months (-23.72 versus -9 events/h) but the difference was not significant at 12 months, though 28% of patients from the IG had an AHI < 30 events/h compared to none in the CG (P = .046). At 12 months, the IG showed a reduction in C-reactive protein (P = .013), glycated hemoglobin (P = .031) and an increase in high density lipoprotein cholesterol (P = .027). CONCLUSIONS An IWLP in patients with obesity and severe OSA is effective for reducing weight and OSA severity. It also results in an improvement in lipid profiles, glycemic control, and inflammatory markers. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Title: Effectiveness of an Intensive Weight Loss Program for Obstructive Sleep Apnea Syndrome (OSAS) Treatment; Identifier: NCT02832414; URL: https://clinicaltrials.gov/ct2/show/record/NCT02832414.
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Affiliation(s)
- Carla López-Padrós
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Neus Salord
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,Section of Respiratory Medicine, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Carolina Alves
- Section of Endocrinology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Núria Vilarrasa
- Section of Endocrinology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Department of Endocrinology and Nutrition Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM-CIBER), Spain
| | - Merce Gasa
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,Section of Respiratory Medicine, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
| | - Rosa Planas
- Department of Rehabilitation, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Monica Montsserrat
- Department of Endocrinology and Nutrition Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - M Nuria Virgili
- Section of Endocrinology, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Department of Endocrinology and Nutrition Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,Department of Medicine, Universitat de Barcelona, Campus Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Carmen Rodríguez
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Sandra Pérez-Ramos
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Esther López-Cadena
- Respiratory Medicine Department, Hospital Universitari Sagrat Cor, Barcelona, Spain
| | | | - Jordi Dorca
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,Section of Respiratory Medicine, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Department of Medicine, Universitat de Barcelona, Campus Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Carmen Monasterio
- Multidisciplinary Sleep Unit, Department of Respiratory Medicine, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,Section of Respiratory Medicine, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Spain
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14
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Wang SH, Keenan BT, Wiemken A, Zang Y, Staley B, Sarwer DB, Torigian DA, Williams N, Pack AI, Schwab RJ. Effect of Weight Loss on Upper Airway Anatomy and the Apnea-Hypopnea Index. The Importance of Tongue Fat. Am J Respir Crit Care Med 2020; 201:718-727. [PMID: 31918559 PMCID: PMC7068828 DOI: 10.1164/rccm.201903-0692oc] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 12/03/2019] [Indexed: 12/21/2022] Open
Abstract
Rationale: Obesity is the primary risk factor for obstructive sleep apnea (OSA). Tongue fat is increased in obese persons with OSA, and may explain the relationship between obesity and OSA. Weight loss improves OSA, but the mechanism is unknown.Objectives: To determine the effect of weight loss on upper airway anatomy in subjects with obesity and OSA. We hypothesized that weight loss would decrease soft tissue volumes and tongue fat, and that these changes would correlate with reductions in apnea-hypopnea index (AHI).Methods: A total of 67 individuals with obesity and OSA (AHI ≥ 10 events/h) underwent a sleep study and upper airway and abdominal magnetic resonance imaging before and after a weight loss intervention (intensive lifestyle modification or bariatric surgery). Airway sizes and soft tissue, tongue fat, and abdominal fat volumes were quantified. Associations between weight loss and changes in these structures, and relationships to AHI changes, were examined.Measurements and Main Results: Weight loss was significantly associated with reductions in tongue fat and pterygoid and total lateral wall volumes. Reductions in tongue fat were strongly correlated with reductions in AHI (Pearson's rho = 0.62, P < 0.0001); results remained after controlling for weight loss (Pearson's rho = 0.36, P = 0.014). Reduction in tongue fat volume was the primary upper airway mediator of the relationship between weight loss and AHI improvement.Conclusions: Weight loss reduced volumes of several upper airway soft tissues in subjects with obesity and OSA. Improved AHI with weight loss was mediated by reductions in tongue fat. New treatments that reduce tongue fat should be considered for patients with OSA.
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Affiliation(s)
- Stephen H. Wang
- Albert Einstein College of Medicine, Bronx, New York
- Center for Sleep and Circadian Neurobiology
| | | | | | | | | | - David B. Sarwer
- Center for Obesity Research and Education at the College of Public Health at Temple University, Philadelphia, Pennsylvania
| | | | | | - Allan I. Pack
- Center for Sleep and Circadian Neurobiology
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Richard J. Schwab
- Center for Sleep and Circadian Neurobiology
- Division of Sleep Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
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15
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Mayat Z, Giardina EGV, Liao M, Aggarwal B. Associations of Inflammation, Physical Activity, and Sleep in a Diverse Population of Women. J Womens Health (Larchmt) 2020; 29:1007-1016. [PMID: 32175800 DOI: 10.1089/jwh.2019.7663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Cardiovascular disease (CVD) is the leading cause of mortality in United States with a recent rise seen in young adults, particularly women. Systemic inflammation, physical activity, and sleep are each individually linked to CVD risk. Whether there is an interaction of these variables, however, is unclear. We evaluated physical activity and sleep among racially ethnically diverse women, ages 20-79 years, to assess associations with systemic inflammation. Methods: We performed a cross-sectional study of 506 women (61% racial/ethnic minority; mean (standard deviation [SD]) age = 37 [15.7] years, body mass index 26.0 [5.7] kg/m2) enrolled in the American Heart Association (AHA) Go Red for Women Strategically Focused Research Network at Columbia University Irving Medical Center (CUIMC). Inflammation, assessed by C-reactive protein (CRP), was analyzed in the Biomarkers Core Laboratory at CUIMC. Physical activity and sleep were assessed using validated questionnaires. Multivariable models adjusted for demographic and clinical confounders were used to evaluate associations between CRP, physical activity, and sleep. Results: Mean (SD) physical activity was 282 (557.2) minutes/week, and mean (SD) sleep duration was 6.75 (1.24) hours/night. Mean CRP was 2.08 (3.56), and 17% of participants were categorized as high risk for obstructive sleep apnea (OSA). Participants who slept <6 hours/night were less likely to be physically active ≥150 minutes/week (odds ratios, ORs [95% confidence interval, CI]: 0.53 [0.33-0.84]). This association was nonsignificant after adjustment. High risk of OSA was associated with CRP ≥2 mg/L (OR [95% CI]: 1.91 [1.11-3.30]) following adjustment. Stratification by race/ethnicity showed that high risk of OSA was associated with CRP ≥2 mg/L among racial/ethnic minorities but not white women (OR [95% CI]: 2.75 [1.43-5.30] vs. 0.94 [0.31-2.88]). Conclusion: High risk of OSA and elevated CRP was significantly associated in women, particularly minority women. Both play a role in CVD, highlighting potential causes for the increased risk of CVD in younger women.
