The Effect of Changes in Cardiorespiratory Fitness and Weight on Obstructive Sleep Apnea Severity in Overweight Adults with Type 2 Diabetes - PubMed (original) (raw)

Randomized Controlled Trial

. 2016 Feb 1;39(2):317-25.

doi: 10.5665/sleep.5436.

David M Reboussin 2, Gary D Foster 3 4, Thomas B Rice 1, Elsa S Strotmeyer 1, John M Jakicic 1, Richard P Millman 5, F Xavier Pi-Sunyer 6, Anne B Newman 1, Thomas A Wadden 7, Gary Zammit 8, Samuel T Kuna 7 9; Sleep AHEAD Research Group of the Look AHEAD Research Group

Collaborators, Affiliations

Randomized Controlled Trial

The Effect of Changes in Cardiorespiratory Fitness and Weight on Obstructive Sleep Apnea Severity in Overweight Adults with Type 2 Diabetes

Christopher E Kline et al. Sleep. 2016.

Abstract

Study objectives: To examine the effect of changes in cardiorespiratory fitness on obstructive sleep apnea (OSA) severity prior to and following adjustment for changes in weight over the course of a 4-y weight loss intervention.

Methods: As secondary analyses of a randomized controlled trial, 263 overweight/obese adults with type 2 diabetes and OSA participated in an intensive lifestyle intervention or education control condition. Measures of OSA severity, cardiorespiratory fitness, and body weight were obtained at baseline, year 1, and year 4. Change in the apnea-hypopnea index (AHI) served as the primary outcome. The percentage change in fitness (submaximal metabolic equivalents [METs]) and change in weight (kg) were the primary independent variables. Primary analyses collapsed intervention conditions with statistical adjustment for treatment group and baseline METs, weight, and AHI among other relevant covariates.

Results: At baseline, greater METs were associated with lower AHI (B [SE] = -1.48 [0.71], P = 0.038), but this relationship no longer existed (B [SE] = -0.24 [0.73], P = 0.75) after adjustment for weight (B [SE] = 0.31 [0.07], P < 0.0001). Fitness significantly increased at year 1 (+16.53 ± 28.71% relative to baseline), but returned to near-baseline levels by year 4 (+1.81 ± 24.48%). In mixed-model analyses of AHI change over time without consideration of weight change, increased fitness at year 1 (B [SE] = -0.15 [0.04], P < 0.0001), but not at year 4 (B [SE] = 0.04 [0.05], P = 0.48), was associated with AHI reduction. However, with weight change in the model, greater weight loss was associated with AHI reduction at years 1 and 4 (B [SE] = 0.81 [0.16] and 0.60 [0.16], both P < 0.0001), rendering the association between fitness and AHI change at year 1 nonsignificant (B [SE] = -0.04 [0.04], P = 0.31).

Conclusions: Among overweight/obese adults with type 2 diabetes, fitness change did not influence OSA severity change when weight change was taken into account.

Clinical trial registration: ClinicalTrials.gov identification number NCT00194259.

Keywords: apnea-hypopnea index; cardiorespiratory fitness; obstructive sleep apnea; physical activity; weight loss.

© 2016 Associated Professional Sleep Societies, LLC.

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Figures

Figure 1

Figure 1

Mean changes (adjusted least-squares means ± standard error) in fitness, body weight, and apnea-hypopnea index (AHI) from baseline at years 1 and 4 according to intervention group. The dashed line (open circles) indicates the Diabetes Support and Education (DSE) group; the solid line (closed squares) indicates the Intensive Lifestyle Intervention (ILI) group. The asterisk indicates a significant difference between the DSE and ILI groups (P < 0.05).

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