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Original Research: Sleep Disorders |

A Randomized Controlled Study to Examine the Effect of a Lifestyle Modification Program in OSAWeight Reduction in OSA

Susanna S. S. Ng, MBChB, FCCP; Ruth S. M. Chan, PhD; Jean Woo, MD; Tat-On Chan, MPhil; Bernice H. K. Cheung, RD; Mandy M. M. Sea, PhD; Kin-Wang To, MBChB; Ken K. P. Chan, MBChB; Jenny Ngai, MBChB; Wing-Ho Yip, MBChB; Fanny W. S. Ko, MD, FCCP; David S. C. Hui, MD, FCCP
Author and Funding Information

From the Division of Respiratory Medicine (Drs Ng, To, K. K. P. Chan, Ngai, Yip, Ko, and Hui and Mr Chan) and Centre for Nutritional Studies (Drs. R. S. M. Chan, Woo, and Sea and Ms Cheung) Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong, China.

CORRESPONDENCE TO: David S. C. Hui, MD, FCCP, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing St, Hong Kong, China; e-mail: dschui@cuhk.edu.hk


FOR EDITORIAL COMMENT SEE PAGE 1127

FUNDING/SUPPORT: This study was funded by the Nutritional Research Foundation of the United Kingdom.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(5):1193-1203. doi:10.1378/chest.14-3016
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BACKGROUND:  Obesity is an important risk factor for OSA. This study aimed to assess the effect of weight reduction through a lifestyle modification program (LMP) on patients with moderate to severe OSA.

METHODS:  This was a parallel group, randomized controlled trial. Altogether, 104 patients with moderate to severe OSA diagnosed on portable home sleep monitoring were randomized to receive a dietician-led LMP or usual care for 12 months. The primary outcome was reduction of apnea-hypopnea index (AHI) at 12 months as assessed by portable home sleep monitoring.

RESULTS:  In the intention-to-treat analysis (ITT), LMP (n = 61) was more effective in reducing AHI from baseline (16.9% fewer events in the LMP group vs 0.6% more events in the control group, P = .011). LMP was more effective in reducing BMI (−1.8 kg/m2, 6.0% of the initial BMI; −0.6 kg/m2, 2.0% of the initial BMI in control group; P < .001). The reduction in daytime sleepiness as assessed by Epworth Sleepiness Scale was not significant in ITT but was more in the LMP group (−3.5 in the LMP group vs −1.1 in the control group, P = .004) by treatment per protocol analysis. There was modest improvement in mental health in the Short Form Health Survey. Eating behavior was improved with increased intake of protein and fiber. These changes were observed 4 months after the initial intensive diet counseling and persisted at 12 months.

CONCLUSIONS:  LMP was effective in reducing the severity of OSA and daytime sleepiness. The beneficial effect was sustained in 12 months.

TRIAL REGISTRY:  ClinicalTrials.gov; No.: NCT01384760; URL: www.clinicaltrials.gov

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