Weight loss therapy for obstructive sleep apnea – Literature review

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Obstructive sleep apnea is a chronic disease characterized by the appearance of apnea or hypopnea episodes during sleep. This condition is associated with several risk factors. Among them, the most important is obesity and it is the only potentially curable. The treatment is polimodal and it involves several therapeutic directions. The purpose of this paper is to establish the role of obesity in the etiology of sleep apnea, as well as the role of the weight loss in its management, both through intensive lifestyle interventions and surgical therapy.

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  • 1. Epstein LJ Kristo D Strollo PJ Jr Friedman N Malhotra A Patil SP et al. Clinical guideline for the evaluation management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263-76.

  • 2. Franklin KA Lindberg E. Obstructive sleep apnea is a common disorder in the population - a review on the epidemiology of sleep apnea. J Thorac Dis. 2015;7(8):1311-22. DOI: 10.3978/j.issn.2072-1439.2015.06.11.

  • 3. Franklin KA Sahlin C Stenlund H Lindberg E. Sleep apnoea is a common occurrence in females. Eur Respir J. 2013;41(3):610-5. DOI: 10.1183/09031936.00212711. Epub 2012 Aug 16.

  • 4. Lindberg E Janson C Gislason T Bjornsson E Hetta J Boman G. Sleep disturbances in a young adult population: can gender differences be explained by differences in psychological status? Sleep. 1997;20(6):381-7.

  • 5. Young T Skatrud J Peppard PE. Risk factors for obstructive sleep apnea in adults. JAMA. 2004;291(16):2013-6.

  • 6. Yaggi H Mohsenin V. Obstructive sleep apnoea and stroke. Lancet Neurol. 2004;3(6):333–42.

  • 7. Lattimore JDL Celermajer DS Wilcox I. Obstructive sleep apnea and cardiovascular disease. JACC. 2003;41(9):1429-37. DOI: 10.1016/S0735-1097(03)00184-0.

  • 8. Shahar E Whitney CW Redline S Lee ET Newman AB Nieto FJ et al. Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001;163(1):19-25.

  • 9. Svatikova A Wolk R Gami AS Pohanka M Somers VK. Interactions between obstructive sleep apnea and the metabolic syndrome. Curr Diab Rep. 2005;5(1):53-8.

  • 10. Engleman H Douglas N. Sleep · 4: Sleepiness cognitive function and quality of life in obstructive apnoea/hypopnoea syndrome. Thorax. 2004;59(7):618-22. DOI: 10.1136/thx.2003.015867

  • 11. Young T Peppard PE Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002;165(9):1217-39.

  • 12. Lacasse Y Godbout C Sériès F. Health-related quality of life in obstructive sleep apnoea. Eur Respir J. 2002;19(3):499-503.

  • 13. Young T Peppard PE Taheri S. Excess weight and sleep-disordered breathing. J Appl Physiol. 2005;99(4):1592-9.

  • 14. Ayyad C Andersen T. Long-term efficacy of dietary treatment of obesity: a systematic review of studies published between 1931 and 1999. Obes Rev. 2000;1(2):113-9.

  • 15. Franklin KA Gíslason T Omenaas E Jogi R Jensen EJ Lindberg E et al. The influence of active and passive smoking on habitual snoring. Am J Respir Crit Care Med. 2004;170(7):799-803. Epub 2004 Jul 8.

  • 16. Valencia-Flores M Orea A Castaño VA Resendiz M Rosales M Rebollar V et al. Prevalence of sleep apnea and electrocardiographic disturbances in morbidly obese patients. Obes Res. 2000;8(3):262-9.

  • 17. Hiestand DM Britz P Goldman M Phillips B. Prevalence of symptoms and risk of sleep apnea in the US population: Results from the national sleep foundation sleep in America 2005 poll. Chest. 2006;130(3):780-6.

  • 18. Grunstein RR Stenlöf K Hedner JA Peltonen M Karason K Sjöström L. Two year reduction in sleep apnea symptoms and associated diabetes incidence after weight loss in severe obesity. Sleep. 2007;30(6):703-10.

  • 19. Sutherland K Lee RW Phillips CL Dungan G Yee BJ Magnussen JS et al. Effect of weight loss on upper airway size and facial fat in men with obstructive sleep apnoea. Thorax. 2011;66(9):797-803. DOI: 10.1136/thx.2010.151613. Epub 2011 Jun 15.

  • 20. Schwartz AR Patil SP Laffan AM Polotsky V Schneider H Smith PL. Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches. Proc Am Thorac Soc. 2008;5(2):185-192. DOI: 10.1513/pats.200708-137MG.

  • 21. Shelton KE Woodson H Gay S Suratt PM. Pharyngeal fat in obstructive sleep apnea. Am Rev Respir Dis. 1993;148(2):462-6.

  • 22. Patil SP Schneider H Schwartz AR Smith PL. Adult obstructive sleep apnea: pathophysiology and diagnosis. Chest. 2007;132(1):325-37.