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Affiliation(s)
- Zara Mayat
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Elsa-Grace V Giardina
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Ming Liao
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Brooke Aggarwal
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
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16
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Yan S, Wang C, Zhao H, Pan Y, Wang H, Guo Y, Yao N, Li B, Cui W. Effects of fasting intervention regulating anthropometric and metabolic parameters in subjects with overweight or obesity: a systematic review and meta-analysis. Food Funct 2020; 11:3781-3799. [DOI: 10.1039/d0fo00287a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Previous studies have shown that fasting produces a potential effect in the prevention and treatment of many diseases.
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Affiliation(s)
- Shoumeng Yan
- Department of Epidemiology and Biostatistics
- School of Public Health
- Jilin University
- Changchun
- P. R. China
| | - Changcong Wang
- Department of Epidemiology and Biostatistics
- School of Public Health
- Jilin University
- Changchun
- P. R. China
| | - Hantong Zhao
- Department of Epidemiology and Biostatistics
- School of Public Health
- Jilin University
- Changchun
- P. R. China
| | - Yingan Pan
- Department of Epidemiology and Biostatistics
- School of Public Health
- Jilin University
- Changchun
- P. R. China
| | - Han Wang
- Department of Epidemiology and Biostatistics
- School of Public Health
- Jilin University
- Changchun
- P. R. China
| | - Yinpei Guo
- Department of Epidemiology and Biostatistics
- School of Public Health
- Jilin University
- Changchun
- P. R. China
| | - Nan Yao
- Department of Epidemiology and Biostatistics
- School of Public Health
- Jilin University
- Changchun
- P. R. China
| | - Bo Li
- Department of Epidemiology and Biostatistics
- School of Public Health
- Jilin University
- Changchun
- P. R. China
| | - Weiwei Cui
- Department of Nutrition and Food Hygiene
- School of Public Health
- Jilin University
- Changchun
- P. R. China
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17
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Carneiro-Barrera A, Díaz-Román A, Guillén-Riquelme A, Buela-Casal G. Weight loss and lifestyle interventions for obstructive sleep apnoea in adults: Systematic review and meta-analysis. Obes Rev 2019; 20:750-762. [PMID: 30609450 DOI: 10.1111/obr.12824] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/17/2022]
Abstract
Lifestyle interventions addressing diet, exercise-training, sleep hygiene, and/or tobacco/alcohol cessation are recommended in the management of obstructive sleep apnoea (OSA). Yet their effectiveness on this condition still requires further research. This systematic review and meta-analysis was aimed at establishing (a) the effectiveness of lifestyle interventions on apnoea-hypopnoea index (AHI), oxygen desaturation index (ODI), excessive daytime sleepiness (EDS), and secondary OSA measures among adults, and (b) which intervention characteristics may drive the greatest improvements. A systematic search of studies was conducted using CINAHL, ProQuest, Psicodoc, Scopus, and Web of Science, from inception to April 2018. Standardized mean differences were calculated using the inverse variance method and random-effects models. The meta-analyses of 13 randomized controlled trials and 22 uncontrolled before-and-after studies (1420 participants) revealed significant reductions on AHI (d = -0.61 and -0.46, respectively), ODI (d = -0.61 and -0.46) and EDS (d = -0.41 and -0.49). Secondary OSA outcomes were also improved after interventions. However, effectiveness of interventions differed depending on their components, OSA severity, and gender. Thus, until future research further supports the differential effectiveness among lifestyle interventions on OSA, those addressing weight loss through diet and exercise-training may be the most effective treatments for male patients with moderate-severe OSA.
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Affiliation(s)
| | - Amparo Díaz-Román
- Mind, Brain, and Behaviour Research Centre, CIMCYC, University of Granada, Granada, Spain
| | | | - Gualberto Buela-Casal
- Mind, Brain, and Behaviour Research Centre, CIMCYC, University of Granada, Granada, Spain
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18
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Choudhury A, Routray D, Swain S, Das AK. Prevalence and risk factors of people at-risk of obstructive sleep apnea in a rural community of Odisha, India: a community based cross-sectional study. Sleep Med 2019; 58:42-47. [PMID: 31078079 DOI: 10.1016/j.sleep.2019.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/23/2018] [Accepted: 03/25/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a progressive sleep disordered breathing condition characterized by repeated episodes of upper airway collapse during sleep. Despite being the most common sleep apnea, it often remains undiagnosed and untreated, especially in rural communities. There is a paucity of literature estimating the prevalence of the disease and associated risk factors from the rural population of Odisha. METHODS It is a cross-sectional study that was conducted in a rural community of Odisha, India to find out the prevalence of people living with the risk of OSA. Multi-staged sampling was done. Participants were evaluated using the Berlin questionnaire (BQ) after obtaining informed consent. Data were analyzed using SPSS with the significance level set at 95%. Univariate and multivariate analysis was done to evaluate the risk factors associated with the condition. RESULTS Out of 200 community dwellers surveyed using the BQ, 25% had a high likelihood of OSA. Among these high risk subjects, snoring was reported by 70%, excessive daytime sleepiness by 50%. Out of those who were at risk of OSA, 28% were smokers and 48% reported alcohol use. The associated risk factors were age >35 years (OR = 4.5, 95% CI = 1.4-13.8, p < 0.05), BMI ≥ 25 kg/m2 (aOR = 3.5, 95% CI = 1.2- 10.5, p < 0.05), alcoholism (aOR = 4.5, 95% CI = 1.8-11.1, p = 0.001), and hypertension (aOR = 11.5, 95% CI = 4.7-28, p < 0.001). The prevalence was not affected by the type of diet (vegetarian vs non-vegetarian), use of tobacco or tea consumption. CONCLUSION OSA is highly prevalent in the rural community of Odisha. Independent risk factors associated with such subjects were obesity, regular alcohol consumption, and hypertension. Further prevalence studies are recommended.
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Affiliation(s)
| | - Dipanweeta Routray
- Department of Community Medicine, S.C.B. Medical College, Cuttack, Odisha, India.
