Abstract
Objective
To examine the bidirectional relationship between weight change and obstructive sleep
apnea (OSA) in the context of a behavioral weight loss intervention.
Patients and Methods
Adults who were overweight or obese (N=114) participated in a 12-month behavioral
weight loss intervention from April 17, 2012, through February 9, 2015. The apnea-hypopnea
index (AHI), a marker of the presence and severity of OSA, was assessed at baseline,
6 months, and 12 months. Linear mixed models evaluated the effect of weight change
on the AHI and the effect of OSA (AHI ≥5) on subsequent weight loss. Secondary analyses
evaluated the effect of OSA on intervention attendance, meeting daily calorie goals,
and accelerometer-measured physical activity.
Results
At baseline, 51.8% of the sample (n=59) had OSA. Adults who achieved at least 5% weight
loss had an AHI reduction that was 2.1±0.9 (adjusted mean ± SE) events/h greater than
those with less than 5% weight loss (P<.05). Adults with OSA lost a mean ± SE of 2.2%±0.9% less weight during the subsequent
6-month interval compared with those without OSA (P=.02). Those with OSA were less adherent to daily calorie goals (mean ± SE: 25.2%±3.3%
vs 34.8%±3.4% of days; P=.006) and had a smaller increase in daily activity (mean ± SE: 378.3±353.7 vs 1060.1±377.8
steps/d; P<.05) over 12 months than those without OSA.
Conclusion
Behaviorally induced weight loss in overweight/obese adults was associated with significant
AHI reduction. However, the presence of OSA was associated with blunted weight loss,
potentially via reduced adherence to behaviors supporting weight loss. These results
suggest that OSA screening before attempting weight loss may be helpful to identify
who may benefit from additional behavioral counseling.
Abbreviations and Acronyms:
12M (12 months), 6M (6 months), AHI (apnea-hypopnea index), BL (baseline), BMI (body mass index), CPAP (continuous positive airway pressure), MVPA (moderate-vigorous physical activity), OSA (obstructive sleep apnea)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: August 03, 2018
Footnotes
Grant Support: Funding for this study was provided by grants R01HL107370 (L.E.B.), R01HL107370-S1 (D.D.M.), K24NR016685 (E.R.C.), and K23HL118318 (C.E.K.) from the National Institutes of Health and by grant K12HS022989 (B.R.-W.) from the Agency for Healthcare Research and Quality .
Potential Competing Interests: Dr Strollo has received personal fees from ResMed, Inspire Medical Systems, and Philips Respironics; has served as a consultant for Jazz Pharmaceuticals and Itamar Medical; has been a member of the NFL General Medical Committee; and has given expert testimony for Harris v Emory.
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