  • 23. Romero-Corral A Caples SM Lopez-Jimenez F Somers VK. Interactions between obesity and obstructive sleep apnea: implications for treatment. Chest. 2010;137(3):711-9. DOI: 10.1378/chest.09-0360.

  • 24. Ong CW O’Driscoll DM Truby H Naughton MT Hamilton GS. The reciprocal interaction between obesity and obstructive sleep apnoea. Sleep Med Rev. 2013;17(2):123-31. DOI: 10.1016/j.smrv.2012.05.002. Epub 2012 Jul 18.

  • 25. Patel SR Malhotra A White DP Gottlieb DJ Hu FB. Association between reduced sleep and weight gain in women. Am J Epidemiol. 2006;164(10):947-54. Epub 2006 Aug 16.

  • 26. Berge S Polotsky VY. Leptin and Leptin Resistance in the Pathogenesis of Obstructive Sleep Apnea: A Possible Link to Oxidative Stress and Cardiovascular Complications. Oxidative Medicine and Cellular Longevity. 2018;2018:5137947. https://doi.org/10.1155/2018/5137947. Available from: https://www.hindawi.com/journals/omcl/2018/5137947/cta/.

  • 27. Ip MS Lam KS Ho C Tsang KW Lam W. Serum leptin and vascular risk factors in obstructive sleep apnea. Chest. 2000;118(3):580-6.

  • 28. Dempsey JA Veasey SC Morgan BJ O’Donnell C. Pathophysiology of sleep apnea. Physiol Rev. 2010;90(1):47-112. DOI: 10.1152/physrev.00043.2008.

  • 29. Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical Guideline for the Evaluation Management and Long-term Care of Obstructive Sleep Apnea in Adults. J Clin Sleep Med. 2009;5(3):263-76.

  • 30. Chirinos JA Gurubhagavatula I Teff K Rader DJ Wadden TA Townsend R et al. CPAP Weight Loss or Both for Obstructive Sleep Apnea. N Engl J Med. 2014;370:2265-75. DOI: 10.1056/NEJMoa1306187. Available from: https://www.nejm.org/doi/full/10.1056/NEJMoa1306187.

  • 31. Dobrosielski DA Papandreou C Patil SP Salas-Salvado J. Diet and exercise in the management of obstructive sleep apnoea and cardiovascular disease risk. Eur Respir Rev. 2017;26(144):160110. DOI: 10.1183/16000617.0110-2016. Pront 2017 Jun 30.

  • 32. Suratt PM McTier RF Findley LJ Pohl SL Wilhoit SC. Changes in breathing and the pharynx after weight loss in obstructive sleep apnea. Chest. 1987;92(4):631-7.

  • 33. Schwartz AR Gold AR Schubert N Stryzak A Wise RA Permutt S et al. Effect of weight loss on upper airway collapsibility in obstructive sleep apnea. Am Rev Respir Dis. 1991;144(3 Pt 1):494-8.

  • 34. Largerstrand L Rossner S. Effects of weight loss on pulmonary function in obese men with obstructive sleep apnoea syndrome. JIM. 1993;234(3):245-7. https://doi.org/10.1111/j.1365-2796.1993.tb00739.x.

  • 35. Soriano-Co M Vanhecke TE Franklin BA Sangal RB Hakmeh B Mc-Cullough PA. Increased central adiposity in morbidly obese patients with obstructive sleep apnoea. Intern Med J. 2011;41(7):560-6. DOI: 10.1111/j.1445-5994.2010.02283.x. Epub 2010 Jun 7.

  • 36. Friedman JM. The function of leptin in nutrition weight and physiology. Nutr Rev. 2002;60(10 Pt 2):S1-14; discussion S68-84 85-7.

  • 37. Howard BV Van Horn L Hsia J Manson JE Stefanick ML Wassertheil-Smoller S et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006;295(6):655-66.

  • 38. Papandreou C Schiza SE Bouloukaki I Hatzis CM Kafatos AG Siafakas NM et al. Effect of Mediterranean diet versus prudent diet combined with physical activity on OSAS: a randomised trial. Eur Respir J. 2012;39(6):1398-404. DOI: 10.1183/09031936.00103411. Epub 2011 Oct 27.

  • 39. Phillips CL Yee BJ Trenell MI Magnussen JS Wang D Banerjee D et al. Changes in regional adiposity and cardio-metabolic function following a weight loss program with sibutramine in obese men with obstructive sleep apnea. J Clin Sleep Med. 2009;5(5):416-21.

  • 40. Ferland A Poirier P Sériès F. Sibutramine versus continuous positive airway pressure in obese obstructive sleep apnoea patients. Eur Respir J. 2009;34(3):694-701. DOI: 10.1183/09031936.00167308. Epub 2009 Apr 8.

  • 41. de Simone G D’Addeo G. Sibutramine: balancing weight loss benefit and possible cardiovascular risk. Nutr Metab Cardiovasc Dis. 2008;18(5):337-41. DOI: 10.1016/j.numecd.2008.03.008. Epub 2008 May 27.