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20
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Kim JW, Lim HJ. Lifestyle Modification in Patients with Obstructive Sleep Apnea. SLEEP MEDICINE RESEARCH 2018. [DOI: 10.17241/smr.2018.00255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Xanthopoulos MS, Berkowitz RI, Tapia IE. Effects of obesity therapies on sleep disorders. Metabolism 2018; 84:109-117. [PMID: 29409812 DOI: 10.1016/j.metabol.2018.01.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/18/2018] [Accepted: 01/26/2018] [Indexed: 12/21/2022]
Abstract
Obesity is a significant risk factor for obstructive sleep apnea syndrome (OSAS), and has also been linked to reductions in sleep quality and quantity. Weight loss has been shown to be an effective treatment for improving OSAS; however, there is a high degree of variability in improvements of OSAS in response to weight loss. There are three modalities of obesity therapies: 1) lifestyle modification, which includes changes in dietary intake and physical activity, along with behavioral interventions; 2) pharmacologic agents; and 3) bariatric surgery. Individuals have a highly variable response to the various obesity interventions, and maintenance of weight loss can be especially challenging. These factors influence the effect of weight loss on sleep disorders. There is still a need for large, well-controlled studies examining short- and long-term efficacy of weight loss modalities and their impact on long-term treatment of OSAS and other sleep parameters, particularly in youth. Nonetheless, given our current knowledge, weight reduction should always be encouraged for people coping with obesity, OSAS, and/or sleep disruptions and resources identified to assist patients in choosing a weight loss approach that will benefit them the most.
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Affiliation(s)
- Melissa S Xanthopoulos
- Sleep Center in the Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Robert I Berkowitz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ignacio E Tapia
- Sleep Center in the Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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22
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Cayanan EA, Marshall NS, Hoyos CM, Phillips CL, Serinel Y, Wong KKH, Yee BJ, Grunstein RR. Maintenance diets following rapid weight loss in obstructive sleep apnea: a pilot 1-year clinical trial. J Sleep Res 2017; 27:244-251. [PMID: 28664540 DOI: 10.1111/jsr.12572] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/05/2017] [Indexed: 01/10/2023]
Abstract
Very low energy diets (VLED) appear to be the most efficacious dietary-based obesity reduction treatments in obstructive sleep apnea (OSA); however, effective weight loss maintenance strategies remain untested in this condition. Our study aimed to assess the feasibility, tolerability and efficacy of two common maintenance diets during a 10-month follow-up period after rapid weight loss using a 2-month VLED. In this two-arm, single-centre, open-label pilot trial, obese adult OSA patients received a 2-month VLED before being allocated to either the Australian Guide to Healthy Eating diet (AGHE) or a low glycaemic index high-protein diet (LGHP). Outcomes were measured at 0, 2 and 12 months. We recruited 44 patients [113.1 ± 19.5 kg, body mass index (BMI): 37.2 ± 5.6 kg m-2 , 49.3 ± 9.2 years, 12 females]. Twenty-four patients were on continuous positive airway pressure (CPAP) or mandibular advancement splint (MAS) therapy for OSA. Forty-two patients completed the VLED. The primary outcome of waist circumference was reduced by 10.6 cm at 2 months [95% confidence interval (CI): 9.2-12.1], and patients lost 12.9 kg in total weight (95% CI: 11.2-14.6). There were small but statistically significant regains in waist circumference between 2 and 12 months [AGHE = 3.5 cm (1.3-5.6) and LGHP = 2.8 cm (0.6-5.0]. Other outcomes followed a similar pattern of change. After weight loss with a 2-month VLED in obese patients with OSA, a structured weight loss maintenance programme incorporating commonly used diets was feasible, tolerable and efficacious for 10 months. This programme may be deployed easily within sleep clinics; however, future research should first test its translation within general clinical practice.
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Affiliation(s)
- Elizabeth A Cayanan
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Camperdown, NSW, Australia.,Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia
| | - Nathaniel S Marshall
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Camperdown, NSW, Australia.,Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia
| | - Camilla M Hoyos
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Camperdown, NSW, Australia
| | - Craig L Phillips
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Camperdown, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Yasmina Serinel
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Camperdown, NSW, Australia
| | - Keith K H Wong
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Camperdown, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Brendon J Yee
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Camperdown, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Ronald R Grunstein
- Sleep and Circadian Research Group, Woolcock Institute of Medical Research, University of Sydney, Camperdown, NSW, Australia.,Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Dobrosielski DA, Papandreou C, Patil SP, Salas-Salvadó J. Diet and exercise in the management of obstructive sleep apnoea and cardiovascular disease risk. Eur Respir Rev 2017; 26:26/144/160110. [PMID: 28659501 PMCID: PMC5559698 DOI: 10.1183/16000617.0110-2016] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 04/26/2017] [Indexed: 01/22/2023] Open
Abstract
Obstructive sleep apnoea (OSA) is associated with increased cardiovascular disease (CVD) morbidity and mortality. It is accepted that OSA and obesity commonly coexist. The American Academy of Sleep Medicine recommends dietary-induced weight loss and exercise as lifestyle treatment options for OSA. However, most clinical trials upon which this recommendation is based have focused on establishing the effectiveness of calorie-restricted, often low-fat diets for improving OSA severity, whereas less attention has been given to the means through which weight loss is achieved (e.g. altered dietary quality) or whether diet or exercise mediates the associations between reduced weight, improved OSA severity and the CVD substrate. The current evidence suggests that the benefits of a low-carbohydrate or Mediterranean diet in overweight and obese individuals go beyond the recognised benefits of weight reduction. In addition, exercise has an independent protective effect on vascular health, which may counter the increased oxidative stress, inflammation and sympathetic activation that occur in OSA patients. This review aims to expand our understanding of the effects of diet and exercise on OSA and associated CVD complications, and sets the stage for continued research designed to explore optimal lifestyle strategies for reducing the CVD burden in OSA patients.
