We read with interest the well-performed and topical systematic review and meta-analysis by Araghi and collegues1 investigating the impact of diet and exercise programs on OSA. However, we were concerned about the robustness of one of the main conclusions, that weight loss by lifestyle intervention may not cure OSA.
Our randomized, controlled 1-year lifestyle intervention trial in the clinical setting based on healthy diet and physical activity, including an initial weight reduction program lasting for 12 weeks in obese patients with mild OSA, showed that all common symptoms related to OSA were effectively reduced, and even more importantly, two out of every three patients belonging to the lifestyle intervention group had AHI under 5; thus they were considered as cured.2 Furthermore, one year after the termination of the intervention, 57% of patients were cured, and of those patients who were able to lose and sustain ≥ 5% (i.e., 5 kg in the present study) from their baseline body weight, altogether 70% were cured from OSA.3 In the follow-up study four years later, one out of every three participants were considered as being objectively cured, i.e., they had AHI under 5; furthermore, the unwanted progression of the disease was effectively prevented.4 Based on our findings and those of others, it seems that when the disease is still at an early stage, it is most likely that the organ systems have the capacity to recover from the adverse impact of OSA, or at least, the unwanted progression of the disease may be prevented with sustained weight loss achieved by healthier lifestyle.4–6 In addition to improving OSA, weight reduction also improves the other obesity related manifestations of the cardio-metabolic syndrome, including low-grade inflammation.2–7 We do agree that there is a definite need for larger, well controlled trials to determine the overall efficacy and long-term success of weight reduction. However, in our opinion there is already enough evidence that a weight reduction program with lifestyle counseling should be offered as part of the routine treatment for obese OSA patients, and we believe it represents the first-line treatment in the early phases of the disease, i.e., mild OSA in overweight/obese patients with a good chance of curing the disease or at least preventing the progression.
CITATION
Tuomilehto H, Uusitupa M. Lifestyle changes aiming at weight loss should always be included in the treatment of obese patients with obstructive sleep apnea. SLEEP 2014;37(5):1021.
DISCLOSURE STATEMENT
The authors have indicated no financial conflicts of interest.
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