  • 42. Ballinger A. Orlistat in the treatment of obesity. Expert Opini Pharmacother. 2000;1(4):841-7.

  • 43. Quan SF O’Connor GT Quan JS Redline S Resnick HE Shahar E et al. Association of physical activity with sleep-disordered breathing. Sleep Breath. 2007;11(3):149-57.

  • 44. Mendelson M Lyons OD Yadollahi A Inami T Oh P Bradley TD. Effects of exercise training on sleep apnoea in patients with coronary artery disease: a randomised trial. Eur Respir J. 2016;48(1):142-50. DOI: 10.1183/13993003.01897-2015. Epub 2016 Apr 13.

  • 45. Redolfi S Bettinzoli M Venturoli N Ravanelli M Pedroni L Taranto-Montemurro L et al. Attenuation of obstructive sleep apnea and overnight rostral fluid shift by physical activity. Am J Respir Crit Care Med. 2015;191(7):856-8. DOI: https://doi.org/10.1164/rccm.201412-2192LE.

  • 46. Awad KM Malhotra A Barnet JH Quan SF Peppard PE. Exercise is associated with a reduced incidence of sleep-disordered breathing. Am J Med. 2012;125(5):485-90. DOI: 10.1016/j.amjmed.2011.11.025.

  • 47. Ross R Dagnone D Jones PJ Smith H Paddags A Hudson R et al. Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized controlled trial. Ann Intern Med. 2000;133(2):92-103.

  • 48. Tuomilehto H Seppä J uusitupa M Peltonen M Martikaine T Sahlman J et al. The impact of weight reduction in the prevention of the progression of obstructive sleep apnea: an explanatory analysis of a 5-year observational follow-up trial. Sleep Med. 2014;15(3):329-35. DOI: 10.1016/j.sleep.2013.11.786. Epub 2014 Jan 31.

  • 49. SAGES Guidelines Committee. Guidelines for clinical application of laparoscopic bariatric surgery: Society of American Gastrointestinal and Endoscopic Surgeons. 2008. Available from: https://www.sages.org/publications/guidelines/guidelines-for-clinical-application-of-laparoscopic-bariatric-surgery/.

  • 50. Mechanick JI Kushner RF Sugerman HJ Gonzalez-Campoy JM Collazo-Clavell ML Spitz AF et al. American Association of Clinical Endocrinologists The Obesity Society and American Society for Metabolic & Bariatric Surgery Medical guidelines for clinical practice for the perioperative nutritional metabolic and nonsurgical support of the bariatric surgery patient. Obesity (Silver Spring). 2009;17 Suppl 1:S1-70 v. DOI: 10.1038/oby.2009.28.

  • 51. Buchwald H Avidor Y Baunwald E Jensen MD Pories W Fahrbach K et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724-37.

  • 52. Dixon JB Schachter LM O’Brien PE Jones K Grima M Lambert G et al. Surgical vs conventional therapy for weight loss treatment of obstructive sleep apnea: a randomized controlled trial. JAMA. 2012;308(11):1142–9.

  • 53. Omana JJ Nguyen SQ Herron D Kini S. Comparison of comorbidity resolution and improvement between laparoscopic sleeve gastrectomy and laparoscopic adjustable gastric banding. Surg Endosc. 2010;24(10):2513-7. DOI: 10.1007/s00464-010-0995-0. Epub 2010 Mar 26.

  • 54. Greenburg DL. Effects of surgical weight loss on measures of obstructive sleep apnea: a meta-analysis. Am J Med. 2009;122(6):535-42. DOI: 10.1016/j.amjmed.2008.10.037.

  • 55. Rao AD Tey BH Ramalingam G Poh AG. Obstructive Sleep Apnoea (OSA) patterns in bariatric surgical practice and response of OSA to weight loss after laparoscopic adjustable gastric banding (LAGB). Ann Acad med Singapore. 2009;38(7):587-7.

  • 56. Ashrafian H Toma T Rowland SP Harling L Tan A Efthimiou E et al. Bariatric Surgery or Non-Surgical Weight Loss for Obstructive Sleep Apnoea? A Systematic Review and Comparison of Meta-analyses. Obes Surg. 2015;25(7):1239-50. DOI: 10.1007/s11695-1533-2.

  • 57. Greenburg DL Lettieri CJ Eliasson AH. Effects of surgical weight loss on measures of obstructive sleep apnea: a meta-analysis. Am J Med. 2009;122(6):535-42. DOI: 10.1016/j.amjmed.2008.10.037.

  • 58. Tuomilehto HP Seppa JM Partinen MM Peltonen M Gylling H Toumilehto JO et al. Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea. Am J Respir Crit Care Med. 2009;179(4):320-7. DOI: 10.1164/rccm.200805-669OC. Epub 2008 Nov 14.

  • 59. Ashrafian H Bueter M Ahmed K Suliman A Bloom SR Darzi A et al. Metabolic surgery: an evolution through bariatric animal models. Obes Rev. 2010;11(12):907-20. DOI: 10.1111/j.1467-789X.2009.00701.x.

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