• NgSusanna S SSSS0000-0002-4554-7312Department of Medicine and Therapeutics and., TamWilson W SWWSAlice Lee Centre for Nursing Studies, National University of Singapore, Singapore, Singapore., LeeRichard W WRWWDepartment of Respiratory and Sleep Medicine, Gosford Hospital, Gosford, New South Wales, Australia., Tat-On Chan, Karen Yiu, Brian T Y Yuen, Ka-Tak Wong, Jean Woo, MaRonald C WRCWDepartment of Medicine and Therapeutics and.Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong., ChanKen K PKKPDepartment of Imaging & Interventional Radiology, Prince of Wales Hospital, Hong Kong., KoFanny W SFWS0000-0001-8454-0087Department of Imaging & Interventional Radiology, Prince of Wales Hospital, Hong Kong., Peter A Cistulli, and David S Hui.
• Department of Medicine and Therapeutics and.
• Am. J. Respir. Crit. Care Med. 2022 Mar 15; 205 (6): 711-720.

AbstractRationale: Craniofacial structure is believed to modulate the effect of weight loss on obstructive sleep apnea (OSA), but whether this affects metabolic profile after weight loss compared with continuous positive airway pressure (CPAP) is unknown among obese Chinese patients with OSA. Objectives: To compare the change in metabolic profile between a lifestyle modification program (LMP), stratified by craniofacial phenotype, and CPAP therapy for 6 months. Methods: We randomly assigned 194 patients with body mass index ⩾ 25 kg/m2 and moderate to severe OSA to participate in the LMP or receive CPAP therapy for 6 months in a 2:1 ratio. Assessments included computed tomography for assessing maxillomandibular volume (MMV), hsCRP (high-sensitivity C-reactive protein), and insulin sensitivity. Measurements and Main Results: Among 128 and 66 subjects in the LMP and CPAP groups, respectively, hsCRP was reduced more in the LMP group than the CPAP group (median [interquartile range], -0.7 [-1.4 to -0.0] vs. -0.3 [-0.9 to 0.4] mg/L; P = 0.012). More patients in the LMP group achieved low hsCRP (<1 mg/L) than the CPAP group (21.1% vs. 9.1%; P = 0.04). Insulin sensitivity improved only in the LMP group, with 3.1 (95% confidence interval, 1.5-6.6) times more patients with normal glucose regulation after intervention. The LMP group was stratified into LMP-small MMV (n = 64) and LMP-large MMV (n = 64) groups according to the median MMV value of 233.2 cm3. There was no significant difference in hsCRP (median [interquartile range], -0.7 [-1.3 to 0.1] vs. -0.7 [-1.5 to -0.2] mg/L; P = 0.884) and insulin sensitivity (median [interquartile range], 0.5 [-0.2 to 1.9] vs. 0.6 [0.1 to 2.0]; P = 0.4860) between the LMP-small MMV and LMP-large MMV groups. Conclusions: Weight reduction alleviated subclinical inflammation and improved insulin sensitivity more than CPAP among obese Chinese patients with moderate to severe OSA, and this effect was not influenced by craniofacial structure. Clinical trial registered with www.clinicaltrials.gov (NCT03287973).

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