| Title |
Weight Reduction by Dietary and Lifestyle Modifications Is Effective in reducing Obstructive Sleep Apnea (OSA) Indices Among Obese OSA Subjects |
| Clinical Question |
In overweight patients with OSA, does intensive lifestyle modification of caloric intake and exercise reduce the severity of OSA as measured by the apena-hypopnea index (AHI) compared to no treatment? |
| Clinical Bottom Line |
Based on one RCT and a systematic review with meta-analysis, diet and exercise is effective in reducing AHI indices and severity of obstructive sleep apnea. |
| Best Evidence |
|
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| 20702607 | Tuomilehto/2010 | 81 patients with BMI 28–40 and mild OSA, intervention group (n = 40), very low-calorie diet and weight-reduction program; control group (n = 41), routine lifestyle counseling. | Randomized Controlled Trial | | Key results | According to the authors, “After 2 years, the reduction in the AHI was significantly greater in the diet and exercise group (P = 0.049). The intervention lowered the risk of OSA with the adjusted odds ratio for OSA of 0.35 (95% CI: 0.12-0.97; P = 0.045)" (Tuomilehto 2010). | | 23361137 | Thomasouli/2013 | Two meta-analyses, one of three studies (n = 261) and another on six studies (n = 483). | Meta-Analysis | | Key results | The authors reported a reduction in the Apnea Hypopnea Index (AHI) (-4.55 events/h, 95 % CI -7.12, -1.98, I(2) = 54.4 %), but found a high level of heterogeneity. (Thomasouli 2013) | |
| Evidence Search |
1st search (for the 2013 article): "lifestyle"[All Fields] AND "obstructive sleep apnoea"[All Fields]
2nd search (for the 2010 article): "lifestyle"[All Fields] AND "obstructive sleep apnea"[All Fields]
|
Comments on
The Evidence |
The 2010 article by Tuomilehto found a significant difference between the control and intervention group (P = 0.045). However, 10 subjects did not complete the 2-year follow-up, which decreased the validity of the article in terms of subject compliance. The 2013 systematic review displayed a high heterogeneity across the studies, leading the reader to doubt the efficacy of life-style modification on decreasing the OSA symptoms in all patients.
|
| Applicability |
Diet and exercise strategies can be effective at reducing the OSA symptoms and should be suggested to the patient as a possible treatment option due to its non-invasive nature. However, due to the strict exercise regiment and diet intervention, one must also consider the motivation of the patient to loose weight and modify their existing life-style. This treatment option could be a good choice for patients with the will power to loose weight and sustain the regiment, while other alternatives should be suggested to the non-motivated patients unlikely wanting to change. |
| Specialty |
(Oral Medicine/Pathology/Radiology) (Dental Hygiene) (Behavioral Science) |
| Keywords |
Obstructive sleep apnea
|
| ID# |
2626 |
| Date of submission |
03/20/2014 |
| E-mail |
mossmanm@livemail.uthscsa.edu |
| Author |
Maxim Mossman |
| Co-author(s) |
|
| Co-author(s) e-mail |
|
| Faculty mentor |
Ronald G. Verrett, DDS, MS |
| Faculty mentor e-mail |
VERRETT@uthscsa.edu |
| |
|
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
| None available | |
 |
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
| None available | |