Figures
- Figure 1.
Prevalence of obstructive sleep apnoea (OSA) (apnoea/hypopnoea index ≥15 events·h−1) in a) males aged 50–69 years and b) females aged 50–69 years with type 2 diabetes compared with estimated prevalence (—) in a general population of the same age range and body mass index (BMI). DT2: type 2 diabetes; SHHS: Sleep Heart Health Study.
- Figure 2.
Intermediary mechanisms implicated in the deterioration of insulin sensitivity in obstructive sleep apnoea patients. HPA: hypothamic-pituitary-adrenal.
- Figure 3.
Prevalence rates of Metabolic Syndrome (MetS) in obstructive sleep apnoea syndrome (OSAS) patients worldwide.
Tables
- Table 1. Lifestyle intervention studies in obstructive sleep apnoea (OSA) patients
Intervention Comparison/control Duration months Subjects n Baseline OSA Outcomes Additional metabolic benefits reported Diagnostic procedure Severity Weight loss intervention Weight loss control p-value Diet + CPAP Ballester [71] Conservative treatment + CPAP Conservative treatment only 3 105 Partially attended night-time respiratory recording Severe (AHI 56±20) -1.1 kg -3.1 kg <0.001 Nil Conservative treatment: sleep hygiene and weight loss programme, home diet prescribed by dietician Monasterio [73] Conservative measures + CPAP Conservative measures only 6 125 PSG Moderate (AHI 20±6) +0.1 kg 6 months -2.7 kg 6 months <0.001 Nonsignificant improvement in blood pressure in both control and CPAP group Conservative measures: weight loss programme following a home diet, avoidance of sedatives and alcohol consumption, avoidance of supine position during sleep and adequate hours of sleep Kajaste [72] Weight reduction strategy + CPAP (individualised CBT + dietary counselling) Weight reduction strategy + CPAP (CBT + dietary counselling) 24 31 males PSG Moderate (AHI 20±6) -19.1 kg 6 months -19.2 kg 6 months >0.05 Nil Intensive Lifestyle Intervention (ILI) Foster [74] ILI: group weight loss programme based on low calorie diet and physical activity prescription of 175 min·week−1 of moderate, developed specifically for obese T2DM patients Three group diabetes support education sessions focused on diet, physical activity and social support 12 264 Unattended PSG Moderate (AHI 23.2±16.5, ODI 19.4±4.9) 10.8 kg post-1-year intervention 0.6 kg post-1-year intervention <000.1 Significant improvement in waist and neck circumference and HBA1c (p<0.001) Tuomilehto [75] Lifestyle intervention: individual tailored counselling and weight reduction programme with emphasis placed on diet, exercise and modification of lifestyle, focusing on eating behaviour One dietary and exercise counselling session 12 71 Embletta Mild (AHI 9.65±12) 10.7 kg post-1-year intervention 2.4 kg post-1-year intervention <0.001 Significantly improved waist circumference (p<0.001) Lifestyle Intervention Kemppainen [76] Lifestyle intervention: individual tailored counselling and weight reduction programme with emphasis on diet, exercise and lifestyle modification (focusing on eating behaviour) One dietary and exercise counselling session 3 52 Embletta Mild (AHI 10.1±6.3) BMI 5.4 kg·m−2 3 months BMI 0.49 kg·m−2 3 months <0.05 Nil Papandreou [77] ILI: individualised weight reduction programme based on a low calorie Mediterranean diet and physical activity prescription of at least 30 min·day−1, developed specifically for obese OSA patients who underwent CPAP treatment Individualised weight reduction programme based on a low calorie prudent diet and physical activity prescription of at least 30 min·day−1, developed specifically for obese OSA patients who underwent CPAP treatment 6 21 PSG Severe (AHI 46.2±32.7) Weight
-8.9 kg
Waist circumference -8.7 cm
Body fat
-4.3%Weight
-7.2 kg
Waist circumference 5.7 cm
Body fat
-2.6%0.162
0.013
0.032Nil Kline [78] ILI: group exercise training based on 150 min per week of moderate intensity aerobic activity followed by resistance training twice per week Stretching exercises 3 43 PSG Moderate (AHI 28.3±5.6) Body fat
-1.1%Body fat
-0.2%<0.01 Significant AHI reduction in exercise group and ODI Ackel-D'Elia [79] ILI: 2-month supervised aerobic exercise three times per week + CPAP therapy CPAP therapy only 2 32 males PSG Moderate (AHI >15) No significant difference in weight parameters between groups >0.05 Subjective sleepiness improved in exercise Other Sengul [80] Exercise training programme (breathing and aerobic exercise) No treatment 6 20 males PSG Moderate (AHI 16.5±5.94) No significant changes in weight parameters between groups > 0.05 Nil Stradling [81] Dietary advice and Arm 1: hypnotherapy type 1 (emphasis on ego strengthening centred on stress reduction) versus Arm 2: hypnotherapy type 2 (emphasis on ego strengthening centred on altering attitudes to food using the Spiegal and Spiegal approach) Dietary advice on two occasions only 18 46 Not stated Not assessed 3 months no significant difference between groups, 18 months follow-up hypnotherapy + stress reduction mean weight loss 3.8 kg compared to baseline. <0.02 Nil Johansson [82] Weight loss programme (very low energy diet using a standard 2.3 MJ per day liquid energy intake protocol Cambridge diet) Usual diet 2.25 63 males Two consecutive unattended sleep studies using a 6-channel ambulatory polyography equipment Severe whole group 37±15 AHI 18.7 kg weight loss 1.1 kg weight loss <0.001 Nil CPAP: continuous positive airway pressure; AHI: apnoea/hyponoea index; PSG: polysomnography; CBT: cognitive behavioural therapy; T2DM: type 2 diabetes mellitus; ODI: oxygen desaturation index; BMI: body mass index.
Vol 22 Issue 129
Table of Contents
Sleep apnoea and metabolic dysfunction