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Affiliation(s)
- Devon A Dobrosielski
- Dept of Kinesiology, Towson University, Towson, MD, USA .,Both authors contributed equally
| | - Christopher Papandreou
- Human Nutrition Dept, Hospital Universitari Sant Joan, Institut d'Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, Reus, Spain.,Both authors contributed equally
| | - Susheel P Patil
- Dept of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jordi Salas-Salvadó
- Human Nutrition Dept, Hospital Universitari Sant Joan, Institut d'Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, Reus, Spain.,Ciber Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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24
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Chowdhuri S, Quan SF, Almeida F, Ayappa I, Batool-Anwar S, Budhiraja R, Cruse PE, Drager LF, Griss B, Marshall N, Patel SR, Patil S, Knight SL, Rowley JA, Slyman A. An Official American Thoracic Society Research Statement: Impact of Mild Obstructive Sleep Apnea in Adults. Am J Respir Crit Care Med 2017; 193:e37-54. [PMID: 27128710 DOI: 10.1164/rccm.201602-0361st] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Mild obstructive sleep apnea (OSA) is a highly prevalent disorder in adults; however, whether mild OSA has significant neurocognitive and cardiovascular complications is uncertain. OBJECTIVES The specific goals of this Research Statement are to appraise the evidence regarding whether long-term adverse neurocognitive and cardiovascular outcomes are attributable to mild OSA in adults, evaluate whether or not treatment of mild OSA is effective at preventing or reducing these adverse neurocognitive and cardiovascular outcomes, delineate the key research gaps, and provide direction for future research agendas. METHODS Literature searches from multiple reference databases were performed using medical subject headings and text words for OSA in adults as well as by hand searches. Pragmatic systematic reviews of the relevant body of evidence were performed. RESULTS Studies were incongruent in their definitions of "mild" OSA. Data were inconsistent regarding the relationship between mild OSA and daytime sleepiness. However, treatment of mild OSA may improve sleepiness in patients who are sleepy at baseline and improve quality of life. There is limited or inconsistent evidence pertaining to the impact of therapy of mild OSA on neurocognition, mood, vehicle accidents, cardiovascular events, stroke, and arrhythmias. CONCLUSIONS There is evidence that treatment of mild OSA in individuals who demonstrate subjective sleepiness may be beneficial. Treatment may also improve quality of life. Future research agendas should focus on clarifying the effect of mild OSA and impact of effective treatment on other neurocognitive and cardiovascular endpoints as detailed in the document.
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Joosten SA, Khoo JK, Edwards BA, Landry SA, Naughton MT, Dixon JB, Hamilton GS. Improvement in Obstructive Sleep Apnea With Weight Loss is Dependent on Body Position During Sleep. Sleep 2017; 40:3746886. [DOI: 10.1093/sleep/zsx047] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Simon A. Joosten
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Jun K. Khoo
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia
| | - Bradley A. Edwards
- Sleep and Circadian Medicine Laboratory, Department of Physiology Monash University, Melbourne, Victoria, Australia
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia
| | - Shane A. Landry
- Sleep and Circadian Medicine Laboratory, Department of Physiology Monash University, Melbourne, Victoria, Australia
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia
| | | | - John B. Dixon
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Garun S. Hamilton
- Monash Lung and Sleep, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
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26
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Puzziferri N. Putting weight-loss-cures-all to rest. Sleep Med 2017; 35:91. [PMID: 28285870 DOI: 10.1016/j.sleep.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/09/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Nancy Puzziferri
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, USA.
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27
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Parretti HM, Jebb SA, Johns DJ, Lewis AL, Christian-Brown AM, Aveyard P. Clinical effectiveness of very-low-energy diets in the management of weight loss: a systematic review and meta-analysis of randomized controlled trials. Obes Rev 2016; 17:225-34. [PMID: 26775902 DOI: 10.1111/obr.12366] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 11/02/2015] [Accepted: 11/04/2015] [Indexed: 12/11/2022]
Abstract
Guidelines suggest that very-low-energy diets (VLEDs) should be used to treat obesity only when rapid weight loss is clinically indicated because of concerns about rapid weight regain. Literature databases were searched from inception to November 2014. Randomized trials were included where the intervention included a VLED and the comparator was no intervention or an intervention that could be given in a general medical setting in adults that were overweight. Two reviewers characterized the population, intervention, control groups, outcomes and appraised quality. The primary outcome was weight change at 12 months from baseline. Compared with a behavioural programme alone, VLEDs combined with a behavioural programme achieved -3.9 kg [95% confidence interval (CI) -6.7 to -1.1] at 1 year. The difference at 24 months was -1.4 kg (95%CI -2.6 to -0.2) and at 38-60 months was -1.3 kg (95%CI -2.9 to 0.2). Nineteen per cent of the VLED group discontinued treatment prematurely compared with 20% of the comparator groups, relative risk 0.96 (0.56 to 1.66). One serious adverse event, hospitalization with cholecystitis, was reported in the VLED group and none in the comparator group. Very-low-energy diets with behavioural programmes achieve greater long-term weight loss than behavioural programmes alone, appear tolerable and lead to few adverse events suggesting they could be more widely used than current guidelines suggest.
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Affiliation(s)
- H M Parretti
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - S A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - D J Johns
- Human Nutrition Research, Medical Research Council, UK and Public Health Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - A L Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - A M Christian-Brown
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
| | - P Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
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28
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Bariatric Surgery or Non-Surgical Weight Loss for Obstructive Sleep Apnoea? A Systematic Review and Comparison of Meta-analyses. Obes Surg 2016; 25:1239-50. [PMID: 25537297 DOI: 10.1007/s11695-014-1533-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is a well-recognised complication of obesity. Non-surgical weight loss (medical, behavioural and lifestyle interventions) may improve OSA outcomes, although long-term weight control remains challenging. Bariatric surgery offers a successful strategy for long-term weight loss and symptom resolution. OBJECTIVES To comparatively appraise bariatric surgery vs. non-surgical weight loss interventions in OSA treatment utilising body mass index (BMI) and apnoea-hypopnoea index (AHI) as objective measures of weight loss and apnoea severity. METHODS A systematic literature review revealed 19 surgical (n = 525) and 20 non-surgical (n = 825) studies reporting the primary endpoints of BMI and AHI before and after intervention. Data were meta-analysed using random effects modelling. Subgroup analysis, quality scoring and risk of bias were assessed. RESULTS Surgical patients had a mean pre-intervention BMI of 51.3 and achieved a significant 14 kg/m(2) weighted decrease in BMI (95%CI [11.91, 16.44]), with a 29/h weighted decrease in AHI (95%CI [22.41, 36.74]). Non-surgical patients had a mean pre-intervention BMI of 38.3 and achieved a significant weighted decrease in BMI of 3.1 kg/m(2) (95%CI [2.42, 3.79]), with a weighted decrease in AHI of 11/h (95%CI [7.81, 14.98]). Heterogeneity was high across all outcomes. CONCLUSIONS Both bariatric surgery and non-surgical weight loss may have significant beneficial effects on OSA through BMI and AHI reduction. However, bariatric surgery may offer markedly greater improvement in BMI and AHI than non-surgical alternatives. Future studies must address the lack of randomised controlled and comparative trials in order to confirm the exact relationship between metabolic surgery and non-surgical weight loss interventions in OSA resolution.
