A lifestyle intervention improved obstructive sleep apnea more than support and education in obese patients with diabetes

Tim Reynolds

doi:10.7326/0003-4819-152-2-201001190-02005

Question

Is an intensive lifestyle intervention (ILI) better than diabetes support and education (DSE) for weight loss and obstructive sleep apnea (OSA) in patients with obesity and type 2 diabetes?

Methods

Design

Randomized controlled trial (Sleep Action for Health in Diabetes [Sleep AHEAD] study; a substudy of the Look AHEAD study). ClinicalTrials.gov NCT00194259.

Allocation

Concealed.*

Blinding

Blinded (sleep technicians and polysomnogram [PSG] assessors).*

Follow-up period

1 year.

Setting

4 university sites (Philadelphia, Pittsburgh, New York, and Providence) in the USA.

Patients

264 patients 45 to 75 years of age (mean age 61 y, 59% women) who had OSA, body mass index ≥ 25 (≥ 27 if using insulin), physician-confirmed type 2 diabetes, hemoglobin A_1c level < 11%, and blood pressure reading < 160/100 mm Hg. Exclusion criteria included past surgery and current medical treatment for OSA.

Intervention

125 patients were allocated to ILI, a diabetes-specific group, behavioral, weight-loss program that included portion-controlled diets and physical activity, and 139 were allocated to DSE with 3 group sessions over 1 year focusing on diet, physical activity, and social support.

Outcomes

Included weight loss and PSG-assessed apnea–hypopnea index (AHI, sum of episodes of apnea and hypopnea per hour).

Patient follow-up

83%.

Main results

The main results are in the Table.

Conclusion

In obese patients with type 2 diabetes, an intensive lifestyle intervention improved weight loss and obstructive sleep apnea more than diabetes support and education.

Intensive lifestyle intervention (ILI) vs diabetes support and education (DSE) in obese patients with type 2 diabetes†

Outcomes	Event rates		At 1 y
	ILI	DSE	RBI/RRR (95% CI)	NNT (CI)
Remission of OSA (AHI < 5)	14%	3.4%	RBI 294% (42 to 1013)	10 (6 to 33)
Severe OSA (AHI ≥ 30)	18%	38%	RRR 51% (23 to 70)	6 (4 to 14)
	Adjusted mean change‡		P value
Weight, kg	−10.8	−0.6	<0.001
AHI	−5.4	4.2	<0.001
Obstructive apnea index	−2.5	6.1	<0.001
Central apnea index	0.02	−0.02	0.85
Hypopnea index	−2.9	−1.7	0.28
Hemoglobin A_1c, %	−0.7	−0.2	<0.001

Outcomes	Event rates		At 1 y
	ILI	DSE	RBI/RRR (95% CI)	NNT (CI)
Remission of OSA (AHI < 5)	14%	3.4%	RBI 294% (42 to 1013)	10 (6 to 33)
Severe OSA (AHI ≥ 30)	18%	38%	RRR 51% (23 to 70)	6 (4 to 14)
	Adjusted mean change‡		P value
Weight, kg	−10.8	−0.6	<0.001
AHI	−5.4	4.2	<0.001
Obstructive apnea index	−2.5	6.1	<0.001
Central apnea index	0.02	−0.02	0.85
Hypopnea index	−2.9	−1.7	0.28
Hemoglobin A_1c, %	−0.7	−0.2	<0.001

†AHI = apnea-hypopnea index (sum of episodes of apnea and hypopnea per hour); OSA = obstructive sleep apnea; other abbreviations defined in Glossary. RBI, RRR, NNT, and CI calculated from data in article.

‡Adjusted by research site.

ACP Journal Club |19 January 2010

A lifestyle intervention improved obstructive sleep apnea more than support and education in obese patients with diabetes

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ACP Journal Club |19 January 2010

A lifestyle intervention improved obstructive sleep apnea more than support and education in obese patients with diabetes

Abstract

Related Articles

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Related Point of Care

Related Topics

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