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 resultsAccording 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).
23361137Thomasouli/2013Two meta-analyses, one of three studies (n = 261) and another on six studies (n = 483).Meta-Analysis
Key resultsThe 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) 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
None available