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29
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Kline CE, Reboussin DM, Foster GD, Rice TB, Strotmeyer ES, Jakicic JM, Millman RP, Pi-Sunyer FX, Newman AB, Wadden TA, Zammit G, Kuna ST. The Effect of Changes in Cardiorespiratory Fitness and Weight on Obstructive Sleep Apnea Severity in Overweight Adults with Type 2 Diabetes. Sleep 2016; 39:317-25. [PMID: 26446118 DOI: 10.5665/sleep.5436] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 09/04/2015] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To examine the effect of changes in cardiorespiratory fitness on obstructive sleep apnea (OSA) severity prior to and following adjustment for changes in weight over the course of a 4-y weight loss intervention. METHODS As secondary analyses of a randomized controlled trial, 263 overweight/obese adults with type 2 diabetes and OSA participated in an intensive lifestyle intervention or education control condition. Measures of OSA severity, cardiorespiratory fitness, and body weight were obtained at baseline, year 1, and year 4. Change in the apnea-hypopnea index (AHI) served as the primary outcome. The percentage change in fitness (submaximal metabolic equivalents [METs]) and change in weight (kg) were the primary independent variables. Primary analyses collapsed intervention conditions with statistical adjustment for treatment group and baseline METs, weight, and AHI among other relevant covariates. RESULTS At baseline, greater METs were associated with lower AHI (B [SE] = -1.48 [0.71], P = 0.038), but this relationship no longer existed (B [SE] = -0.24 [0.73], P = 0.75) after adjustment for weight (B [SE] = 0.31 [0.07], P < 0.0001). Fitness significantly increased at year 1 (+16.53 ± 28.71% relative to baseline), but returned to near-baseline levels by year 4 (+1.81 ± 24.48%). In mixed-model analyses of AHI change over time without consideration of weight change, increased fitness at year 1 (B [SE] = -0.15 [0.04], P < 0.0001), but not at year 4 (B [SE] = 0.04 [0.05], P = 0.48), was associated with AHI reduction. However, with weight change in the model, greater weight loss was associated with AHI reduction at years 1 and 4 (B [SE] = 0.81 [0.16] and 0.60 [0.16], both P < 0.0001), rendering the association between fitness and AHI change at year 1 nonsignificant (B [SE] = -0.04 [0.04], P = 0.31). CONCLUSIONS Among overweight/obese adults with type 2 diabetes, fitness change did not influence OSA severity change when weight change was taken into account. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identification number NCT00194259.
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Affiliation(s)
| | | | - Gary D Foster
- Temple University, Philadelphia, PA.,Weight Watchers International, New York, NY
| | | | | | | | | | | | | | | | | | - Samuel T Kuna
- University of Pennsylvania, Philadelphia PA.,Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
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30
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Effect of oxygen desaturation threshold on determination of OSA severity during weight loss. Sleep Breath 2015; 20:33-42. [DOI: 10.1007/s11325-015-1180-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/27/2015] [Accepted: 04/07/2015] [Indexed: 12/22/2022]
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31
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Amount of weight loss or gain influences the severity of respiratory events in sleep apnea. Med Biol Eng Comput 2015; 53:975-88. [DOI: 10.1007/s11517-015-1290-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/26/2015] [Indexed: 11/25/2022]
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32
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Sudhakaran S, Surani SR. Comorbidity of diabetes and obstructive sleep apnea in hospitalized patients. Hosp Pract (1995) 2015; 43:79-84. [PMID: 25599880 DOI: 10.1080/21548331.2015.1004295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Obstructive sleep apnea (OSA) and type 2 diabetes are two morbidities commonly encountered in the hospitalized setting. Both diseases will present with an array of complications if not managed in a timely, competent manner. However, a growing body of evidence suggests a link between these two pathologies. It is our hope that through careful review of the literature, we may generate heightened awareness of the OSA/diabetes comorbidity. Through better understanding of these conditions and their interactions, we may insure efficient management in the clinical setting and prevent exacerbation of common complications.
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Blomster H, Laitinen TP, Hartikainen JE, Laitinen TM, Vanninen E, Gylling H, Sahlman J, Kokkarinen J, Randell J, Seppä J, Tuomilehto H. Mild obstructive sleep apnea does not modulate baroreflex sensitivity in adult patients. Nat Sci Sleep 2015. [PMID: 26203292 PMCID: PMC4487157 DOI: 10.2147/nss.s82443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a chronic and progressive disease. OSA is associated with increased cardiovascular morbidity and mortality, the risk being more frequently encountered with severe degrees of OSA. Increased sympathetic activation and impaired cardiac autonomic control as reflected by depressed baroreceptor reflex sensitivity (BRS) are possible mechanisms involved in the cardiovascular complications of OSA. However, it is not known at what stage of OSA that changes in BRS appear. The aim of this study was to evaluate BRS in patients with mild OSA. METHODS The study population consisted of 81 overweight patients with mild OSA and 46 body weight-matched non-OSA subjects. BRS, apnea-hypopnea index, body mass index, and metabolic parameters were assessed. The phenylephrine test was used to measure BRS. RESULTS Patients in the OSA group were slightly but significantly older than the non-OSA population (50.3±9.3 years vs 45.7±11.1 years, P=0.02). Body mass index, percentage body fat, blood pressure, fasting glucose, insulin, and lipid levels did not differ between the OSA patients and non-OSA subjects. Absolute BRS values in patients with mild OSA and non-OSA subjects (9.97±6.70 ms/mmHg vs 10.51±7.16 ms/mmHg, P=0.67) and BRS values proportional to age-related and sex-related reference values (91.4%±22.7% vs 92.2%±21.8%, P=0.84) did not differ from each other. BRS <50% of the sex-specific reference value was found in 6% of patients with mild OSA and in 2% of non-OSA subjects (P=0.29). CONCLUSION Patients with mild OSA did not show evidence of disturbed BRS in comparison with weight-matched non-OSA controls.
