• J Clin Sleep Med · Nov 2014

    Randomized Controlled Trial Multicenter Study Comparative Study

    Sleep architecture following a weight loss intervention in overweight and obese patients with obstructive sleep apnea and type 2 diabetes: relationship to apnea-hypopnea index.

    • Ari Shechter, Marie-Pierre St-Onge, Samuel T Kuna, Gary Zammit, Arindam RoyChoudhury, Anne B Newman, Richard P Millman, David M Reboussin, Thomas A Wadden, John M Jakicic, F Xavier Pi-Sunyer, Rena R Wing, Gary D Foster, and Sleep AHEAD Research Group of the Look AHEAD Research Group.
    • Columbia University, New York, NY.
    • J Clin Sleep Med. 2014 Nov 15; 10 (11): 1205-11.

    Study ObjectivesTo determine if weight loss and/ or changes in apnea-hypopnea index (AHI) improve sleep architecture in overweight/ obese adults with type 2 diabetes (T2D) and obstructive sleep apnea (OSA).MethodsThis was a randomized controlled trial including 264 overweight/ obese adults with T2D and OSA. Participants were randomized to an intensive lifestyle intervention (ILI) or a diabetes and support education (DSE) control group. Measures included anthropometry, AHI, and sleep at baseline and year-1, year-2, and year-4 follow-ups.ResultsChanges in sleep duration (total sleep time [TST]), continuity [wake after sleep onset (WASO)], and architecture stage 1, stage 2, slow wave sleep, and REM sleep) from baseline to year 1, 2, and 4 did not differ between ILI and DSE. Repeated-measure mixed-model analyses including data from baseline through year-4 for all participants demonstrated a significant positive association between AHI and stage 1 sleep (p < 0.001), and a significant negative association between AHI and stage 2 (p = 0.01) and REM sleep (p < 0.001), whereas changes in body weight had no relation to any sleep stages or TST. WASO had a significant positive association with change in body weight (p = 0.009).ConclusionsCompared to control, the ILI did not induce significant changes in sleep across the 4-year follow-up. In participants overall, reduced AHI in overweight/ obese adults with T2D and OSA was associated with decreased stage 1, and increased stage 2 and REM sleep. These sleep architecture changes are more strongly related to reductions in AHI than body weight, whereas WASO may be more influenced by weight than AHI.Clinical Trial Registration NumberNCT00194259.© 2014 American Academy of Sleep Medicine.

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