OSA(S) og vægt
Philip Tønnesen, M.D., dr.med.
Overlæge
Dansk Center for Søvnmedicin
Glostrup Hospital
Danmark
12.marts 2015
Thorax 2015;70:258-264 doi:10.1136/thoraxjnl-2014205361
Effects of CPAP on body weight in patients
with obstructive sleep apnoea: a meta-analysis
of randomised trials
Luciano F Drager1,2,3, André R Brunoni1,
Raimundo Jenner1, Geraldo Lorenzi-Filho2,Isabela M Benseñor1,3, Paulo A Lotufo1,3
Introduktion

This meta-analysis was designed to assess
whether OSA treatment with CPAP promotes
changes in body mass index (BMI) and weight.
Metode

Randomised trials of CPAP versus controls with
a minimum treatment duration of 4 weeks that
objectively measured BMI. Mean 3 Months.
Forest plot for weight.
Luciano F Drager et al. Thorax 2015;70:258-264
Copyright © BMJ Publishing Group Ltd & British Thoracic Society. All rights reserved.
Forest plot for body mass index.
Luciano F Drager et al. Thorax 2015;70:258-264
Copyright © BMJ Publishing Group Ltd & British Thoracic Society. All rights reserved.
Resultater (1)

3181 patients from 25 randomised trials that measured
BMI and weight.

All studies enrolled mainly overweight and obese
patients.

The fixed-effects meta-analysis revealed that CPAP
promoted significant increase on BMI (Hedges’ g=0.14,
95% CI 0.07 to 0.21, I2=16.2%)



Weight (Hedges’ g=0.17, 95% CI 0.10 to 0.24, I2=0%).
BMI 31.1
Weight increase: 0.427 + 0.718 Kg in CPAP
Resultater (2)

Meta-regression analyses including age, gender,
baseline BMI, baseline weight, OSA severity, CPAP
compliance, use of sham CPAP, study duration, study
design (crossover/parallel), study origin
(Western/Eastern), recommendation for dietary changes
or physical activity

No single predictor influenced the main outcome for
weight.

Baseline weight was a predictor of increased BMI after
CPAP.
Meta-analyse Konklusion

OSA treatment with CPAP promotes significant increase
in BMI and weight.
 Additional therapies for body weight reduction must be
recommended for overweight or obese patients with
OSA initiated on CPAP.

Comparison of Weight Loss Among Named Diet
Programs in Overweight and Obese AdultsA Metaanalysis

B C. Johnston, et all. JAMA. 2014;312(9):923-933.
doi:10.1001/jama.2014.10397.

Main Outcomes and Measures Weight loss and body
mass index at 6- and 12-month follow-up (±3 months for
both periods).

Results (1)

48 randomized trials (N= 7286) compared with no diet.

Low-carbohydrate diets
6-M: 8.73 kg [CI95%: 7.27 to 10.20 kg]
12-M: 7.25 kg [95% CI, 5.33 to 9.25 kg]

Low-fat diets
6-M: 7.99 kg [95% CI, 6.01 - 9.92 kg]
12-M: 7.27 kg [95% CI, 5.26 to 9.34 kg]
 Weight loss differences between individual diets were
minimal.
RESULTS (2)

Behavioral support
6-M:
3.23 kg [95% CI, 2.23 to 4.23 kg]
12-M: 1.08 kg [95% CI, −1.82 to 3.96 kg]

Exercise
6-M: 0.64 kg [95% CI, −0.35 to 1.66 kg]
12-M: 2.13 kg [95% CI, 0.43 to 3.85 kg]
Meta-analyse Konklusion


Conclusions and Relevance
Significant weight loss was observed with any lowcarbohydrate or low-fat diet.
 Weight loss differences between individual named diets
were small.

This supports the practice of recommending any diet that
a patient will adhere to in order to lose weight.
 Obesity SurgeryThe Journal of Metabolic Surgery and
Allied Care 10.1007/s11695-014-1533-2
Bariatric Surgery or Non-Surgical Weight Loss for
Obstructive Sleep Apnoea? A Systematic Review and
Comparison of Meta-analyses
Ashrafian H et al.

Objectives
To compare bariatric surgery vs. non-surgical weight loss
in OSA: BMI and AHI

Meta-analysis
19 surgical (n = 525) and 20 non-surgical (n = 825) studies
reporting the primary endpoints of BMI and AHI before
and after intervention.


Results
Surgical patients had a mean pre-intervention BMI of
51.3:
BMI: -14 kg/m2 (95%CI [11.91, 16.44])
AHI: -29/h (95%CI [22.41, 36.74]). [AHI: 46 to 17]

Non-surgical patients had a mean pre-intervention BMI
of 38.3:
BMI: -3.1 kg/m2 (95%CI [2.42, 3.79]),
AHI: -11/h (95%CI [7.81, 14.98]). [AHI: 38 to 27]
Meta-analysis Conclusion

Both bariatric surgery and non-surgical weight loss may
have significant beneficial effects on OSA through BMI
and AHI reduction.

However, bariatric surgery may offer markedly greater
improvement in BMI and AHI than non-surgical
alternatives.

Future studies must address the lack of randomised
controlled and comparative trials in order to confirm the
exact relationship between metabolic surgery and nonsurgical weight loss interventions in OSA resolution
Overall conclusion




CPAP giver vægtøgning
Tilråd slankekur til overvægtige
De fleste kure medfører et vægtab på ca 7 kg efter 1 år
Både bariatisk kirurgi og slankekure medfører fald i AHI