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Affiliation(s)
- Henry Blomster
- Department of Otorhinolaryngology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tomi P Laitinen
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha Ek Hartikainen
- Department of Internal Medicine, University of Eastern Finland, Kuopio, Finland ; Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Tiina M Laitinen
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland, Kuopio, Finland
| | - Esko Vanninen
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland, Kuopio, Finland
| | - Helena Gylling
- Department of Clinical Nutrition, School of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland ; Department of Medicine, Division of Internal Medicine, University of Helsinki, Helsinki, Finland
| | - Johanna Sahlman
- Department of Otorhinolaryngology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jouko Kokkarinen
- Department of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Jukka Randell
- Department of Respiratory Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Juha Seppä
- Department of Otorhinolaryngology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Henri Tuomilehto
- Department of Clinical Nutrition, School of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland ; Oivauni Sleep Clinic, Kuopio, Finland
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Shechter A, St-Onge MP, Kuna ST, Zammit G, RoyChoudhury A, Newman AB, Millman RP, Reboussin DM, Wadden TA, Jakicic JM, Pi-Sunyer FX, Wing RR, Foster GD. 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 2014; 10:1205-11. [PMID: 25325608 DOI: 10.5664/jcsm.4202] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 07/20/2014] [Indexed: 12/18/2022]
Abstract
STUDY OBJECTIVES To determine if weight loss and/ or changes in apnea-hypopnea index (AHI) improve sleep architecture in overweight/ obese adults with type 2 diabetes (T2D) and obstructive sleep apnea (OSA). METHODS This was a randomized controlled trial including 264 overweight/ obese adults with T2D and OSA. Participants were randomized to an intensive lifestyle intervention (ILI) or a diabetes and support education (DSE) control group. Measures included anthropometry, AHI, and sleep at baseline and year-1, year-2, and year-4 follow-ups. RESULTS Changes in sleep duration (total sleep time [TST]), continuity [wake after sleep onset (WASO)], and architecture stage 1, stage 2, slow wave sleep, and REM sleep) from baseline to year 1, 2, and 4 did not differ between ILI and DSE. Repeated-measure mixed-model analyses including data from baseline through year-4 for all participants demonstrated a significant positive association between AHI and stage 1 sleep (p < 0.001), and a significant negative association between AHI and stage 2 (p = 0.01) and REM sleep (p < 0.001), whereas changes in body weight had no relation to any sleep stages or TST. WASO had a significant positive association with change in body weight (p = 0.009). CONCLUSIONS Compared to control, the ILI did not induce significant changes in sleep across the 4-year follow-up. In participants overall, reduced AHI in overweight/ obese adults with T2D and OSA was associated with decreased stage 1, and increased stage 2 and REM sleep. These sleep architecture changes are more strongly related to reductions in AHI than body weight, whereas WASO may be more influenced by weight than AHI. CLINICAL TRIAL REGISTRATION NUMBER NCT00194259.
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Affiliation(s)
| | | | - Samuel T Kuna
- University of Pennsylvania, Philadelphia, PA and Philadelphia Veterans Affairs Medical Center, Philadelphia, PA
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Kulkas A, Leppänen T, Sahlman J, Tiihonen P, Mervaala E, Kokkarinen J, Randell J, Seppä J, Töyräs J, Tuomilehto H. Weight loss alters severity of individual nocturnal respiratory events depending on sleeping position. Physiol Meas 2014; 35:2037-52. [DOI: 10.1088/0967-3334/35/10/2037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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36
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Effects of a pragmatic lifestyle intervention for reducing body mass in obese adults with obstructive sleep apnoea: a randomised controlled trial. BIOMED RESEARCH INTERNATIONAL 2014; 2014:102164. [PMID: 25136550 PMCID: PMC4127266 DOI: 10.1155/2014/102164] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 06/16/2014] [Accepted: 07/04/2014] [Indexed: 12/13/2022]
Abstract
This study investigated the effects of a pragmatic lifestyle intervention in obese adults with continuous positive airway pressure-treated obstructive sleep apnoea hypopnoea syndrome (OSAHS). Sixty patients were randomised 1 : 1 to either a 12-week lifestyle intervention or an advice-only control group. The intervention involved supervised exercise sessions, dietary advice, and the promotion of lifestyle behaviour change using cognitive-behavioural techniques. Outcomes were assessed at baseline (week 0), intervention end-point (week 13), and follow-up (week 26). The primary outcome was 13-week change in body mass. Secondary outcomes included anthropometry, blood-borne biomarkers, exercise capacity, and health-related quality of life. At end-point, the intervention group exhibited small reductions in body mass (−1.8 [−3.0, −0.5] kg; P = 0.007) and body fat percentage (−1 [−2, 0]%; P = 0.044) and moderate improvements in C-reactive protein (−1.3 [−2.4, −0.2] mg·L−1; P = 0.028) and exercise capacity (95 [50, 139] m; P < 0.001). At follow-up, changes in body mass (−2.0 [−3.5, −0.5] kg; P = 0.010), body fat percentage (−1 [−2, 0]%; P = 0.033), and C-reactive protein (−1.3 [−2.5, −0.1] mg·L−1; P = 0.037) were maintained and exercise capacity was further improved (132 [90, 175] m; P < 0.001). This trial is registered with ClinicalTrials.gov NCT01546792.
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Mohanty S, Mohanty P, DI Biase L, Bai R, Trivedi C, Santangeli P, Santoro F, Hongo R, Hao S, Beheiry S, Burkhardt D, Gallinghouse JG, Horton R, Sanchez JE, Bailey S, Hranitzky PM, Zagrodzky J, Natale A. Long-term outcome of catheter ablation in atrial fibrillation patients with coexistent metabolic syndrome and obstructive sleep apnea: impact of repeat procedures versus lifestyle changes. J Cardiovasc Electrophysiol 2014; 25:930-938. [PMID: 24903158 DOI: 10.1111/jce.12468] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 04/22/2014] [Accepted: 05/05/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Metabolic syndrome (MS) and obstructive sleep apnea (OSA) are well-known independent risk factors for atrial fibrillation (AF) recurrence. This study evaluated ablation outcome in AF patients with coexistent MS and OSA and influence of lifestyle modifications (LSM) on arrhythmia recurrence. METHODS AND RESULTS We included 1,257 AF patients undergoing first catheter ablation (30% paroxysmal AF). Patients having MS + OSA were classified into Group 1 (n = 126; 64 ± 8 years; 76% male). Group 2 (n = 1,131; 62 ± 11 years; 72% male) included those with either MS (n = 431) or OSA (n = 112; no CPAP users) or neither of these comorbidities (n = 588). Patients experiencing recurrence after first procedure were divided into 2 subgroups; those having sporadic events (frequency < 2 months) remained on previously ineffective antiarrhythmic drugs (AAD) and aggressive LSM, while those with persistent arrhythmia (incessant or ≥2 months) underwent repeat ablation. After 34 ± 8 months of first procedure, 66 (52%) in Group 1 and 386 (34%) in Group 2 had recurrence (P < 0.001). Recurrence rate in only-MS, only-OSA, and without MS/OSA groups were 40%, 38%, and 29%, respectively. Patients with MS + OSA experienced substantially higher recurrence compared to those with lone MS or OSA (52% vs. 40% vs. 38%; P = 0.036). Of the 452 patients having recurrence, 250 underwent redo-ablation and 194 remained on AAD and LSM. At 20 ± 6 months, 76% of the redo group remained arrhythmia-free off AAD whereas 74% of the LSM group were free from recurrence (P = 0.71), 33% of which were off AAD. CONCLUSIONS MS and OSA have additive negative effect on arrhythmia recurrence following single procedure. Repeat ablation or compliant LSM increase freedom from recurrent AF.
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Affiliation(s)
- Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.,College of Natural Sciences, University of Texas at Austin, Texas, USA
| | - Prasant Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Luigi DI Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.,Department of Biomedical Engineering, University of Texas at Austin, Texas, USA.,Department of Cardiology, University of Foggia, Foggia, Italy.,Albert Einstein College of Medicine at Montefiore Hospital, New York, USA
| | - Rong Bai
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.,Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Pasquale Santangeli
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.,Department of Cardiology, University of Foggia, Foggia, Italy
| | | | | | - Steven Hao
- California Pacific Medical Center, California, USA
| | | | - David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - Rodney Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Javier E Sanchez
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Shane Bailey
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Patrick M Hranitzky
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Jason Zagrodzky
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.,Department of Biomedical Engineering, University of Texas at Austin, Texas, USA.,California Pacific Medical Center, California, USA.,Division of Cardiology, Stanford University, Palo Alto, California, USA.,Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA.,Case Western Reserve University, Cleveland, Ohio, USA
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Smith SS, Waight C, Doyle G, Rossa KR, Sullivan KA. Liking for high fat foods in patients with Obstructive Sleep Apnoea. Appetite 2014; 78:185-92. [DOI: 10.1016/j.appet.2014.03.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 03/18/2014] [Accepted: 03/19/2014] [Indexed: 11/26/2022]
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Mitchell LJ, Davidson ZE, Bonham M, O'Driscoll DM, Hamilton GS, Truby H. Weight loss from lifestyle interventions and severity of sleep apnoea: a systematic review and meta-analysis. Sleep Med 2014; 15:1173-83. [PMID: 25192671 DOI: 10.1016/j.sleep.2014.05.012] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 03/27/2014] [Accepted: 05/28/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Excess body weight is a risk factor for obstructive sleep apnoea (OSA). The aim of the systematic review was to establish whether weight loss via lifestyle interventions such as diet and exercise are useful in the treatment of OSA. METHODS A literature search was conducted between 1980 and February 2012. Systematic reviews and randomised controlled trials (RCTs) with participants who had OSA, were overweight or obese, and who had undergone lifestyle interventions with the aim of improving sleep apnoea were included. Meta analyses were conducted for a subset of RCTs with appropriate data. RESULTS Two systematic reviews and eight RCTs were included. Meta-analyses were conducted for four RCTs comparing intensive lifestyle interventions to a control. The overall weighted mean differences for weight change, change in apnoea -hypopnoea index (AHI) and change in oxygen desaturation index of ≥4% were as follows: -13.76 kg (95% confidence interval (CI) -19.21, --8.32), -16.09 (95% CI -25.64, -6.54) and -14.18 (95% CI -24.23, -4.13), respectively. Although high heterogeneity within the meta analyses, all studies favoured the interventions. Long-term follow-up data from three RCTs suggest that improvements in weight and AHI are maintained for up to 60 months. CONCLUSIONS Intensive lifestyle interventions are effective in the treatment of OSA, resulting in significant weight loss and a reduction in sleep apnoea severity. Weight loss via intensive lifestyle interventions could be encouraged as a treatment for mild to moderate OSA.
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Affiliation(s)
- Lana J Mitchell
- Department of Nutrition and Dietetics, Monash University, Melbourne, Vic, Australia
| | - Zoe E Davidson
- Department of Nutrition and Dietetics, Monash University, Melbourne, Vic, Australia.
| | - Maxine Bonham
- Department of Nutrition and Dietetics, Monash University, Melbourne, Vic, Australia
| | - Denise M O'Driscoll
- Department of Respiratory and Sleep Medicine, Eastern Health, Melbourne, Vic, Australia; Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Vic, Australia
| | - Garun S Hamilton
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Vic, Australia; Monash Lung and Sleep, Monash Health, Melbourne, Vic, Australia
| | - Helen Truby
- Department of Nutrition and Dietetics, Monash University, Melbourne, Vic, Australia
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Tuomilehto H, Uusitupa M. Lifestyle changes aiming at weight loss should always be included in the treatment of obese patients with obstructive sleep apnea. Sleep 2014; 37:1021. [PMID: 24790281 DOI: 10.5665/sleep.3682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Henri Tuomilehto
- Oivauni Sleep Clinic, Kuopio, Finland ; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Matti Uusitupa
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland ; Clinical Research Center, Kuopio University Hospital, Kuopio, Finland
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41
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The impact of weight reduction in the prevention of the progression of obstructive sleep apnea: an explanatory analysis of a 5-year observational follow-up trial. Sleep Med 2014; 15:329-35. [DOI: 10.1016/j.sleep.2013.11.786] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 10/22/2013] [Accepted: 11/01/2013] [Indexed: 01/29/2023]
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42
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Vascular adhesion molecules in men with obstructive sleep apnea: associations with obesity and metabolic syndrome. Sleep Breath 2014; 18:869-74. [DOI: 10.1007/s11325-014-0958-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 02/07/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
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Abstract
Despite its pervasiveness in primary care, deficient sleep often is underappreciated as a cue to other health risks. Accordingly, this review discusses contemporary evidence-based perspectives on impaired sleep and its associations with other lifestyle medicine concerns, including obesity, cardiovascular conditions, psychological problems, and health-compromising habits. The potential clinical benefits of promoting sleep health also will be considered.
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Affiliation(s)
- Lisa Terre
- Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri
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Affiliation(s)
- Tomas Konecny
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
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Kulkas A, Leppänen T, Sahlman J, Tiihonen P, Mervaala E, Kokkarinen J, Randell J, Seppä J, Tuomilehto H, Töyräs J. Novel parameters reflect changes in morphology of respiratory events during weight loss. Physiol Meas 2013; 34:1013-26. [DOI: 10.1088/0967-3334/34/9/1013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pahkala R, Seppä J, Ikonen A, Smirnov G, Tuomilehto H. The impact of pharyngeal fat tissue on the pathogenesis of obstructive sleep apnea. Sleep Breath 2013; 18:275-82. [PMID: 23877124 DOI: 10.1007/s11325-013-0878-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 06/13/2013] [Accepted: 07/09/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Obesity is the most important risk factor for obstructive sleep apnea (OSA); however, the exact underlying mechanisms are still not fully understood. The aim of this study was to examine the morphology of upper airways in overweight habitual snorers and in mild OSA patients. Furthermore, the associations between weight loss, parapharyngeal fat pad area and OSA were assessed in a 1-year randomised, controlled follow-up study originally conducted to determine the effects of lifestyle changes with weight reduction as a treatment of OSA. METHODS Thirty-six overweight adult patients with mild OSA [apnea-hypopnea index (AHI) 5-15 events/h] and 24 weight-matched habitual snorers (AHI < 5 events/h) were included in the study. All patients underwent nocturnal cardiorespiratory recordings and multislice computed tomography (CT) of parapharyngeal fat pad area, the smallest diameter and area in naso-, oro- and hypopharynx, the smallest diameter and area of the whole pharyngeal airway, the distance from the hyoid bone to the mandibular plane and to cervical tangent as well as the distance between mandibular symphysis and cervical spine. In addition, OSA patients were further randomised to receive either an active 1-year lifestyle intervention with an early weight loss programme or routine lifestyle counselling. After 1 year, the cardiorespiratory recordings and CT scans were repeated. RESULTS The pharyngeal fat pad area was significantly larger, and the distance from the hyoid bone to cervical spine was longer in patients with OSA than in habitual snorers (p = 0.002 and p = 0.018, respectively). The multiple regression analysis showed that besides a large pharyngeal fat pad area and a long distance from the cervical spine to hyoid bone, also a short distance from the mandibular symphysis to cervical tangent increased a risk to OSA. During the 1-year follow-up in OSA patients, the pharyngeal fat pad area and AHI decreased significantly in the intervention group (p = 0.003 and p < 0.001, respectively). CONCLUSIONS In the early stages of OSA, the pharyngeal fat pad seems to play an important role in the development of disease in overweight patients. Furthermore, weight reduction by lifestyle intervention-based programme reduces both central obesity and pharyngeal fat pads, resulting in an improvement of OSA.
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Affiliation(s)
- R Pahkala
- Institute of Dentistry, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland,
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Spörndly-Nees S, Igelström H, Lindberg E, Martin C, Åsenlöf P. Facilitators and barriers for eating behaviour changes in obstructive sleep apnoea and obesity – a qualitative content analysis. Disabil Rehabil 2013; 36:74-81. [DOI: 10.3109/09638288.2013.782354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kuna ST, Reboussin DM, Borradaile KE, Sanders MH, Millman RP, Zammit G, Newman AB, Wadden TA, Jakicic JM, Wing RR, Pi-Sunyer FX, Foster GD. Long-term effect of weight loss on obstructive sleep apnea severity in obese patients with type 2 diabetes. Sleep 2013; 36:641-649A. [PMID: 23633746 DOI: 10.5665/sleep.2618] [Citation(s) in RCA: 157] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
STUDY OBJECTIVES To examine whether the initial benefit of weight loss on obstructive sleep apnea (OSA) severity at 1 year is maintained at 4 years. DESIGN Randomized controlled trial with follow-up at 1, 2, and 4 years. SETTING 4 Look AHEAD clinical centers. PARTICIPANTS Two hundred sixty-four obese adults with type 2 diabetes and OSA. INTERVENTIONS Intensive lifestyle intervention with a behavioral weight loss program or diabetes support and education. MEASUREMENTS Change in apnea-hypopnea index on polysomnogram. RESULTS The intensive lifestyle intervention group's mean weight loss was 10.7 ± 0.7 (standard error), 7.4 ± 0.7, and 5.2 ± 0.7 kg at 1, 2, and 4 years respectively, compared to a less than 1-kg weight loss for the control group at each time (P < 0.001). Apnea-hypopnea index difference between groups was 9.7 ± 2.0, 8.0 ± 2.0, and 7.7 ± 2.3 events/h at 1, 2 and 4 years respectively (P < 0.001). Change in apnea-hypopnea index over time was related to the amount of weight loss (P < 0.0001) and intervention, independent of weight loss (P = 0.001). Remission of OSA at 4 years was 5 times more common with intensive lifestyle intervention (20.7%) than diabetes support and education (3.6%). CONCLUSIONS Among obese adults with type 2 diabetes and OSA, intensive lifestyle intervention produced greater reductions in weight and apnea-hypopnea index over a 4 year period than did diabetes support and education. Beneficial effects of intensive lifestyle intervention on apneahypopnea index at 1 year persisted at 4 years, despite an almost 50% weight regain. Effect of intensive lifestyle intervention on apnea-hypopnea index was largely, but not entirely, due to weight loss.
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Aurora RN, Punjabi NM. Obstructive sleep apnoea and type 2 diabetes mellitus: a bidirectional association. THE LANCET RESPIRATORY MEDICINE 2013; 1:329-38. [PMID: 24429158 DOI: 10.1016/s2213-2600(13)70039-0] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Obstructive sleep apnoea and type 2 diabetes are common medical disorders that have important clinical, epidemiological, and public health implications. Research done in the past two decades indicates that obstructive sleep apnoea, through the effects of intermittent hypoxaemia and sleep fragmentation, could contribute independently to the development of insulin resistance, glucose intolerance, and type 2 diabetes. Conversely, type 2 diabetes might increase predisposition to, or accelerate progression of, obstructive and central sleep apnoea, possibly through the development of peripheral neuropathy and abnormalities of ventilatory and upper airway neural control. Although more research is needed to clarify the mechanisms underlying the bidirectional association between the two disorders, their frequent coexistence should prompt all health-care professionals to embrace clinical practices that include screening of a patient presenting with one disorder for the other. Early identification of obstructive sleep apnoea in patients with metabolic dysfunction, including type 2 diabetes, and assessment for metabolic abnormalities in those with obstructive sleep apnoea could reduce cardiovascular disease risk and improve the quality of life of patients with these chronic diseases.
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Affiliation(s)
- R Nisha Aurora
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Naresh M Punjabi
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
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